Factors related to decreased vitamin D levels in men with spinal cord injury living in a subtropical region

Mauricio Sprenger Bassuino, Elisa Lettnin Kaminski, Laís Oliveira Garcia, Rafael Linden, Marina Venzon Antunes, Rodolfo Herberto Schneider, Denise Cantarelli Machado

Abstract


AIMS: To evaluate the levels of vitamin D, parathyroid hormone and calcium in individuals with spinal cord injury and to identify related factors.

METHODS: A cross-sectional study included men with spinal cord injury, living in the South Region of Brazil. A questionnaire was applied to evaluate socioeconomic data, life habits and health. The time elapsed since the spinal cord injury was considered. Vitamin D was evaluated in plasma via liquid chromatography; calcium and PTH were measured in serum by a colorimetric method and electrochemiluminescence respectively. For data analysis, linear regression and chi-square test were utilized. Values of p<0.05 were considered significant.  

RESULTS: The study included 39 paraplegic or tetraplegic men with spinal cord injury. The mean age was 35.52±9.78 years, and the mean time since injury was 6.09±5.55 years. The mean biochemical levels were: 19.0 ±6.98 ng/mL for vitamin D; 9.54±0.52 mg/dL for total calcium; and 34.81±10.84 pg/mL for parathyroid hormone. Individuals with sun exposure for more than two hours daily had higher vitamin D levels than those exposed up to one hour per day (p=0.001). Linear regression identified an inverse relationship between lesion time and vitamin D levels (regression coefficient: -0.424; p=0.029), while the other parameters did not show significant differences regarding the time elapsed since the lesion. Subjects with income above four minimum wages had higher vitamin D values (mean 25.67±5.45 ng/mL) when compared to those with income up to four minimum wages (mean 18.43±6.79 ng/mL) (p=0.021).

CONCLUSIONS: Levels of vitamin D were inversely correlated to the time elapsed since the spinal cord injury, probably due to insufficient sun exposure resulting from prolonged limitation of mobility. In addition, lower levels of vitamin D were associated to lower income. These factors may aggravate bone loss associated with decreased mobility resulting from spinal cord injury.

Keywords


Vitamin D; parathyroid hormone; spinal cord injury; paraplegia; monthly income; socioeconomic status.

Full Text:

PDF IN ENGLISH

References


Soleyman-Jahi S, Yousefian A, Maheronnaghsh R, Shokraneh F, Zadegan SA, Soltani A, Hosseini SM, Vaccaro AR, Rahimi-Movaghar V. Evidence-based prevention and treatment of osteoporosis after spinal cord injury: a systematic review. Eur Spine J. 2017:1-17. https://doi.org/10.1007/s00586-017-5114-7

Viúdes M de AA, Costa JM da, Nunes CMP. Profile of patients admitted for spinal cord injury in public teaching hospital. Rev Médica Minas Gerais. 2015;25(3):380-6. https://doi.org/10.5935/2238-3182.20150074

Gifre L, Vidal J, Carrasco JL, Muxi A, Portell E, Monegal A, Gua-abens N, Peris P. Risk factors for the development of osteoporosis after spinal cord injury. A 12-month follow-up study. Osteoporos Int. 2015;26(9):2273-80. https://doi.org/10.1007/s00198-015-3150-x

Harlow L, Sahbani K, Nyman JS, Cardozo CP, Bauman WA, Tawfeek HA. Daily parathyroid hormone administration enhances bone turnover and preserves bone structure after severe immobilization‐induced bone loss. Physiol Rep. 2017;5(18):e13446. https://doi.org/10.14814/phy2.13446

Imamura M, Takami M da P, Barbosa SBB, Silva AR, Pinheiro CM, Guerra LMC, Rosa CDP, Bernardo WM, Battistella LR. Osteoporosis in spinal cord injury: rehabilitation. Acta Fisiatrica. 2013;20(2)112-7. https://doi.org/10.5935/0104-7795.20130018

Troy KL, Morse LR. Measurement of Bone: Diagnosis of SCI-induced osteoporosis and fracture risk prediction. Top Spinal Cord Inj Rehabil. 2015;21(4):267-74. https://doi.org/10.1310/sci2104-267

Lobos S, Cooke A, Simonett G, Ho C, Boyd SK, Edwards WB. Assessment of bone mineral density at the distal femur and the proximal tibia by dual-energy x-ray absorptiometry in individuals with spinal cord injury: precision of protocol and relation to injury duration. J Clin Densitom. 2017:1-9. https://doi.org/10.1016/j.jocd.2017.05.006

Karapolat I, Karapolat HU, Kirazli Y, Capaci K, Akkoc Y, Kumanlioglu K. Longitudinal study of bone loss in chronic spinal cord injury patients. J Phys Ther Sci. 2015;27(5):1429-33.

https://doi.org/10.1589/jpts.27.1429

Martins JS, Palhares MDO, Teixeira OCM, Gontijo Ramos M. Vitamin D status and its association with parathyroid hormone concentration in Brazilians. J Nutr Metab. 2017;ID9056470. https://doi.org/10.1155/2017/9056470

Dawson-Hughes B. Vitamin D and muscle function. J Steroid Biochem Mol Biol. 2017;173:313-6. https://doi.org/10.1016/j.jsbmb.2017.03.018

Holick MF, Binkley NC, Bischoff-Ferrari HA, Gordon CM, Hanley DA, Heaney RP, Murad MH, Weaver CM; Endocrine Society. Evaluation, treatment, and prevention of vitamin D deficiency: an Endocrine Society clinical practice guideline. J Clin Endocrinol Metab. 2011;96(7):1911-30. https://doi.org/10.1210/jc.2011-0385

Bauman WA, Zhang R, Morrison N, Spungen AM. Acute Suppression of Bone Turnover With Calcium Infusion in Persons With Spinal Cord Injury. J Spinal Cord Med. 2009;32(4):398-403. https://doi.org/10.1080/10790268.2009.11754393

Hummel K, Craven C, Giangregorio L. Serum 25(OH)D, PTH and Correlates of Suboptimal 25(OH)D Levels in Persons with Chronic Spinal Cord Injury. Spinal Cord. 2016;50(11):812-6. https://doi.org/10.1038/sc.2012.67

Nemunaitis GA, Mejia M, Nagy JA, Johnson T, Chae J, Roach MJ. A Descriptive Study on Vitamin D Levels in Individuals With Spinal Cord Injury in an Acute Inpatient Rehabilitation Setting. PMR. 2010;2(3):202-8. https://doi.org/10.1016/j.pmrj.2010.01.010

Nogueira PC, Rabeh SAN, Caliri MHL, Dantas RAS, Haas VJ. Burden of care and its impact on health-related quality of life of caregivers of individuals with spinal cord injury. Rev Lat Am Enfermagem. 2012;20(6):1048-56. https://doi.org/10.1590/S0104-11692012000600006

Opperman EA, Buchholz AC, Darlington GA, Martin Ginis KA. Dietary supplement use in the spinal cord injury population. Spinal Cord. 2010;48(1):60-4. https://doi.org/10.1038/sc.2009.86

Bauman WA, Emmons RR, Cirnigliaro CM, Kirshblum SC, Spungen AM. An effective oral vitamin D replacement therapy in persons with spinal cord injury. J Spinal Cord Med. 2011;34(5):455-60. https://doi.org/10.1179/2045772311Y.0000000032

Özgirgin N, Koyuncu E, Yüzer GFN, Taşoğlu O, Yenigün DY. Is spinal cord injury a risk factor for vitamin D deficiency? Turk J Phys Med Rehab 2016;1(62):57-63 https://doi.org/10.5606/tftrd.2016.39260

Pearce SH, Cheetham TD. Diagnosis and management of vitamin D deficiency. Br Med J. 2010;340:142-7. https://doi.org/10.1136/bmj.b5664

Bauman WA, Zhong YG, Schwartz E. Vitamin D deficiency in veterans with chronic spinal cord injury. Metabolism. 1995;44(12):1612-6. https://doi.org/10.1016/0026-0495(95)90083-7

Mechanick JI, Pomerantz F, Flanagan S, Stein A, Gordon WA, Ragnarsson KT. Parathyroid hormone suppression in spinal cord injury patients is associated with the degree of neurologic impairment and not the level of injury. Arch Phys Med Rehabil. 1997;78:692-6. https://doi.org/10.1016/S0003-9993(97)90075-7

Flueck JL, Perret C. Vitamin D deficiency in individuals with a spinal cord injury: A literature review. Spinal Cord. 2016;55(5):428-34. https://doi.org/10.1038/sc.2016.155

Khan AH, Jafri L. Ionized calcium cannot predict vitamin D deficiency. Indian J Clin Biochem. 2011;26(4):428-9. https://doi.org/10.1007/s12291-011-0157-8

Kich DM, Vieira FA de S, Bassuino M, Linden R. Determinação de 25-hidroxivitamina D2 e D3 em plasma por CLAE-DAD. J Bras Patol Med Lab. 2012:329-36.

Lai JKC, Lucas RM, Clements MS, Harrison SL, Banks E. Assessing vitamin D status: Pitfalls for the unwary. Mol Nutr Food Res. 2010;54(8):1062-71. https://doi.org/10.1002/mnfr.200900468

Unger MD, Cuppari L, Titan SM, Magalhães MCT, Sassaki AL, Reis LM, Jorgetti V, Moysés RMA. Vitamin D status in a sunny country: Where has the sun gone? Clin Nutr. 2010;29(6):784-8. https://doi.org/10.1016/j.clnu.2010.06.009

Lensmeyer GL, Wiebe DA, Binkley N, Drezner MK. HPLC method for 25-hydroxyvitamin D measurement: Comparison with contemporary assays. Clin Chem. 2006;52(6):1120-6. https://doi.org/10.1373/clinchem.2005.064956

Tan CO, Battaglino R a, Morse LR. Spinal Cord Injury and Osteoporosis: Causes, mechanisms, and rehabilitation strategies. Int J Phys Med Rehabil. 2013;1:1-10.




DOI: http://dx.doi.org/10.15448/1980-6108.2018.2.28381

.................................................................................................................................................................................................................................................................................................


This journal is a member of COPE (Committee on Publication Ethics) and follow the principles recommended by this international reference organization on integrity and ethics in scientific publication.

Licença Creative Commons
Except where otherwise noted, the material published in this journal is licensed under a Creative Commons Attribution 4.0 International licence, which permits unrestricted use, distribution, and reproduction in any medium, provided the original publication is properly cited.
Attribution — You must give appropriate credit, provide a link to the license, and indicate if changes were made. You may do so in any reasonable manner, but not in any way that suggests the licensor endorses you or your use.

 
 Member of OASPA


Copyright: © 2006-2018 EDIPUCRS