폐경후 한국인 여성의 혈중 25-hydroxyvitamin D 상태와 25-hydroxyvitamin D가 골대사에 미치는 영향

Abstract

Objectives: Active vitamin D is one of the key bone-related hormone. Vitamin D deficiency causes osteomalacia, and even its insufficiency would bring irreversible bone loss and increased risk of fracture. We evaluated the concentration of 25-hydroxyvitamin D(25(OH)D) and parathyroid hormone(PTH) level and their relations to the bone mineral density. Methods: The nine hundred eight Korean postmenopausal women who visited our hospital during January 2001 to December 2002 were evaluated on their 25(OH)D status with other biochemical analyses. For further analysis of the factors affecting the vitamin D status and relations with bone mass, 94 women were additionally studied of the bone mineral density(BMD) and the bone markers. Results: The mean serum 25(OH)D level was 16.3ng/mL(40.6 nM) in the whole women throughout the year. The prevalence of vitamin D insufficient patients defined as 25(OH)D less than 12ng/mL was 27.9%. Serum 25(OH)D checked during the winter season, from October to March, was inversely related to serum PTH level (r=-0.197, p<0.001) and also negatively associated with age(r=-0.143, p=0.06). The threshold to notice the secondary increase in the parathyroid hormone seemed to be higher than 12ng/mL in our cohort. Ninety four postmenopausal women had taken the DXA(Hologic QDR 4500A), then they were divided into 3 groups; vitamin D sufficient group[25(OH)D>12ng/mL], vitamin D insufficient group[12>25(OH)D > 6ng/mL], vitamin D deficient group[25(OH)D <6ng/mL]. In the vitamin D deficient group, women were slightly older and had significantly lower BMD at the lumbar vertebrae, the femoral neck, femoral trochanter and total hip(p<0.05) than the vitamin D sufficient group. There were more patients with vertebral fracture in the vitamin D deficient group than in the vitamin D insufficient and sufficient group (75% vs. 18.9%, 16.0%, p=0.046). Conclusion: We found out that the status of vitamin D expressed in 25(OH)D in Korean postmenopausal women were much worse and were affecting bone negatively. Therefore we need to be alarmed at this finding since this surely will affect the bone health especially in the postmenopausal women and to consider the adequate replacement of vitamin D in these patients.