FORT LAUDERDALE, FLA. — Screening for vitamin D deficiency should be part of the initial evaluation of patients with Paget's disease, Dr. Jennifer J. Kelly and Dr. Arnold M. Moses said in a poster presentation at a meeting sponsored by the Paget Foundation for Paget's Disease of Bone and Related Disorders.
Blood collected from 37 patients (mean age 72) at their initial visit to a metabolic bone clinic revealed that just three (8%) had levels of 25(OH)D considered to be optimal (greater than 32 ng/mL), while 21 (58%) were vitamin D deficient (below 20 ng/mL), said the study investigators, of the State University of New York Upstate Medical University, Syracuse.
The median 25(OH)D level among the 24 men in the group was 20 ng/mL, compared with just 13 ng/mL among the 13 women.
Women were more likely than men (5 vs. 2) to be grossly vitamin D deficient (0–9 ng/mL), while men were in the majority in the intermediate range between 10 and 32 ng/mL (20 men vs. 7 women).
Levels greater than 32 ng/mL were seen in only two men and one woman.
Season also influenced 25(OH) D levels, which were on average 9 ng/mL higher during the “light” months of the year (May-September) than during the “dark” period of November-March.
Of the 13 patients whose blood had been collected during the light months, 7 (54%) had 25(OH)D levels of 20 ng/mL or above, compared with just 3 (20%) of the 15 sampled during the dark months. Women had lower median vitamin D levels than men in both the light and dark months.
The initial idea for this investigation came from a patient seen in the metabolic bone clinic who had both hypovitaminosis D and documented active Paget's disease of the tibia with intense pain in the area.
The pain resolved completely when the patient's vitamin D deficiency was treated.
Aside from reducing musculoskeletal pain, other potential benefits of correcting hypovitaminosis D in patients with Paget's disease include ensuring that markers of bone turnover actually reflect Paget's disease activity, decreasing fracture risk, improving muscle strength and balance, and reducing the risks of both hypocalcemia and osteomalacic new bone formation resulting from bisphosphonate treatment, Dr. Kelly and Dr. Moses said.