Acta Médica Costarricense (Sep 2012)
Hipovitaminosis D en Costa Rica, reporte inicial: Estudio de casos y controles Hypovitaminosis D in Costa Rica: initial report on a case control study
Abstract
Objetivo: describir, por primera vez en Costa Rica, las características clínicas de pacientes con hipovitaminosis D. Materiales y métodos: estudio retrospectivo, en donde se detectó, entre los reportes del Laboratorio de Hormonas del Hospital San Juan de Dios, a 17 pacientes con niveles de 25-hidroxivitamina D (25(OH)VD)en rangos subnormales (Objective: To describe for the first time in Costa Rica, the clinical characteristics of patients with Hypovitaminosis D. Materials and methods: Retrospective study, in which17 patients with subnormal levels of 25-hydroxivitamin D25 (OH)VD (<75 nmol/L) were identified amongst the reports from the Hormone Laboratory at the San Juan de Dios Hospital. Also, 15 controls with normal levels, and similar age and gender were identified. Results: There was no difference in age (52.76±20.88 years in cases vs. 46.33±12.50 in controls), gender (58.85% in cases vs. 80% in controls were females).In the group with Hypovitaminosis, mean levels of 25(OH)VD(59.2±10.37 nmol/L) were lower and those of PTH were higher (146.86±103.76 vs. 47.82±13.77 ng/ml in controls, p=0.004). There was no difference in calcium levels (8.98 cases vs. 9.38 mg/dl controls p=.352), phosphorus (4.09 cases vs. 2.99 mg/ dl controls p=.104) nor BMD at hip and lumbar spine. There were no differences in the prevalence of nephrotic syndrome, chronic liver failure, chronic renal disease and of sun block use between both groups. There were no hospitalized patients in either group. Subjects with hypovitaminosis on the cases group indicated an average of 0.6 hours of sun exposure per week, compared with 1.46 in the control group (p=0.297). In the cases group, we observed a higher prevalence of falls (23.5% vs. 6.7% p=0.039), fractures (17.6% vs. 0%, p=0.024), diabetes (17.6% vs. 6.7% p=0,158), fatigue (29.4% vs. 13.3% p=0.012), weakness (41.2% vs. 33% p=0.010), and use of inducers of cytochrome P450 pathway (29.3% vs. 0% p=0.009). Body weight was less in cases with deficiency of25(OH)VD (26.6% with overweight or obesity vs. 66.7% p=0.009). Conclusions: Hypovitaminosis D may occur in tropical countries, such as Costa Rica. It is characterized by higher levels of PTH, low body weight, a high number off alls and fractures, fatigue, weakness, diabetes and use of inducers of liver enzymatic activity. Both groups had low sun exposure
