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Research Paper | Neurology | Pakistan | Volume 12 Issue 6, June 2023
The Trend of Vitamin D3 Deficiency in Younger Populations with Spinal Cord Injury in Pakistan
Dr. Tahreem Fatima [2] | Dr. Abrar Ullah Khan | Dr. Azam Niaz | Dr. Umar Nadeem | Dr. M. Haris Masood | Dr. Umar Hassan | Dr. Ayesha Farooq
Abstract: Background: Vitamin D3 deficiency has been reported as a worldwide epidemic and has been detected in 53.3% of the population in Pakistan. [1] It has been found as well that low levels of vitamin D3 are implicated as a primarily etiological factor for many bone diseases. As a result, many growing publications stated the prevalence of vitamin D deficiency in acute and chronic spinal cord injury patients. [2 - 4] The early detection of vitamin D3 deficiency, especially in younger patients, followed by an early treatment plan is essential for the prevention of osteoporosis and its long - term related consequences, hence making it essential to study the trend of Vitamin D3 levels in younger populations with Spinal Cord Injury. [5] Objective: Our study aims to detect the status of serum 25 - hydroxy vitamin D [vitamin D25 (OH) ] levels in younger patients with acute and chronic spinal cord injury (SCI) to make an early diagnosis of sublesional bone loss and to advocate the supplementation of Vitamin D3 as a treatment for sublesional osteoporosis thus lowering the morbidity and mortality among young patients with SCI. Methods and Materials: It was a prospective cohort study. The study was conducted in SCI trauma center at the Mayo Hospital Lahore, Pakistan over a 1 - year duration. The sample size comprised of eighty - five patients. The sampling method used was stratified random sampling. The patients included in the study aged between 12 and 35 years with documented new onset of SCI based on history, clinical neurological examination and radiological findings, and they were classified as having complete or incomplete sensorimotor impairments according to level of SCI. The patients excluded from the study were patients with other comorbidities that could interfere with the serum vitamin D3 levels and those younger than 12 years or older than 35 year. SPSS version 27 was used for data analysis. Samples were collected according to hospital policy after obtaining written consent from the patients in the regional language. The assessment was done using the American Spinal Cord Injury Association Scale (ASIA) spine scoring scheme. Vitamin D3 was measured using the standard measurement technique at the local hospital diagnostic center. The studied subjects were divided into 2 groups: Group A included complete SCI patients as ASIA grade 5, and Group B included incomplete SCI patients as ASIA grade 1 - 3. On further work up, among these two groups, and depending upon serum concentrations of 25 (OH) D levels, patients were classified into vitamin D deficient with a serum level less than <30 nmol/L, vitamin D insufficient with a serum level between 30 to <50 nmol/L, and vitamin D sufficient with a serum level greater than ?50 nmol/L (According to NIH). Results: Mean vitamin D3 level in 75 ASCI subjects (mean age 30.82 ? 6.77 years, was 20.56 ? 11.22 ng/ml. Fifty subjects (58.82%) were vitamin D deficient, 15 subjects (17.64%) were vitamin D insufficient and the rest (n=20, 23.52%) were vitamin D sufficient. There was no significant difference in vitamin D levels as per gender, age, mode of trauma, type of injury and injury location. Patients admitted on the fifth day of injury had maximum vitamin D levels (mean 25.7143 ? 8.32 ng/ml). The mean vitamin D level of subjects with samples taken during the summer season was significantly higher as compared to the winter season (p value <0.05). Study included a total of seventy - five patients with 35 female and 40 male patients aged between 12 and 35 with documented SCI. A blood sample for 25 (OH) D concentration was drawn upon admission for both groups and one after 6 months at follow up. Mean ? SD serum 25 (OH) D concentration in group A (complete spinal cord injury at presentation) was 31.81 ? 13.79 nmol/L (range from 20 to 50 nmol/L) and 20.43?13.51 nmol/L (range from 8 to 45 nmol/L) at 6 months after injury, in low and insufficient range respectively.
Keywords: Spinal cord injury, serum 25 (OH) D, ASIA score
Edition: Volume 12 Issue 6, June 2023,
Pages: 519 - 522