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Abstract: SA-PO219

Association of Vitamin D Levels and Bone Mineral Density in Elderly CKD Patients With Hip Fracture

Session Information

Category: Bone and Mineral Metabolism

  • 402 Bone and Mineral Metabolism: Clinical

Authors

  • Roy, Debajyoti M., Changi General Hospital, Singapore, Singapore
  • Ng, Chee Yong, Changi General Hospital, Singapore, Singapore
  • Yeon, Wenxiang, Changi General Hospital, Singapore, Singapore
  • Koduri, Sreekanth, Changi General Hospital, Singapore, Singapore
Background

Vitamin D deficiency is common in chronic kidney disease (CKD) and is associated with lower bone mineral density (BMD), decreased muscle strength, and increased hip fracture risk. Guidelines have suggested optimal Vitamin D levels between 20-30ng/ml. However, Vitamin D metabolism is altered in CKD, and optimal levels are unknown.

Methods

We included 1097 patients with hip fractures. CKD was defined as estimated glomerular filtration rate <60ml/min/1.73m2, and low BMD defined as T score ≤-2.5 at femoral neck. We assessed the utility of using a 25-Vitamin D (25(OH)D) threshold of 30ng/dl, as well as a new threshold, to predict low BMD, in patients with, and without CKD.

Results

CKD was present in 479 (44%) patients. Using threshold of 25(OH)D <30ng/ml. there was no significant differences in patients with CKD and low BMD, compared to the other groups. We identified 27ng/ml as a better threshold with the Youden index. Using 25(OH)D<27ng/ml as a threshold, 360 of 482 patients (74.7%) with low Vitamin D had low BMD, compared to only 185/276 (67%) of patients with adequate Vitamin D, p=0.02, which was irrespective of presence or absence of CKD. Furthermore, patients with CKD and 25(OH)D <27ng/ml had a higher odds ratio of mortality upon follow-up, 1.61, 95% CI: 1.08 – 2.39, compared to those with CKD and 25(OH)D≥ 27ng/ml.

Conclusion

Vitamin D <27ng/ml is associated with low BMD in patients with, and without, CKD. Further prospective studies targeting Vitamin D repletion to at least 27ng/ml, and outcome of hip fractures will be useful to validate these findings.