Serum 25(OH)D, PTH and Correlates of Suboptimal 25(OH)D Levels in Persons with Chronic Spinal Cord Injury

Spinal Cord, 2012 · DOI: 10.1038/sc.2012.67 · Published: November 1, 2012

Spinal Cord Injury Nutrition & Dietetics Musculoskeletal Medicine

Simple Explanation

This study investigates vitamin D levels and their relationship to bone health in people with chronic spinal cord injury (SCI). It looks at how often suboptimal vitamin D levels and secondary hyperparathyroidism occur in this population. The research also explores factors that might be linked to vitamin D deficiency and the connection between parathyroid hormone (PTH) and vitamin D levels in individuals with SCI. The study found that a significant portion of individuals with chronic SCI had suboptimal vitamin D levels and that factors like the time of year and supplement use were associated with these levels. These findings could help improve bone health management in this population.

Study Duration

April 2009 and December 2011

Participants

62 adult men and women with chronic SCI

Evidence Level

Cross-sectional cohort study

Key Findings

1
Thirty-nine percent of the cohort had suboptimal serum 25(OH)D levels.
2
Factors associated with suboptimal vitamin D levels included having vitamin D assessed in the winter months, lack of a calcium supplement, lack of a vitamin D supplement, younger age, paraplegia, and lack of bisphosphonate.
3
Significant associations were observed between serum PTH and 25(OH)D and between PTH and C-telopeptide of type I collagen (CTX-I).

Research Summary

The study aimed to identify the proportion of individuals with chronic SCI that have suboptimal vitamin D status and secondary hyperparathyroidism, and to identify correlates of suboptimal vitamin D status. Results showed that a significant percentage of the SCI population had suboptimal vitamin D levels and secondary hyperparathyroidism. Winter months, lack of supplements and younger age were associated with vitamin D deficiency. The study concludes that disruption of the vitamin D-PTH axis is likely an important contributor to declines in bone mineral density in the chronic SCI population and monitoring serum 25(OH)D levels is crucial.

Practical Implications

Personalized Supplementation

Vitamin D and calcium supplementation should be tailored to individual needs and monitored regularly in individuals with SCI.

Seasonal Awareness

Vitamin D levels should be closely monitored during winter months, especially in individuals with SCI.

Bone Health Monitoring

Regular monitoring of vitamin D, PTH and bone turnover markers is necessary to prevent increased bone resorption among individuals with chronic SCI.

Study Limitations

1
Unable to distinguish between newly occurring, recent or longstanding suboptimal vitamin D levels with the current study design.
2
Other medications known to effect vitamin D metabolism, such as anticonvulsants, sex hormone levels, as well as sun exposure, and supplement adherence were not considered.
3
Recruitment bias due to many participants recruited via physician referral from an outpatient osteoporosis clinic.

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