Abstract
Study design:
Literature review of studies investigating vitamin D status in individuals with a spinal cord injury (SCI).
Objectives:
Prevalence of vitamin D deficiency seems to be high in the general population. Little is known regarding such a deficiency in individuals with a SCI. This review aimed to examine the literature that investigated vitamin D status in this population.
Setting:
Switzerland.
Methods:
A literature review was performed to investigate the prevalence of vitamin D deficiency in individuals with a SCI and to determine the factors leading to deficiency.
Results:
Sixteen studies which met all the inclusion criteria were identified. All of these studies assessed total serum 25-hydroxy vitamin D status in individuals with an acute or chronic SCI. Overall, the prevalence of vitamin D deficiency or insufficiency seems to be high (range: 32–93%) in this population compared with that in able-bodied persons. The main factors are immobility, low physical activity and bedrest, and therefore not enough exposure to sunlight. In addition, age, skin pigmentation, lesion level, occurrence of pressure ulcers, body mass index, season and latitude appeared to be further determinants for vitamin D deficiency. In athletes, playing their sport indoors or outdoors may have an additional role in developing vitamin D deficiency.
Conclusion:
The available studies suggest that individuals with a SCI are at increased risk for vitamin D insufficiency/deficiency. Nutritional strategies and supplementation recommendations need to be developed to prevent these conditions in SCI.
Sponsorship:
Not applicable.
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References
Bischoff-Ferrari HA, Dawson-Hughes B, Willett WC, Staehelin HB, Bazemore MG, Zee RY et al. Effect of Vitamin D on falls: a meta-analysis. JAMA 2004; 291: 1999–2006.
Bruyere O, Cavalier E, Souberbielle JC, Bischoff-Ferrari HA, Beaudart C, Buckinx F et al. Effects of vitamin D in the elderly population: current status and perspectives. Arch Public Health 2014; 72: 32.
Carroll A, Onwuneme C, McKenna MJ, Mayne PD, Molloy EJ, Murphy NP . Vitamin D status in Irish children and adolescents: value of fortification and supplementation. Clin Pediatr (Phila) 2014; 53: 1345–1351.
Pludowski P, Karczmarewicz E, Bayer M, Carter G, Chlebna-Sokol D, Czech-Kowalska J et al. Practical guidelines for the supplementation of vitamin D and the treatment of deficits in Central Europe - recommended vitamin D intakes in the general population and groups at risk of vitamin D deficiency. Endokrynol Pol 2013; 64: 319–327.
Farrokhyar F, Tabasinejad R, Dao D, Peterson D, Ayeni OR, Hadioonzadeh R et al. Prevalence of vitamin D inadequacy in athletes: a systematic-review and meta-analysis. Sports Med 2015; 45: 365–378.
Reid IR . What diseases are causally linked to vitamin D deficiency? Arch Dis Child 2016; 101: 185–189.
Calder AD . Radiology of osteogenesis imperfecta, rickets and other bony fragility states. Endocr Dev 2015; 28: 56–71.
Tsugawa N . [Bone and nutrition. Vitamin D intake and bone]. Clin Calcium 2015; 25: 973–981.
Szabo A . [Skeletal and extra-skeletal consequences of vitamin D deficiency]. Orv Hetil 2011; 152: 1312–1319.
Mandarino NR, Junior F, Salgado JV, Lages JS, Filho NS . Is vitamin D deficiency a new risk factor for cardiovascular disease? Open Cardiovasc Med J 2015; 9: 40–49.
Beveridge LA, Witham MD . Controversy in the link between vitamin D supplementation and hypertension. Expert Rev Cardiovasc Ther 2015; 13: 971–973.
Annweiler C, Rolland Y, Schott AM, Blain H, Vellas B, Herrmann FR et al. Higher vitamin D dietary intake is associated with lower risk of Alzheimer's disease: a 7-year follow-up. J Gerontol A Biol Sci Med Sci 2012; 67: 1205–1211.
Wong G, Lim WH, Lewis J, Craig JC, Turner R, Zhu K et al. Vitamin D and cancer mortality in elderly women. BMC Cancer 2015; 15: 106.
Ceglia L, Harris SS . Vitamin D and its role in skeletal muscle. Calcif Tissue Int 2013; 92: 151–162.
Zittermann A . Vitamin D in preventive medicine: are we ignoring the evidence? Br J Nutr 2003; 89: 552–572.
Garland DE, Stewart CA, Adkins RH, Hu SS, Rosen C, Liotta FJ et al. Osteoporosis after spinal cord injury. J Orthop Res 1992; 10: 371–378.
Biering-Sorensen F, Bohr HH, Schaadt OP . Longitudinal study of bone mineral content in the lumbar spine, the forearm and the lower extremities after spinal cord injury. Eur J Clin Invest 1990; 20: 330–335.
Holick MF . Optimal vitamin D status for the prevention and treatment of osteoporosis. Drugs Aging 2007; 24: 1017–1029.
Bartoszewska M, Kamboj M, Patel DR . Vitamin D, muscle function, and exercise performance. Pediatr Clin North Am 2010; 57: 849–861.
Holick MF . Vitamin D: A millenium perspective. J Cell Biochem 2003; 88: 296–307.
Flueck JL, Hartmann K, Strupler M, Perret C . Vitamin D deficiency in Swiss elite wheelchair athletes. Spinal Cord (e-pub ahead of print 15 March 2016; doi:10.1038/sc.2016.33).
Pritchett K, Pritchett R, Ogan D, Bishop P, Broad E, LaCroix M . 25(OH)D Status of Elite Athletes with Spinal Cord Injury Relative to Lifestyle Factors. Nutrients 2016; 8: pii: E374.
Hummel K, Craven BC, Giangregorio L . Serum 25(OH)D, PTH and correlates of suboptimal 25(OH)D levels in persons with chronic spinal cord injury. Spinal Cord 2012; 50: 812–816.
Bauman WA, Emmons RR, Cirnigliaro CM, Kirshblum SC, Spungen AM . An effective oral vitamin D replacement therapy in persons with spinal cord injury. J Spinal Cord Med 2011; 34: 455–460.
Vaziri ND, Pandian MR, Segal JL, Winer RL, Eltorai I, Brunnemann S . Vitamin D, parathormone, and calcitonin profiles in persons with long-standing spinal cord injury. Arch Phys Med Rehabil 1994; 75: 766–769.
Zhou XJ, Vaziri ND, Segal JL, Winer RL, Eltorai I, Brunnemann SR . Effects of chronic spinal cord injury and pressure ulcer on 25(OH)-vitamin D levels. J Am Paraplegia Soc 1993; 16: 9–13.
Bauman WA, Zhong YG, Schwartz E . Vitamin D deficiency in veterans with chronic spinal cord injury. Metabolism 1995; 44: 1612–1616.
Pedrera JD, Manas P, Gomez MA, Canal ML, Lavado JM, Hernandez ER et al. Ultrasound bone mass in paraplegic patients. Spinal Cord 2002; 40: 83–87.
Javidan AN, Sabour H, Latifi S, Vafa M, Shidfar F, Khazaeipour Z et al. Calcium and vitamin D plasma concentration and nutritional intake status in patients with chronic spinal cord injury: a referral center report. J Res Med Sci 2014; 19: 881–884.
Barbonetti A, Sperandio A, Micillo A, D'Andrea S, Pacca F, Felzani G et al. Independent association of aitamin D with physical function in people with chronic spinal cord injury. Arch Phys Med Rehabil 2016; 97: 726–732.
Barbonetti A, Vassallo MR, Felzani G, Francavilla S, Francavilla F . Association between 25(OH)-vitamin D and testosterone levels: evidence from men with chronic spinal cord injury. J Spinal Cord Med 2015; 39: 246–252.
Bauman WA, Morrison NG, Spungen AM . Vitamin D replacement therapy in persons with spinal cord injury. J Spinal Cord Med 2005; 28: 203–207.
Benlidayi IC, Basaran S, Seydaoglu G, Guzel R . Vitamin D profile of patients with spinal cord injury and post-stroke hemiplegia: all in the same boat. J Back Musculoskelet Rehabil (e-pub ahead of print 6 July 2015; doi:10.3233/BMR-150615).
Oleson CV, Patel PH, Wuermser LA . Influence of season, ethnicity, and chronicity on vitamin D deficiency in traumatic spinal cord injury. J Spinal Cord Med 2010; 33: 202–213.
Nemunaitis GA, Mejia M, Nagy JA, Johnson T, Chae J, Roach MJ . A descriptive study on vitamin D levels in individuals with spinal cord injury in an acute inpatient rehabilitation setting. PM R 2010; 2: 202–208 quiz 228.
Karapolat I, Karapolat HU, Kirazli Y, Capaci K, Akkoc Y, Kumanlioglu K . Longitudinal study of bone loss in chronic spinal cord injury patients. J Phys Ther Sci 2015; 27: 1429–1433.
Mechanick JI, Pomerantz F, Flanagan S, Stein A, Gordon WA, Ragnarsson KT . Parathyroid hormone suppression in spinal cord injury patients is associated with the degree of neurologic impairment and not the level of injury. Arch Phys Med Rehabil 1997; 78: 692–696.
Ritter CS, Brown AJ . Direct suppression of Pth gene expression by the vitamin D prohormones doxercalciferol and calcidiol requires the vitamin D receptor. J Mol Endocrinol 2011; 46: 63–66.
Moslehi N, Shab-Bidar S, Mirmiran P, Hosseinpanah F, Azizi F . Determinants of parathyroid hormone response to vitamin D supplementation: a systematic review and meta-analysis of randomised controlled trials. Br J Nutr 2015; 114: 1360–1374.
Deckers MM, de Jongh RT, Lips PT, Penninx BW, Milaneschi Y, Smit JH et al. Prevalence of vitamin D deficiency and consequences for PTH reference values. Clin Chim Acta 2013; 426: 41–45.
Jiang SD, Dai LY, Jiang LS . Osteoporosis after spinal cord injury. Osteoporos Int 2006; 17: 180–192.
Anagnostis P, Karras S, Goulis DG . Vitamin D in human reproduction: a narrative review. Int J Clin Pract 2013; 67: 225–235.
Blomberg Jensen M . Vitamin D and male reproduction. Nat Rev Endocrinol 2014; 10: 175–186.
Kirmani S, Atkinson EJ, Melton LJ 3rd, Riggs BL, Amin S, Khosla S . Relationship of testosterone and osteocalcin levels during growth. J Bone Miner Res 2011; 26: 2212–2216.
Heijboer AC, Oosterwerff M, Schroten NF, Eekhoff EM, Chel VG, de Boer RA et al. Vitamin D supplementation and testosterone concentrations in male human subjects. Clin Endocrinol (Oxf) 2015; 83: 105–110.
Pilz S, Frisch S, Koertke H, Kuhn J, Dreier J, Obermayer-Pietsch B et al. Effect of vitamin D supplementation on testosterone levels in men. Horm Metab Res 2011; 43: 223–225.
Kalava UR, Cha SS, Takahashi PY . Association between vitamin D and pressure ulcers in older ambulatory adults: results of a matched case-control study. Clin Interv Aging 2011; 6: 213–219.
Libon F, Cavalier E, Nikkels AF . Skin color is relevant to vitamin D synthesis. Dermatology 2013; 227: 250–254.
Wortsman J, Matsuoka LY, Chen TC, Lu Z, Holick MF . Decreased bioavailability of vitamin D in obesity. Am J Clin Nutr 2000; 72: 690–693.
Close GL, Russell J, Cobley JN, Owens DJ, Wilson G, Gregson W et al. Assessment of vitamin D concentration in non-supplemented professional athletes and healthy adults during the winter months in the UK: implications for skeletal muscle function. J Sports Sci 2013; 31: 344–353.
Halliday TM, Peterson NJ, Thomas JJ, Kleppinger K, Hollis BW, Larson-Meyer DE . Vitamin D status relative to diet, lifestyle, injury, and illness in college athletes. Med Sci Sports Exerc 2011; 43: 335–343.
Willis KS, Smith DT, Broughton KS, Larson-Meyer DE . Vitamin D status and biomarkers of inflammation in runners. Open Access J Sports Med 2012; 3: 35–42.
Storlie DM, Pritchett K, Pritchett R, Cashman L . 12-Week vitamin D supplementation trial does not significantly influence seasonal 25(OH) D status in male collegiate athletes. Int J Health Nutr 2011; 2: 8–13.
Constantini NW, Arieli R, Chodick G, Dubnov-Raz G . High prevalence of vitamin D insufficiency in athletes and dancers. Clin J Sport Med 2010; 20: 368–371.
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Flueck, J., Perret, C. Vitamin D deficiency in individuals with a spinal cord injury: a literature review. Spinal Cord 55, 428–434 (2017). https://doi.org/10.1038/sc.2016.155
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DOI: https://doi.org/10.1038/sc.2016.155
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