DOI: http://dx.doi.org/10.18203/issn.2454-2156.IntJSciRep20195721

Inadequate vitamin D level: association with low energy fractures of distal radius in young patients and its predictors in Karachi, Pakistan

Muhammad Muzzammil, Ranjeet Kumar, Muhammad Saeed Minhas, Vinod Kumar, Syed Jahanzed, Abdul Qadir

Abstract


Background: The objective of the study was to determine association of inadequacy of vitamin D level with low energy fractures of distal radius and its predictors in young patients in Karachi Pakistan.

Methods: Cross-sectional study was conducted on 220 young patients, visited hospital with low energy fracture of distal radius. A questionnaire was designed and filled after taking consent includes details regarding age, gender, occupation, area of skin and sun exposure duration, dietary habits, type of clothing and residence used. Serum Vitamin D3 levels were determined and compared with serum calcium levels, serum phosphorus and alkaline phosphatase levels.  

Results: Among 220 patients ranging from 12-45 years, mean 28±23.33 SD. Female were 172 (78.18%). Mostly have history of fall 127 (57.72%) and RTA 63 (28.63). Sun exposure duration in majority of participant was 1-2 hour/day 132 (60%). Variable coloured clothes used by majority participant 135 (61.36%) and variable fabric 102 (46.36%). 202 (91.8%) patients had deficiency of vitamin D and correlated with duration of sunlight exposure significantly, also with exposure of large skin area, dietary consumption of vitamin D rich food and worn variable clothing colours. Serum phosphorus level and serum alkaline phosphatase level were negatively correlated with vitamin D significantly whereas positively correlated with serum calcium.

Conclusions: Prevalence of vitamin D deficiency is very high in low energy fracture of distal radius in young population and sun exposure duration found to be most common predictor of inadequate D levels. A national food fortification program and campaign of public awareness to increase sunlight exposure and increase intake of vitamin D rich food are urgently needed.


Keywords


Low energy, Distal radius, Fracture, Inadequate D level, Sun exposure

Full Text:

PDF

References


Holick MF. Vitamin D: a millenium perspective. J Cell Biochem. 2003;88:296–307.

Vitamin D. Available from: https://en.wikipedia. org/ wiki/Vitamin_D. Accessed on 16 August 2019.

Al-Mogbel ES. Vitamin D status among Adult Saudi Females visiting Primary Health Care Clinics. Int J Health Sci (Qassim). 2012;6(2):116-26.

Glerup H, Mikkelsen K, Poulsen L, Hass E, Overbeck S, Thomsen J, et al. Commonly recommended daily intake of vitamin D is not sufficient if sunlight exposure is limited. J Intern Med. 2000;247(2):260-8.

Holick MF. Vitamin D deficiency. N Engl J Med. 2007;357(3):266-81.

Lips P, van Schoor NM. The effect of vitamin D on bone and osteoporosis. Best Pract Res Clin Endocrinol Metab. 2011;25(4):585-91.

Eriksen EF, Glerup H. Vitamin D deficiency and aging: implications for general health and osteoporosis. Biogerontology. 2002;3(1–2):73–7.

Hodgkin P, Kay OM, Hine PM, Lumb QA, Stanbury SW. Vitamin D deficiency in Asian at home and in Britain. Lancet. 1973;2:167-72.

Harinarayan CV, Ramalakshmi T, Prasad UV, Sudhakar D, Srinivasarao PV, Sarma KV, et al. High prevalence of low dietary calcium, high phytate consumption, and vitamin D deficiency in healthy south Indians. Am J Clin Nutr. 2007;55:1062-7.

Marwaha RK, Tandon N, Reddy DRHK, Aggarwal R, Singh R, Sawhney RC, et al. Prevalence and significance of low 25hydroxyvitamin D concentrations in healthy subjects in Delhi. Am J Clin Nutr. 2005;82:477-82.

Goswami R, Mishra SK, Kochupillai N. Prevalence & potential significance of vitamin D deficiency in Asian Indians. Indian J Med Res. 2008;127:229-38.

Bischoff-Ferrari HA. Optimal serum 25-hydroxyvitamin D levels for multiple health outcomes. Adv Experimen Med Biol (Review). 2014;810:500-25.

Dahlquist DT, Dieter BP, Koehle MS. Plausible ergogenic effects of vitamin D on athletic performance and recovery. J Int Soc Sports Nutr (Review). 2015;12:33.

Glerup H, Mikkelsen K, Poulsen L, Hass E, Overbeck S, Thomsen J, et al. Commonly recommended daily intake of vitamin D is not sufficient if sunlight exposure is limited. J Intern Med. 2000;247(2):260-8.

Lips P, Bouillon R, van Schoor NM, Vanderschueren D, Verschueren S, Kuchuk N, et al. Reducing fracture risk with calcium and vitamin D. Clin Endocrinol Oxf. 2010;73:277-85.

Cummings SR, Kelsey JL, Nevitt MC, O'Dowd KJ. Epidemiology of osteoporosis and osteoporotic fractures. Epidemiol Rev. 1985;7:178-208.

Chung KC, Spilson SV. The frequency and epidemiology of hand and forearm fractures in the United States. J Hand Surg Am. 2001;26(5):908.

Kopylov P, Johnell O, Redlund-Johnell I, Bengner U. Fractures of the distal end of the radius in young adults: a 30-year follow-up. J Hand Surg [Br]. 1993;18(1):45-9.

Pogue DJ, Viegas SF, Patterson RM, Peterson PD, Jenkins DK, Sweo TD, et al.: Effects of distal radius fracture malunion on wrist joint mechanics. J Hand Surg [Am]. 1990;15(5):721-7.

Mallmin H, Ljunghall S, Persson I, Naessen T, Krusemo UB, Bergstrom R. Fracture of the distal forearm as a forecaster of subsequent hip fracture: a population-based cohort study with 24 years of follow-up. Calcif Tissue Int. 1993;52:269–72.

Owen RA, Melton LJ, Ilstrup DM, Johnson KA, Riggs BL. Colles' fracture and subsequent hip fracture risk. Clin Orthop Relat Res. 1982:37–43.

Bu FX, Armas L, Lappe J, Zhou Y, Gao G, Wang HW, et al. Comprehensive association analysis of nine candidate genes with serum 25-hydroxy vitamin D levels among healthy Caucasian subjects. Hum Genet. 2010;128:549–56.

Rab SM. Occult osteomalacia amongst health and pregnant women in Pakistan. Lancet. 1976;2:1211-3.

Atiq M, Suria A, Nizami SQ, Ahmed I. Maternal Vitamin D deficiency in Pakistan. Acta Obstet Gynaecol Scand. 1998;77:970-3.

Sahibzada AS, Khan MS, Javed M. Presentation of osteomalacia in Kohistani women. J Ayub Med Coll Abottabad. 2004;16:63-5.

Baig A, Anjum P, Khani MK, Islam N, Rahman A. Pattern of serum Vitamin D in OPD patients. Pak J Surg. 2007;23:145-9.

Masud F. Vitamin D levels for optimum bone health. Singapore Med J. 2007;48:207-12.

National Nutrition Survey Pakistan 2011. Nutrition Wing, Cabinet Division, Government of Pakistan. Available from: https://www.humanitarianresponse. info/sites/www.humanitarianresponse.info/files/documents/files/NNS%202011.pdf. Accessed on 16 August 2019.

Bjelakovic G, Gluud LL, Nikolova D, Whitfield K, Wetterslev J, Simonetti RG, et al. Vitamin D supplementation for prevention of mortality in adults. Cochrane database of systematic reviews. 2011;(7):CD007470.

Masood Z, Mahmood Q, Ashraf KT. Vitamin D Deficiency-An Emerging Public Health Problem in Pakistan. JUMDC. 2010;1(1):4-9.

Khan AH, Iqbal R, Naureen G, Dar FJ, Ahmed FN. Prevalence of vitamin D deficiency and its correlates: results of a community-based study conducted in Karachi, Pakistan. Arch Osteoporos. 2012;7(1- 2):275-82.

Pittas A, Dawson-Hughes B, Li T, Van Dam R, Willett WC, Manson JE, et al. Vitamin D and calcium intake in relation to type 2 diabetes in women. Diabetes Care. 2006;29:650-6.

Holick MF. The vitamin D epidemic and its health consequences. J Nutr. 2005;135(11):2739S-48S.

Daly RM, Gagnon C, Lu ZX, Magliano DJ, Dunstan DW, Sikaris KA, et al. Prevalence of vitamin D deficiency and its determinants in Australian adults aged 25 years and older: a national, population-based study. Clin Endocrinol (Oxf). 2012;77(1):26-35.

Alagol F, Shihadeh Y, Boztepe H. Sunlight exposure and vitamin D in Turkish women. J Endocrinol Invest. 2000;23:173-7.

Gannage-Yared MH, Chemali R, Yaacoub N, Halaby G. Hypovitaminosis D in a sunny country: relation to lifestyle and bone markers. J Bone Miner Res. 2000;15:1856-62.

Meddeb N, Sahli H, Chahed M. Vitamin D deficiency in Tunisia. Osteoporos Int. 2005;16:180-3.

Hashemipour S, Larijani B, Adibi H, Javadi E, Sedaghat M, Pajouhi M. Vitamin D deficiency and causative factors in the population of Tehran BMC Public Health. 2004;4(1):38.

Matsuoka LY, Wortsman J, Dannenberg MJ. Clothing prevents ultraviolet-B radiation-dependent photosynthesis of vitamin D3. J Clin Endocrinol Metab. 1992;75:1099-103.

Oyen J, Apalset EM, Gjesdal CG, Brudvik C, Lie SA, Hove LM. Vitamin D inadequacy is associated with low-energy distal radius fractures: a case-control study. Bone. 2011;48(5):1140-5.