Vitamin d deficiency and bone density in patients after stroke
Introduction: Vitamin D deficiency and osteoporosis are highly prevalent among stroke patients. The adverse effects of vitamin D deficiency on bone metabolism seem to be aggravated by immobilization of paretic extremities. Objectives: The purpose of this study was to determine the level of vitamin D in patients with osteoporosis following a stroke. Material and methods: In this cross-sectional study participants consisted of 40 patients (33 women, 7 men) with mean age of 66.5 ± 9.8 years. The inclusion criteria were patients after a first stroke (≤ 1.5 years from a stroke), who were treated at the Medical Rehabilitation Clinic, Clinical Center of Vojvodina in Novi Sad, Serbia. Lunar Prodigy Primo densitometer was used to determine the bone mineral density in patients after stroke. DXA measurement was performed at the lumbar spine L2-L4 segment in anterio-posterior (AP) position. Vitamin D was determined as follow; reference values: 25 (OH) vitD ˃30 ng / dl, total calcium 2.1-2.60 mmol/l, phosphorus 3.0-4.5 mg/dl, parathyroid hormone (PTH) 14.0-72.0 pg/ml. Results: Seventeen (42.50%) patients had osteoporosis of the lumbar spine, while 6 (15%) had osteoporosis of the femur. The study also showed that 10 patients (25%) had levels of serum 25 (OH) vitamin D ˂ than 30 ng/dl, while 30 patients (75%) had serum levels of 25 (OH) vitamin D ≥30 ng/dl. The average values of PTH were 48,71± 36 pg/ml, and phosporusa 3.51±0.72 mg/dl. Only 2.5% of the patients were receiving antiresorptive bone therapy and vitamin D supplementation at the time of the initial evaluation. Conclusion: Low BMD (bone mineral density) and low levels of serum 25(OH) vitamin D are common amongst patients with history of stroke. Vitamin D supplementation and antiresorptive therapy prevent further bone loss, falls and fracture in poststroke patients, however, longitudinal studies are needed to confirm this hypothesis.
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