Vitamin D Metabolic Pathway Components in Orthopedic Patientes—Systematic Review
Abstract
:1. Introduction
2. Methods
3. Results and Discussion
3.1. Total Knee Arthroplasty (TKA)
3.1.1. Vitamin D
3.1.2. Cholesterol
3.1.3. Vitamin D Binding Protein (VDBP)
3.1.4. Cytochrome-P450-Mediated Metabolism of Vitamin D
3.1.5. Vitamin D Receptor (VDR)
3.2. Hip Arthroplasty
3.2.1. Vitamin D
3.2.2. Vitamin D Receptor (VDR)
3.3. Anterior Cruciate Ligament (ACL)
Vitamin D
3.4. Rotator Cuff (RC)
Vitamin D
3.5. Shoulder Arthroplasty
Vitamin D
4. Conclusions
Author Contributions
Funding
Informed Consent Statement
Data Availability Statement
Acknowledgments
Conflicts of Interest
References
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Component of Pathway | Number of Patients | Biological Material | Method of Identification/Analysis | Results | References |
---|---|---|---|---|---|
Vitamin D | n = 92 | Serum | I125 radioimmunoassay | Patients with normal preoperative vitamin D levels showed better results of physical activity; therefore, it seems that vitamin D deficiency adversely affects early postoperative functional results after TKA | [17] |
Vitamin D | n = 120 | Serum | No data | TKA should be not delayed among patients with vitamin D deficiency. Use of appropriate postoperative supplementation is able to improve recovery in patients | [18] |
Vitamin D | n = 174 | Serum | No data (analysis done as a service in the diagnostic laboratory) | Supplementation of vitamin D should be used in patients prior to TKA. A loading dose regimen of 50,000 IU weekly for 4 weeks followed by a maintenance dose of 2000 IU/d more effectively improves vitamin D deficiency in comparison to a low-dose, daily regimen among TKA patients | [19] |
Vitamin D (+ calcium) | n = 142,147 | Serum | No data (analysis done as a service in the diagnostic laboratory) | After TKA, implant survival was significantly better in people taking a combination of calcium and vitamin D (at a dose of 800 IU or more) for more than 1 year compared to those who had never used it | [20] |
Vitamin D | n = 226 (postmenopausal women) | Serum | No data (analysis done as a service in the diagnostic laboratory) | Vitamin D deficiency may adversely affect early functional outcomes in postmenopausal women after TKA and may be considered as a risk factor for moderate to severe postoperative knee pain (in correlation with smoking and high mass index) | [21] |
Cholesterol (+ apolipoprotein A1) | n = 20 | Serum | No data (analysis done as a service in the diagnostic laboratory) | Vitamin D deficiency is associated with a higher rate of all-cause revision TSA but not medical complications compared to controls | [22] |
Total triglycerides (TG), total cholesterol (TC), high-density lipoprotein cholesterol (HDL-C), low-density lipoprotein cholesterol (LDL-C), apolipoprotein A1 (ApoA1), and apolipoprotein B (ApoB) | n = 184 | Serum, synovial fluid | No data (analysis done as a service in the diagnostic laboratory) | Any significant differences were not determined in serum TG and ApoB concentrations between both groups, while primary knee osteoarthritis patients had higher TC and LDL-C levels, and lower HDL-C and ApoA1 levels | [23] |
Vitamin D binding protein (VDBP) (+ 25(OH)D, parathyroid hormone (PTH), calcium, C-reactive protein (CRP), and albumin) | n = 33 | Serum | No data (analysis done as a service in the diagnostic laboratory) | A molar ratio of vitamin D to VDBP should be considered to provide a useful indicator of biological activity in TKA aspect | [24] |
Vitamin D metabolites and sex steroids (included total and free serum concentrations of 25OHD, 1,25(OH)2D3, 24,25-dihydroxyvitamin-D, DBP, albumin, sex hormone binding globulin (SHBG), calcium, and parathyroid hormone (PTH)) | n = 25 | Serum | No data (analysis done as a service in the diagnostic laboratory) | The concentration of serum albumin and SHBG decreased postoperatively. Unexpectedly, the concentrations of DBP and 25OHD remained unchanged, but 1,25(OH)2D3 decreased after surgery. 1,25(OH)2D3 was lower (about 24%) 3 weeks postoperatively compared to preoperative levels, while 24,25-dihydroxyvitamin-D was unchanged in postmenopausal women. The calculated conversion ratio of 25OHD to 1,25(OH)2D3 was strongly related to the preoperative effects of serum 25-OHD and PTH, while serum calcium was the most predictive after surgery | [25] |
CYP27B1 and CYP24A1 activity in vitamin D pathway | n = 25 | Serum | No data on the method of determination (analysis done as a service in the diagnostic laboratory) | High activity of CYP24A1 in women concomitantly with lower CYP27B1 levels means that a greater proportion of the substrate pool is inactivated due to increased CYP24A1 activity, which alone or in combination with decreased CYP27B1 activity may result in the low 1,25(OH)2D3 | [25] |
Relationship of the Fok1, Cdx2, and Apa1 polymorphisms in the gene for VDR and serum 25(OH)D levels | n = 787 | Serum/blood | Chemiluminescent assay with equal specificity for both D2 and D3; VDR genotype was determined by the polymerase chain reaction (PCR) and restriction fragment length polymorphism (RFLP) analysis (polymorphic sites for Fok1, Cdx2, and Apa1) | Vitamin D may be associated with pain severity, the evidence for an association between vitamin D genetic variability and knee OA pain is very weak in this study and should be expanded | [30] * |
Vitamin D receptor gene polymorphisms (+level of TNF-α, a factor that inhibits macrophage migration (MIF), and 25-hydroxycholecalciferol) | n = 205 | Serum/blood | PCR-RFLP was applied to SNP analysis for ApaI and TaqI, while vitamin D, serum and synovial TNF-α and MIF assays were performed using ELISA kits | KOA severity was correlated with significantly lower serum concentration of 25-hydroxycholecalciferol and significant increasing TNF-α and MIF levels | [32] ** |
Component of Pathway | Number of Patients | Biological Material | Method of Identification/Analysis | Results | References |
---|---|---|---|---|---|
Vitamin D | 158, included 110 | No data | Liquid chromatography with tandem mass spectrometry detection | (1) 25(OH)D levels were correlated with change in peak extension and peak power generation. (2) The effect of 25(OH)D on the change in these variables is modest. Studies with longer follow-up are warranted to establish the role of vitamin D in THA rehabilitation | [58] |
Vitamin D | 11,247 people (national, population-based cohort study) | Fasting serum or fasting plasma | Competitive chemiluminescent immunoassay with an interassay coefficient of variation | Increasing serum 25-hydroxy-vitamin D concentrations were associated with an increased risk of hip arthroplasty for OA in males, while no significant association was observed in females | [59] |
Vitamin D | n = 87 | No data | High-performance liquid chromatography | Vitamin D status did not appear to affect physical recovery after THA. The drop in vitamin D after surgery deserves further investigation, but could possibly be explained by hemodilution | [46] |
Vitamin D | n = 200 (88 men, 122 women) | Serum | No data | (1) From 200 patients, 79 (39.5%) had low serum vitamin D (serum 25-hydroxy vitamin D < 32 ng/mL). (2) There were no associations between serum vitamin D level and the attainment of in-hospital functional milestones as well as length of hospital stay or perioperative complications after THA | [39] |
Vitamin D | n = 1083 (567 women, 516 men) | Serum | ARCHITECT® 25-OH vitamin D assay | (1) A total of 86% of the study population was vitamin D insufficient and 63% of patients were vitamin D deficient. Of the 1083 vitamin D serum levels measured in this study, only 8% were in the target range of 30 to 60 ng/mL. Serum vitamin D levels of all 1083 patients were normally distributed, with a mean of 17.1 ng/mL. (2) The length of stay was longer in patients with hypovitaminosis D compared to patients with normal serum 25-OH-D levels | [48] |
Vitamin D | n = 219 | Non-fasting serum samples from blood | Radioreceptor assay | (1) Of 219 patients, 102 (46.6%) had low vitamin D levels (25-hydroxyvitamin D < 30 ng/mL). Low vitamin D status did not adversely affect short-term function at 6 weeks after THA. (2) There was no association between serum vitamin D levels and the within-patient changes of scores of each outcome measurement | [47] |
Vitamin D | n = 100 | Serum | I125 radioimmunoassay | The level of serum vitamin D was lower, and the percentages of vitamin D insufficiency and deficiency patients were higher in the HFS patients compared to those in the THA patients | [60] |
VDBP status | n = 64 | Peripheral venous blood sampling | No data | (1) Acute PPIs of the hip and knee joints show a significantly reduced calcium and 25 OH vitamin D3 levels as well as lowered proteins (albumin and total protein) compared with chronic infections as well as primary endoprostheses and aseptic replacement operations. (2) Substitution of vitamin D3 and calcium with simultaneous adaptation of the protein balance is recommended in all PPIs, especially in the acute PPI | [61] |
VDBP status | n = 103 (65 females, 38 males, | Bone mRNA levels | Bone mRNA levels for vitamin D metabolizing enzymes CYP27B1 and CYP24A1 were measured by qRT-PCR. | (1) Serum 25(OH)D levels were associated with MWT with values significantly greater in patients with higher serum 25(OH)D levels. (2) Serum 25(OH)D levels were negatively associated with bone surface/bone volume (BS/BV), and together with bone CYP27B1 and CYP24A1 mRNA accounted for 10% of the variability of BS/BV | [62] |
CYP24A1 |
Component of Pathway | Number of Patients | Biological Material | Method of Identification/Analysis | Results | References |
---|---|---|---|---|---|
25-hydroxyvitamin D | CTR n = 11(non-injured); ACL n = 18 (injured) | Plasma | Chemiluminescent assay | (1) In 73% of CRT, the content of 25-hydroxyvitamin D was lower than 30 ng/mL. (2) 2 weeks before surgery, 56% ACL had content of 25-hydroxyvitamin D lower than 30 mg/mL, and 50% ACL 3 min after surgery | [67] |
25-hydroxyvitamin D; 1.25-hydroxyvitan D; | n = 12 | Plasma | Chemiluminescent assay | (1) 90 min after the injury, the concentration of 25(OH)D decreased significantly and IFNγ activity significant increased. (2) Despite the inverse correlation of the 25(OH)D change, changes in IFNγ were correlated with the concentration of 1.2 (OH D and the ratio of 1,25(OH)D to 25(OH)D both before and after ACL reconstruction | [62] |
25-hydroxyvitamin D | n = 14, after intense exercise | Plasma | Chemiluminescent assay | (1) Mean concentration of 25(OH)D was 28.0 ± 2.5 ng/mL; in 36% of patients, the 25(OH)D concentration was higher than 32 ng/mL, and 64% were below this level. (2) Intense exercise caused a significant increase in serum 25(OH)D levels immediately after training | [64] * |
25-hydroxyvitamin D | n = 153 (group 1 25(OH)D <20 ng/mL n = 51; group 2 25(OH)D 20–30 ng/mL n = 51; group 3 25(OH)D >30 ng/mL n = 51) | Serum | Chemiluminescent assay | Graft acceptance failure rates in the study groups 1, 2, and 3 were 5.88%, 1.96%, and 1.96%, respectively. There was no correlation between serum vitamin D levels and the effectiveness of graft acceptance after ACL reconstruction | [65] |
25-hydroxyvitamin D; D-binding protein (DBV) | C57-BL6 mice | Plasma | ELISA | (1) The increase in the dose of vitamin D in the diet resulted in a higher content of 25(OH)D in the plasma and lower amount of vitamin D-binding protein (DBP). (2) There was no correlation between the vitamin D dose and osteoarthritis, but the protective effect of vitamin D was demonstrated. In females who received superphysiological doses of vitamin D, it was milder | [66] |
Component of Pathway | Number of Patients | Biological Material | Method of Identification/Analysis | Results | References |
---|---|---|---|---|---|
25-hydroxyvitamin D | n = 176 | Serum | No data | (1) A total of 44% of patients had hypovitaminosis of vitamin D (content of 25(OH)D < 20 ng/mL) and 29% had normal levels of vitamin D (content of 25(OH)D > 30 ng/mL). (2) Mean serum concentration of 25(OH)D among all patients was 24.7 ± 13.7 ng/mL. (3) 25(OH)D concentration was positively correlated with age | [72] |
25-hydroxyvitamin D; fatty degeneration | Group 1: patients with a full-thickness tear n = 228; Group 2: patients with other conditions of the shoulder n = 138 | Serum | 25(OH)D was measured using the radioimmunoassay test. The fatty degeneration of supraspinatus, infraspinatus, and subscapularis was measured with themagnetic resonance arthrography | (1) Mean serum 25(OH)D level was shown to be 44.02 ng/mL (group 1) and 43.64 ng/mL (group 2). (2) A lower level of vitamin D in the serum was associated with higher fatty degeneration in the muscles of the cuff | [73] |
25-hydroxyvitamin D; vitamin D receptor (VDR) | n = 26 | Serum | 25(OH)D was assessed using liquid chromatography; VDR was measured by western blotting | (1) Mean serum 25(OH)D level one year after injured was 20.5 ± 9.2 ng/mL. A total of 23.1% of patients had normal vitamin D levels (>20 ng/mL). (2) Patients who had lower 25(OH)D levels before surgery also had lower serum levels one year after surgery. (3) Patients with higher levels of vitamin D preoperatively and one year after surgery had a lower index of the isokinetic muscle efficiency test. (4) There was no correlation between vitamin D concentration and muscle fat degeneration, and between the vitamin receptor VDR and other parameters studied | [75] |
25-hydroxyvitamin D | n = 28 (male Sprague–Dawley rats) | Serum | No data | (1) There was no correlation between low vitamin D concentration and total mineral density and fraction of cortical bone volume, whole, or spongy bone 4 weeks after surgery. (2) Histological analysis showed less bone formation and less collagen fiber organization in the vitamin D deficient specimens at 4 weeks as compared with control. (3) The data suggest that vitamin D hypovitaminosis may adversely affect healing at the rotator cuff repair site | [77] |
Component of Pathway | Number of Patients | Biological Material | Method of Identification/Analysis | Results | References |
---|---|---|---|---|---|
Vitamin D | n = 5022 | Serum | No data on the method of determination (analysis done as a service in the diagnostic laboratory) | (1) There was a significantly higher rate of revision shoulder arthroplasty in patients with vitamin D deficiency compared to the control group. (2) No significant differences were found in any of the other complications | [78] |
Vitamin D | n = 218 | Serum | No data on the method of determination (analysis done as a service in the diagnostic laboratory) | The authors noted that the vast majority of shoulder arthroplasty patients had vitamin D deficiencies at least <30 ng/mL, and it was increased in patients with a high body mass index | [79] |
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Płomiński, J.; Grzybowski, R.; Fiedorowicz, E.; Sienkiewicz-Szłapka, E.; Rozmus, D.; Król-Grzymała, A.; Jarmołowska, B.; Kordulewska, N.; Cieślińska, A. Vitamin D Metabolic Pathway Components in Orthopedic Patientes—Systematic Review. Int. J. Mol. Sci. 2022, 23, 15556. https://doi.org/10.3390/ijms232415556
Płomiński J, Grzybowski R, Fiedorowicz E, Sienkiewicz-Szłapka E, Rozmus D, Król-Grzymała A, Jarmołowska B, Kordulewska N, Cieślińska A. Vitamin D Metabolic Pathway Components in Orthopedic Patientes—Systematic Review. International Journal of Molecular Sciences. 2022; 23(24):15556. https://doi.org/10.3390/ijms232415556
Chicago/Turabian StylePłomiński, Janusz, Roman Grzybowski, Ewa Fiedorowicz, Edyta Sienkiewicz-Szłapka, Dominika Rozmus, Angelika Król-Grzymała, Beata Jarmołowska, Natalia Kordulewska, and Anna Cieślińska. 2022. "Vitamin D Metabolic Pathway Components in Orthopedic Patientes—Systematic Review" International Journal of Molecular Sciences 23, no. 24: 15556. https://doi.org/10.3390/ijms232415556