AB1011 Vitamin D Status – A Transversal Evaluation in Rheumatic Patients
Authors: J.L. Borges, S. Fernandes, V. Vieira, A. Cardoso, H. Madeira, M.J. Mediavilla, R. Leitão, C. Silva, A. Faustino
Journal: Annals of the Rheumatic Diseases (2016)

<h3>Background</h3> Vitamin D deficiency is a condition reported both in young adults and in elderly and institutionalized patients. It has been increasingly recognized and, although conflicting data subsists, hypovitaminosis D has been related to a variety of rheumatic conditions from osteoporosis (OP) to inflammatory diseases and generalized pain syndromes. <h3>Objectives</h3> To assess vitamin D status in a rheumatic outpatient setting. <h3>Methods</h3> Observational, transversal, retrospective study encompassing rheumatic outpatients with at least one 25-hidroxyvitamin D determination since 2014. Data ascertained included gender, age, parathyroid hormone (PTH) and vitamin D levels, rheumatic conditions (&lt;3/patient), co morbidities and therapeutics. Bone mineral density was assessed by densitometry (DXA) and results classified as normal (Tscore &gt;-1), osteopenia (-2.5&lt;Tscore&lt;-1) and osteoporosis (Tscore&lt;-2.5). Statistics: Mann-Whitney, Kruskal-Wallis, ANOVA and Chi-Squared tests and Pearson9s correlation; p&lt;0.05. Software: SPSS 17. <h3>Results</h3> 370 patients included, 87.3% female, mean age 64.9±13.9 years (y), 151 patients &lt;65y. Most prevalent rheumatic conditions: osteoarthritis (OA; 47.8%), OP (43.5% - 33.5% of which with reported fractures), fibromyalgia (FM; 14.6%) and rheumatoid arthritis (RA; 13.2%); 43.9% patients had inflammatory diseases. Most common co morbidities: arterial hypertension (38.6%), dyslipidemia (32.4%) and depression (22.9%). 38.4% were on synthetic Disease Modifying Anti-Rheumatic Drugs (DMARD); 34.1% on corticosteroids (CTC), 49.2% on bisphosphonates (BF) and 69.5% on calcium/vitamin D (Ca/D) supplements. As for patients with available DXA, 41.4% were classified as having osteopenia and 43.6% as having osteoporosis. Mean vitamin D was 29.7±24.5μg/L; 65.4% patients had vitamin D levels &lt;30μg/L. Mean PTH was 56.6±31.3ng/L and alkaline phosphatase (ALP) was 73.8±31.8U/L. In the group &gt;65y, mean PTH was higher than in the &lt;65y group (61.3±33.6 vs 49.7±26.1, p=0.015); 70.9% of the patients &lt;65y and 61.6% of the patients &gt;65y had vitamin D&lt;30 – not significant. We compared vitamin D in OP vs OP with fractures vs OA vs associated OP/OA and found lower vitamin D levels in patients with isolated OA (38.7±32.5 vs 38.1±33.9 vs 25.9±23.3 vs 30.6±20.7, p=0.012); 76.6% with isolated OA had vitamin D&lt;30. 55.7% of the patients on BF &gt;5y, 61.2% on BF &lt;5y and 72.3% without BF had vitamin D&lt;30 (p=0.013). 68.7% in the group with inflammatory conditions and 62.9% in the group with non-inflammatory conditions had vitamin D &lt;30 – not significant. We further compared vitamin D levels in OA vs AR, AR vs FM and OA vs FM, DMARD and CTC use and Ca/D supplementation and found no difference. There was a positive correlation between age and vitamin D (r=0.111, p=0.033), age and PTH (r=0.208, p=0.010) and vitamin D and ALP levels (r=0.311, p&lt;0.0001). <h3>Conclusions</h3> In this study, vitamin D levels &lt;30μg/L were found in nearly 2/3 of patients, across disease groups. There was a tendency for higher vitamin D levels in elderly patients, in the group with OP comparing with OA and in the group on BF, which may be related to previous supplementation. A potential bias is the fact rheumatologists request vitamin D dosing in patients with risk factors/clinical features of hypovitaminosis. <h3>Disclosure of Interest</h3> None declared