Vitamin D deficiency in Ukraine: current evidence.

BACKGROUND: Data from numerous studies demonstrate the high frequency of vitamin D deficiency (VDD) and insufficiency (VDI) in many countries worldwide that depend on age and sex, seasons, country, and concomitant pathology. This research aimed to study vitamin D status in the Ukrainian population during 2016-2022 years depending on age, sex, month, and year of the observation, and compare the results with the data of previous Ukrainian epidemiologic studies. METHODS: In a single-center cohort study, we analyzed the serum total 25-hydroxyvitamin D (25(OH)D) level in 7,418 subjects aged 20-99 years. The analysis was performed depending on age, sex, month, season, and year of the observation. Also, we compared the results with the data of previous Ukrainian studies. 25(OH)D level was measured using the electrochemiluminescence method. RESULTS: The mean serum 25(OH)D level in the total group was 31.0 [22.3-41.1] ng/mL, the lowest level was in the age group 90-99 years old. No gender differences were found in 25(OH)D levels, except the one for the women aged 60-69 years old who had higher vitamin D levels compared to male parameters. 41.6% of the subjects had an optimal (> 30-50 ng/mL) 25(OH)D level, 27.3% had VDI, and 19.5% had a VDD. The suboptimal and high serum concentration of 25(OH)D (> 50-100 ng/mL) was found in 11.4% of the subjects. Also, we established the increase of serum 25(OH)D level from 2016 to 2022 with the highest values in 2020-2022. Seasonal variations of 25(OH)D concentration confirmed the highest index in autumn (33.0 [24.0-42.4] ng/mL) and the lowest one in the spring (28.5 [19.7-38.7] ng/mL) with the highest 25(OH)D level in September and the lowest one in March. CONCLUSION: Our results confirmed a decrease in VDD and VDI in 2020-2022 in the Ukrainian population compared to the previous years (2016-2019) and previous Ukrainian studies with similar age and seasonal particularities. It may be the consequence of an improvement in public awareness of global vitamin D deficiency, its positive skeletal and extra-skeletal effects, as well as more intensive vitamin D supplementation due to the COVID-19 pandemic in the recent years.

[10-YEAR MORTALITY IN PATIENTS AFTER HIP FRACTURES].

The aim is to study the indexes of short- and long-term mortality in patients after hip fractures (HF). In a retrospective study, the data of 146 women and 82 men with HF aged 50 years and older (mean age (Me [25Q-75Q]): 74.5 [64.7-80.8] years old) hospitalized in 2005-2007 were analyzed. Life outcome data were collected three times (in 2015, 2016 and 2017) by the researcher by telephone contact with patients or their relatives. The analysis was carried out depending on age, gender, type of fracture, the presence of concomitant diseases. The average follow-up period was 121.3 [30.6-143.9] months (143.4 [133.4-150.0] months for surviving patients and 49.4 [10.2-120.3] months for deceased). Women accounted for 64 % of all subjects with HF and were significantly older than men. The average age at the time of death for the deceased (81.2 [72.2-85.1] years) was significantly higher in women (82.0 [72.9-86.8]) compared with men (76, 8 [66.3-84.8] years; Z=2.0; p=0.04), although it did not differ from the indexes of survivors at the end of the study (79.2 [72.8-89.4] years). Hospital mortality rates were 1.3%, 6-month, 1-, 5- and 10-year mortality, respectively - 11.8%, 18.4%, 36.8 \% and 48.2%. Mortality rate was higher in men only in the age group of 80-89 years, while there were no significant differences in mortality depending on the type of fracture. Survival rates did not differ depending on gender, type of fracture, and were significantly higher (p=0.004) in the patients older than 70 years compared with younger patients.

[Vertebral pain syndrome and quality of life in senior women with vertebral fractures depending on their quantity and localization.]

The features of vertebral pain (VP) and quality of life in postmenopausal women were analyzed depending on the number and location of vertebral fractures (VF). It was found that the intensity of pain in thoracic and lumbar spines, according to McGill pain index, was significantly higher in patients with two or more VF compared to women without any fractures, and absence of differences in subjects with a single VF. Most indices of 11-component Numerical Rating Scale at the thoracic spine were significantly higher only in females with two or more VF. In patients with thoracic spine fractures most parameters of VP measured at this level were significantly higher compared to control values, whereas in patients with lumbar spine fractures most indices did not differ from the corresponding parameters in subjects without fractures. There were no established significant differences of quality of life indices according to the EuroQol-5D questionnaire in senior women depending on the number and location of VF, while disturbances of daily activity parameters according to the Roland-Morris questionnaire were found in patients with 2 or more VF.

Epidemiology of Hip Fractures in Two Regions of Ukraine.

Worldwide, the number of hip fractures, the most important osteoporotic complication in the elderly, continues to increase in line with the ageing of the population. In some countries, however, including the Ukraine, data on the incidence of hip fracture are limited. This article describes the first analysis to characterize the incidence of hip fracture in the Ukrainian population from the age of 40 years. It is based on data from two regional studies, namely, the Vinnitsa city study and the STOP study, which were performed during 1997-2002 and 2011-2012 years, respectively. Hip fracture incidence rates were demonstrated to increase with increasing age. The rates were higher among younger men than women, however, with a female preponderance from the age of 65 years upwards. The incidence of hip fractures in Ukraine is 255.5 per 100,000 for women aged 50 years and older and 197.8 per 100,000 for men of the corresponding age. Overall, the incidence of hip fracture was comparable with data from neighboring countries, such as Poland and Romania. Hip fractures constitute a serious healthcare problem in Ukraine, and changes in healthcare are required to improve the management and long-term care of osteoporosis and its complications.

[Marital status and place of living as social determinants of vertebral pain syndrome and disturbance of life quality in women of older age groups.]

In order to study the role of the marital status and place of residence, as the social determinants of the development of vertebral pain syndrome and related disorders of life activity, the results of a survey of 148 postmenopausal women aged 50-69 years were analyzed. Respondents were divided into groups depending on their marital status (living in a family with husbands and other relatives, only with husbands or alone) and places of residence (in rural or urban areas). The results of this study suggest that family status and place of residence in women of older age groups do not directly influence on the back pain, however they contribute to impairment of vital functions associated with back pain, in particular, psychological state, general activity, working capacity, and also stipulate a higher frequency of requests for medical care and hospitalizations. In single women the level of disruption of daily activity is significantly higher, although the incidence of disability in doing household chores is significantly lower than in married women. Single women reliably seek medical help more often and are hospitalized throught back pain. It was also found the significant correlations between the place of residence and the frequency of health problems related to back pain, psychological and mood disorders, general activity, relationships with others, daily disability in work, impaired ability to move and the frequency of medical help seeking throught back pain. In conclusion, ite should be taken into account in planning of treatment and rehabilitation of women of older age groups with back pain.

Epidemiology of hip fracture and the development of FRAX in Ukraine.

A country-specific FRAX model has been developed for the Ukraine to replace the Austrian model hitherto used. Comparison of the Austrian and Ukrainian models indicated that the former markedly overestimated fracture probability whilst correctly stratifying risk. INTRODUCTION: FRAX has been used to estimate osteoporotic fracture risk since 2009. Rather than using a surrogate model, the Austrian version of FRAX was adopted for clinical practice. Since then, data have become available on hip fracture incidence in the Ukraine. METHODS: The incidence of hip fracture was computed from three regional estimates and used to construct a country-specific FRAX model for the Ukraine. The model characteristics were compared with those of the Austrian FRAX model, previously used in Ukraine by using all combinations of six risk factors and eight values of BMD (total number of combinations =512). RESULTS: The relationship between the probabilities of a major fracture derived from the two versions of FRAX indicated a close correlation between the two estimates (r > 0.95). The Ukrainian version, however, gave markedly lower probabilities than the Austrian model at all ages. For a major osteoporotic fracture, the median probability was lower by 25% at age 50 years and the difference increased with age. At the age of 60, 70 and 80 years, the median value was lower by 30, 53 and 65%, respectively. Similar findings were observed for men and for hip fracture. CONCLUSION: The Ukrainian FRAX model should enhance accuracy of determining fracture probability among the Ukrainian population and help to guide decisions about treatment. The study also indicates that the use of surrogate FRAX models or models from other countries, whilst correctly stratifying risk, may markedly over or underestimate the absolute fracture probability.

[Features of vertebral pain syndromes in older women depending on the duration of postmenopausal period and bone mineral density indices].

We have analyzed the vertebral pain syndrome (VPS) rate in 2 844 women aged 40-89 years, divided into groups according to the period of life (reproductive, perimenopausal and postmenopausal (PMP)) and evaluated the relationship between VPS frequency and indices of bone mineral density (BMD). It was found that the frequency of VPS during different physiological periods of woman life ranges from 84,1 to 94,4 %, with significant increase when the PMP period is more than 20 years compared with women in reproductive and early postmenopausal periods. The significant increase of the VPS frequency in thoracic and lumbar spines starts from 1-3 years of PMP and is retained at higher level for all subsequent periods of PMP. In postmenopausal women, a significant increase of the relative risk of VPS in the thoracic (in 1,3-1,4 times) and the lumbar (1,2-1,3 times) spines was found. In patients with osteoporosis with duration of PMP for 1-3 years, the frequency of VPS in thoracic spine was significantly higher than the indices in women with osteopenia, while patients with duration of PMP of 7-9 years had significantly higher frequency comparing to groups with osteopenia and norms. In patients without vertebral fractures and osteoporosis VPS frequency in the thoracic spine was significantly higher during periods of 4-6 and 7-9 years of PMP compared with women in reproductive period and compared with the women with normal BMD indices. The revealed features of the VPS should be considered while planning therapeutic interventions in women of older age groups.

[AGE AND SEX FEATURES OF BONE MINERAL DENSITY IN RATS].

In vivo assessment of bone mineral density (BMD) and bone mineral content (BMC) indices gives an objective description of the possible rates of bone loss during aging and various diseases, as well as response to treatment by various drugs, affecting bone metabolism. This study was conducted on 376 Wistar rats of both genders, divided into 12 age groups using the method of dual-energy X-ray absorptiometry. Studying the parameters of BMD and BMC depending on age and sex has found no bone mass opeak) in rats of both sexes. Bone mineral density indices were increased in both male and female rats during growing, more pronounced in males. These differences are noted in all age groups of animals. Moreover, we have established age and gender particularities of BMC indices in different parts of the skeleton. In female rats, a significant increase of BMD and BMC parameters have been detected in age from 1.5 to 2 months (33%), from 2 to 3 months - by 12.5%. In males, the increase of BMD indices was found to happen 1 month later and it was less pronounced (from 2 to 3 months - 27%, from 4 to 5 months - 5%). In other age periods, the dynamics of BMD indices had only an upward trend, but significant differences different groups were not established. Our results of BMD and BMC indices and their age and gender features can be used for further research in osteology as reference data for modeling of experimental osteoporosis in rats and study of response to the use of different antiosteoporotic drugs.