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AB1011 Vitamin D Status – A Transversal Evaluation in Rheumatic Patients
  1. J.L. Borges1,
  2. S. Fernandes1,
  3. V. Vieira2,
  4. A. Cardoso3,
  5. H. Madeira1,
  6. M.J. Mediavilla1,
  7. R. Leitão1,
  8. C. Silva1,
  9. A. Faustino1
  1. 1Rheumatology, Instituto Português de Reumatologia, Lisbon
  2. 2Centro Hospitalar de Leiria, Leiria
  3. 3Nutrition, Instituto Português de Reumatologia, Lisbon, Portugal

Abstract

Background Vitamin D deficiency is a condition reported both in young adults and in elderly and institutionalized patients. It has been increasingly recognized and, although conflicting data subsists, hypovitaminosis D has been related to a variety of rheumatic conditions from osteoporosis (OP) to inflammatory diseases and generalized pain syndromes.

Objectives To assess vitamin D status in a rheumatic outpatient setting.

Methods Observational, transversal, retrospective study encompassing rheumatic outpatients with at least one 25-hidroxyvitamin D determination since 2014. Data ascertained included gender, age, parathyroid hormone (PTH) and vitamin D levels, rheumatic conditions (<3/patient), co morbidities and therapeutics. Bone mineral density was assessed by densitometry (DXA) and results classified as normal (Tscore >-1), osteopenia (-2.5<Tscore<-1) and osteoporosis (Tscore<-2.5). Statistics: Mann-Whitney, Kruskal-Wallis, ANOVA and Chi-Squared tests and Pearson's correlation; p<0.05. Software: SPSS 17.

Results 370 patients included, 87.3% female, mean age 64.9±13.9 years (y), 151 patients <65y. Most prevalent rheumatic conditions: osteoarthritis (OA; 47.8%), OP (43.5% - 33.5% of which with reported fractures), fibromyalgia (FM; 14.6%) and rheumatoid arthritis (RA; 13.2%); 43.9% patients had inflammatory diseases. Most common co morbidities: arterial hypertension (38.6%), dyslipidemia (32.4%) and depression (22.9%). 38.4% were on synthetic Disease Modifying Anti-Rheumatic Drugs (DMARD); 34.1% on corticosteroids (CTC), 49.2% on bisphosphonates (BF) and 69.5% on calcium/vitamin D (Ca/D) supplements. As for patients with available DXA, 41.4% were classified as having osteopenia and 43.6% as having osteoporosis. Mean vitamin D was 29.7±24.5μg/L; 65.4% patients had vitamin D levels <30μg/L. Mean PTH was 56.6±31.3ng/L and alkaline phosphatase (ALP) was 73.8±31.8U/L. In the group >65y, mean PTH was higher than in the <65y group (61.3±33.6 vs 49.7±26.1, p=0.015); 70.9% of the patients <65y and 61.6% of the patients >65y had vitamin D<30 – not significant. We compared vitamin D in OP vs OP with fractures vs OA vs associated OP/OA and found lower vitamin D levels in patients with isolated OA (38.7±32.5 vs 38.1±33.9 vs 25.9±23.3 vs 30.6±20.7, p=0.012); 76.6% with isolated OA had vitamin D<30. 55.7% of the patients on BF >5y, 61.2% on BF <5y and 72.3% without BF had vitamin D<30 (p=0.013). 68.7% in the group with inflammatory conditions and 62.9% in the group with non-inflammatory conditions had vitamin D <30 – not significant. We further compared vitamin D levels in OA vs AR, AR vs FM and OA vs FM, DMARD and CTC use and Ca/D supplementation and found no difference. There was a positive correlation between age and vitamin D (r=0.111, p=0.033), age and PTH (r=0.208, p=0.010) and vitamin D and ALP levels (r=0.311, p<0.0001).

Conclusions In this study, vitamin D levels <30μg/L were found in nearly 2/3 of patients, across disease groups. There was a tendency for higher vitamin D levels in elderly patients, in the group with OP comparing with OA and in the group on BF, which may be related to previous supplementation. A potential bias is the fact rheumatologists request vitamin D dosing in patients with risk factors/clinical features of hypovitaminosis.

Disclosure of Interest None declared

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