Postmenopausal Osteoporosis
http://www.100md.com
《新英格兰医药杂志》
To the Editor: In discussing vitamin D deficiency, Rosen (Aug. 11 issue)1 refers to a serum level of 25-hydroxyvitamin D below 15 ng per milliliter (37.4 nmol per liter). I believe that this level is too low. Studies have shown increases in serum parathyroid hormone levels2 and decreases in bone mineral density3 at approximately 20 ng per milliliter (50 nmol per liter) and below. In addition, levels below 20 ng per milliliter have been associated with decreases in intestinal calcium absorption and lower-extremity function. Therefore, vitamin D deficiency should be considered if the serum 25-hydroxyvitamin D level is below 20 ng per milliliter, and perhaps even below 30 ng per milliliter (75 nmol per liter).4
Andrew S. Chan, M.D.
Kaiser Panorama City Medical Center
Panorama City, CA 91402
References
Rosen CJ. Postmenopausal osteoporosis. N Engl J Med 2005;353:595-603.
Need AG, O'Loughlin PD, Morris HA, Horowitz M, Nordin BE. The effects of age and other variables on serum parathyroid hormone in postmenopausal women attending an osteoporosis center. J Clin Endocrinol Metab 2004;89:1646-1649.
Hickey L, Gordon CM. Vitamin D deficiency: new perspectives on an old disease. Curr Opin Endocrinol Diabetes 2004;11:18-25.
Heaney RP. Vitamin D: how much do we need, and how much is too much? Osteoporos Int 2000;11:553-555.
Dr. Rosen replies: Dr. Chan raises an important point: At what level of 25-hydroxyvitamin D should the patient be considered to have vitamin D deficiency? In my review article, I cited a report that up to two of every three women with hip fracture had vitamin D levels of less than 15 ng per milliliter.1 More recently, Gaugris et al., in a meta-analysis of 30 studies, found that up to 70 percent of all postmenopausal women with a history of any fracture had levels below 15 ng per milliliter, and that among all postmenopausal women in the meta-analysis, up to 86 percent had levels below 20 ng per milliliter.2 However, there was significant heterogeneity in the populations studied with regard to the prevalence of vitamin D deficiency. I agree that to consider a patient as having vitamin D deficiency, the cutoff should be higher than 15 ng per milliliter, although whether it should be 20, 25, or 30 ng per milliliter is still being debated.3
Clifford J. Rosen, M.D.
St. Joseph Hospital
Bangor, ME 04401
rofe@aol.com
References
LeBoff MS, Kohlmeier L, Hurwitz S, Franklin J, Wright J, Glowacki J. Occult vitamin D deficiency in postmenopausal US women with acute hip fracture. JAMA 1999;281:1501-1511.
Gaugris S, Heaney RP, Boonen S, Kurth H, Bentkover JD, Sen SS. Vitamin D inadequacy among post-menopausal women: a systematic review. QJM 2005;98:667-676.
Hanley DA, Davison KS. Vitamin D insufficiency in North America. J Nutr 2005;135:332-337.
Andrew S. Chan, M.D.
Kaiser Panorama City Medical Center
Panorama City, CA 91402
References
Rosen CJ. Postmenopausal osteoporosis. N Engl J Med 2005;353:595-603.
Need AG, O'Loughlin PD, Morris HA, Horowitz M, Nordin BE. The effects of age and other variables on serum parathyroid hormone in postmenopausal women attending an osteoporosis center. J Clin Endocrinol Metab 2004;89:1646-1649.
Hickey L, Gordon CM. Vitamin D deficiency: new perspectives on an old disease. Curr Opin Endocrinol Diabetes 2004;11:18-25.
Heaney RP. Vitamin D: how much do we need, and how much is too much? Osteoporos Int 2000;11:553-555.
Dr. Rosen replies: Dr. Chan raises an important point: At what level of 25-hydroxyvitamin D should the patient be considered to have vitamin D deficiency? In my review article, I cited a report that up to two of every three women with hip fracture had vitamin D levels of less than 15 ng per milliliter.1 More recently, Gaugris et al., in a meta-analysis of 30 studies, found that up to 70 percent of all postmenopausal women with a history of any fracture had levels below 15 ng per milliliter, and that among all postmenopausal women in the meta-analysis, up to 86 percent had levels below 20 ng per milliliter.2 However, there was significant heterogeneity in the populations studied with regard to the prevalence of vitamin D deficiency. I agree that to consider a patient as having vitamin D deficiency, the cutoff should be higher than 15 ng per milliliter, although whether it should be 20, 25, or 30 ng per milliliter is still being debated.3
Clifford J. Rosen, M.D.
St. Joseph Hospital
Bangor, ME 04401
rofe@aol.com
References
LeBoff MS, Kohlmeier L, Hurwitz S, Franklin J, Wright J, Glowacki J. Occult vitamin D deficiency in postmenopausal US women with acute hip fracture. JAMA 1999;281:1501-1511.
Gaugris S, Heaney RP, Boonen S, Kurth H, Bentkover JD, Sen SS. Vitamin D inadequacy among post-menopausal women: a systematic review. QJM 2005;98:667-676.
Hanley DA, Davison KS. Vitamin D insufficiency in North America. J Nutr 2005;135:332-337.