Elsevier

Bone

Volume 6, Issue 2, 1985, Pages 63-67
Bone

Original article
The effect of trauma on serum concentrations of vitamin D metabolites in patients with hip fracture

https://doi.org/10.1016/8756-3282(85)90308-4Get rights and content

Abstract

In a previous study we observed lower serum concentrations of 25(OH)D, 24,25(OH)2D, and 1,25(OH)2D in patients with hip fracture than in aged control subjects. In order to evaluate the effect of trauma on vitamin D metabolite levels, we measured serum concentrations of vitamin D binding protein (DBP) in 118 patients with hip fracture and 71 aged control subjects. Serum DBP was lower in the patients than in the controls (mean ± SD 315 ± 60 vs 371 ± 44 mg/l, P < 0.001). Serum DBP correlated positively with serum total protein, albumin, α2-globulin, and the vitamin D metabolite levels in the patients. When correcting for differences in serum DBP, serum 25(OH)D and 24,25(OH)2D still were significantly lower in patients than in controls, whereas serum 1,25(OH)2D was not. The free 1,25(OH)2D index (105 X molar ratio 1,25(OH)2DDBP) was lower in patients than in controls, but the level of significance was marginal. This difference was not significant when patients and controls with impairment of renal function were excluded. It is concluded that the difference in serum 25(OH)D and 24,25(OH)2D between patients and controls is largely pre-existent. However, the lower serum 1,25(OH)2D in the patients is mainly caused by the trauma. The free 1,25(OH)2D concentrations are almost similar in the two groups when renal function is normal.

Résumé

Nous avons observé lors d'une étude antérieure que les taux sériques de 25OHD, de 24,25(OH)2D et de 1,25(OH)2D étaient plus bas chez les malades présentant une fracture du col fémoral que chez les témoins de même âge. Afin d'évaluer l'effet du traumatisme sur les taux des métabolites de la vitamine D, nous avons mesuré les concentrations sériques de la protéine porteuse de la vitamine D(PPD) chez 118 malades ayant une fracture du col et 71 témoins âgés. Le taux sérique de la PPD était corrélé positivement chez les malades avec celui des protines totales, ceux de l'albumine, des α 2 globulines et des métabolites de la vitamine D. Après correction en fonction de ces différences du taux de la PPD, les concentrations sériques de la 25OHD et de la 24,25(OH)2D étaient encore significativement plus bas chez les malades que chez les témoins, alors que les taux de la 1,25(OH)2D n'étaient plus différents. L'indice de 1,25(OH)2D libre (105 × rapport molaire 1,25(OH)2D/PPD) était plus bas chez les malades que chez les témoins, mais la différence n'existait plus après exclusion des malades et des témoins ayant une fonction rénale altérée. On peut en conclure que la différence des taux sériques de la 25(OH)D et de la 24,25(OH)2D entre les malades et les témoins préexiste nettement à la fracture. L'abaissement du taux sérique de la 1,25(OH)2D chez les malades est causée principalement par le traumatisme. Les concentrations de la 1,25(OH)2D sont presque similaires dans les deux groupes lorsque la fonction rénale est normale.

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