Source: Spine  |  Posted 9 years ago

A high risk of increasing deterioration faced by patients with advanced peripheral arterial disease (PAD) can in fact be curbed relatively easily, suggest authors of a study in Austria.

Patients with stage IV PAD, and especially those who feel severely restricted by the condition, are at high risk of developing vitamin D deficiency, secondary hyperparathyroidism and, ultimately, osteomalacia due to immobilization and subsequent lack of exposure to sunlight.

These conditions, in turn, lead to further deterioration, report Dr A Fahrleitner and colleagues from the Karl-Franzens University, Graz, and Krankenhaus der Barmherzigen Bruder (SK), Vienna.

However, a simple, inexpensive approach to mitigating the clinical symptoms and generally to improving quality of life for these patients is to monitor their vitamin D metabolism and provide vitamin D replacement therapy, suggest these authors.

Objective of this study at a university hospital was to investigate via vitamin D status whether patients with PAD tend to develop vitamin D deficiency that in turn influences their clinical symptoms.

Researchers evaluated 327 patients, excluding those with secondary causes of bone disease or bone active medication. Of 161 PAD patients ultimately enrolled, 84 had stage II disease and 77 had stage IV. Forty-five people matched for age and gender served as controls.

For all patients, researchers determined serum chemistry, 25-hydroxyvitamin D (vitamin D3) intact parathyroid hormone (iPTH), alkaline phosphatase (ALP) and osteocalcin.

Patients were then stratified by an individual restriction score into one of three groups: mildly, moderately or severely restricted in daily life due to the underlying disease.

Those with advanced PAD versus patients with PAD II showed significantly lower vitamin D3 and calcium values and significantly higher iPTH, osteocalcin and ALP levels.

Also, those who considered themselves severely restricted in every day life by the underlying disease showed lower vitamin D3 and higher iPTH levels than did those who reported only moderate or mild restriction.