Abstract
SummaryWe investigated the relationship between serum 25(OH)D levels, grip strength, and fall score in elderly osteoporotic women for fall risk assessment. Both low serum 25(OH)D and low grip strength were independently associated with increased fall risk. The serum 25(OH)D cutoff specific to increased fall risk was 14 mg/dL (35 nmol/L).PurposeThis study aimed to establish a cutoff value of serum 25-hydroxyvitamin D (25(OH)D) for fall assessment and investigate the relationship between serum 25(OH)D, grip strength, and fall score adjusted for age in osteoporotic elderly Japanese women.MethodsThis is a cross-sectional study utilizing collected data of osteoporotic elderly (age ≥65 years) female patients. A questionnaire for fall risk assessment was used, in which a score ≥ 6 was determined as increased fall risk. Serum 25(OH)D levels and grip strength were measured, and the cutoff points were calculated by receiver operating curve (ROC) analysis. Logistic regression analysis with age adjustment was conducted for potential risk factors for fall.ResultsAfter applying eligibility criteria, finally, 349 patients were enrolled. The median patient age was 77.0 years, and the mean serum 25(OH)D level was 15.6 ng/mL (36 nmol/L). Based on the ROC analysis, we defined the cutoff values of serum 25(OH)D level and grip strength as 14 ng/mL (35 nmol/L) and 15 kg, respectively. A multivariate analysis adjusted for age was conducted. Low serum 25(OH)D level and grip strength were independent risk factors for ≥6 fall risk scores.ConclusionBoth low serum 25(OH)D level and low grip strength were independently associated with increased fall risk score in osteoporotic elderly women. The appropriate serum 25(OH)D cutoff specific to the increased fall risk group in this population was 14 mg/dL (35 nmol/L). These findings might be used for the identification of patients with high fall risks. These results should be confirmed in other patient groups.
Highlights
Vitamins D2 and D3 are synthesized from provitamins D2 and D3, respectively, by absorption of ultraviolet rays in the skin
Vitamin D receptors are found in the central nervous system, and it has been suggested that vitamin D and its derivative forms have a neuroprotective effect [7, 8]
The increased risk group was associated with older age, low bone mineral density in the hip, more previous fractures, and low grip strength
Summary
Vitamins D2 and D3 are synthesized from provitamins D2 and D3, respectively, by absorption of ultraviolet rays in the skin. Vitamin D is orally ingested from food. Once both vitamins D are absorbed, the first and 25th positions of vitamin D are hydroxylated in the liver and kidney to form 1,25(OH)2D3, which has active effects in various organ systems [1, 2]. Vitamin D is an essential factor for musculoskeletal organs. It has been reported that an increase in bone density is facilitated by a sufficient supply of active vitamin D3 [3,4,5]. Its relationship with muscle has been reported; for example, atrophy of type II muscle fibers has been reported in sarcopenic patients with vitamin D deficiency [6]. Vitamin D receptors are found in the central nervous system, and it has been suggested that vitamin D and its derivative forms have a neuroprotective effect [7, 8]
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