Immobility as a Major Cause of Bone Remodeling in Residents of a Long-Stay Geriatric Ward

Abstract

Residents of a long-stay geriatric ward at the University Hospital Basel were included in a study to investigate the effects of hypovitaminosis D and immobility. All 91 women (mean age 82.5 years) and 92 men (mean age 78.7 years) were enrolled in the study. Measurements included bone resorption, as measured by urinary deoxypyridinoline (dpd), serum 25-hydroxyvitamin D (25OHD), serum intact parathyroid hormone (iPTH), and their correlations with a four grade mobility score. Mobility score reflected the degree of weight bearing, ranging from walking independently to primarily bed bound. In 86% of all residents, serum 25OHD levels were below the normal limit of 12 ng/ml. Secondary hyperparathyroidism (HPT) was detected in 24% of all patients, using 55 pg/ml as the upper limit for serum iPTH. No significant correlation was found between urinary dpd and serum 25OHD or serum iPTH. Mobility index and both urinary dpd (f: P = 0.001, r = 0.37; m: P < 0.0001, r = 0.47) and serum calcium (female: P = 0.007, r = 0.28; male: P = 0.02, r = 0.24) were positively related. In institutionalized elderly people with a high prevalence of vitamin D deficiency serum intact PTH levels did not correlate with bone resorption as measured by urinary deoxypyridinolin. However, more immobile subjects had significantly higher excretion rates for urinary dpd and higher serum calcium levels. Our results suggest that in elderly people immobility may contribute to bone loss that might preempt the development of secondary HPT through elevation of serum calcium.

Effect of Age-Related Chronic Immobility on Markers of Bone Turnover

“…This observation is different from our findings in that serum PTH was not only significantly positively correlated with, but also a significant independent predictor of, both bone resorption and bone formation markers. Of note, our population was older (mean age, 86.0 versus 80.6 years) and had a higher proportion of subjects with secondary hyperparathyroidism (42% versus 24%) compared with the study by Bischoff et al (2) Previous studies have reported bone turnover increases with increasing age. (22,27,28) In a study of 432 women between 1 and 40 years postmenopause, markers of both bone resorption and formation remained elevated into late menopause.…”

“…Interestingly, a positive relationship between better walking score and serum albumin and serum 1,25 dihydroxyvitamin D was observed in this study. Bischoff et al (2) studied 183 long stay residents (mean age, 79 years) of a geriatric ward in a city hospital with a high prevalence of vitamin D deficiency (86%). In this study, immobility was associated with a higher urinary deoxypyridinoline/creatinine ratio (DPD), a marker of bone resorption.…”

“…(2,3) Bischoff et al (2) studied 183 long stay residents of a hospital geriatric ward and found poorer mobility was associated with higher bone resorption, as measured by urinary deoxypyridinoline. Sorva et al, (3) studying 55 bedridden elderly subjects, again found accelerated bone resorption (serum carboxyterminal cross-linked telepeptide of type I collagen [ICTP]), but no change in bone formation rates (carboxyterminal propeptide of type I procollagen [PICP]).…”

Sacroplasty versus Vertebroplasty: Comparable Clinical Outcomes for the Treatment of Fracture-Related Pain

“…35 In particular, bed rest is known to be associated with such risks as progressive loss of bone mineralization and muscle mass, as well as the development of pneumonia and pulmonary embolism, which may outweigh the benefits of bed rest for some patients. [36][37][38][39][40] Sacroplasty is a relatively new minimally invasive percutaneous intervention that provides a treatment alternative to current therapeutic options. Several case series have reported near-immediate relief of pain and improvement in mobility after the procedure, similar to reported outcomes of vertebroplasty.…”

25-Hydroxyvitamin D, Dementia, and Cerebrovascular Pathology in Elders Receiving Home Services

“…Studies in community-dwelling elders have revealed that 73% of blacks and 35% of whites have low vitamin D concentrations (Ͻ50 nmol/L) and 21% of blacks and 11% of whites have very low serum vitamin D levels (Ͻ25 nmol/L) during the wintertime, 21 and these rates are higher in inactive elders. 37 Homebound elders are at increased risk of inadequacy because of limited sun exposure, decreased 7-dehydrocholesterol in the skin, physical impairment, high BMI, and inadequate nutrition. Although increased sun exposure is controversial, dietary modifications may be beneficial.…”