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*For medical professionals only
Director Bian Pingda of Zhejiang Provincial People's Hospital published the 62nd article
related to the prevention and treatment of osteoporosis in the medical community.
Recently, a secondary school teacher, Ms.
Shao, came to the outpatient clinic, and after examination, it was found that she was severely deficient in vitamin D (serum 25-hydroxyvitamin D is 8 ng/ml).
Four other teachers from the same department were invited to check and found that all of them had vitamin D deficiency
.
Long-term vitamin D deficiency will not only affect the absorption of calcium and phosphorus in the intestines, induce osteomalacia and osteoporosis, but also lead to muscle weakness and easy falls and fractures [1].
So, who should get tested for vitamin D? How do I choose a detection method? What are the diagnostic criteria for vitamin D deficiency?
Who needs vitamin D testing?
▌People at higher risk of vitamin D deficiency This group includes at
least [2]:(1) pregnant and lactating women; (2) The elderly, especially those who are bedridden for a long time and do not leave home; (3) People with insufficient exposure to sunlight, such as otaku women who do not like to go out, people who have been engaged in night shift or indoor work for a long time, etc.
; (4) Young women who use sunscreen excessively, or who
need to cover their head or face for a long time due to religion, culture or customs.
▌Patients
with osteomalacia-related symptoms may have joint and muscle pain in the hip, waist and pelvis, as well as hyperalgesia, muscle weakness, faltering gait, personality changes, etc
.
When a person has the above symptoms, vitamin D deficiency should be considered and vitamin D testing
should be received promptly.
▌ The
reason why osteoporosis patients with osteoporosis should be routinely tested for vitamin D is because vitamin D deficiency can affect calcium absorption and aggravate osteoporosis; Second, before using strong anti-bone resorption drugs, attention should be paid to calcium and vitamin D supplementation, otherwise hypocalcemia
is prone to occur during treatment.
How to choose a vitamin D detection method?
At present, the methods for evaluating 25-hydroxyvitamin D mainly include immunoassay (immunoassay) and liquid chromatography-tandem mass spectrometry (mass spectrometry) [3].
Immunoassay measurement due to the combination of large-scale analytical instruments, so it has the characteristics of automation, can regularly process a large number of samples, help to save labor costs, is currently the main detection method in China, but immunoassay can not quantitatively distinguish 25-hydroxyvitamin D 2 and 25-hydroxyvitamin D3, and insufficient detection capacity for 25-hydroxyvitamin D2 (about 50%)
.
Mass spectrometry can simultaneously detect 25-hydroxyvitamin D 2 and 25-hydroxyvitamin D 3, and according to the values of the two to sum the total amount of 25-hydroxyvitamin D, so it is more sensitive and accurate than immunoassay, but because mass spectrometry currently uses semi-automated sample processing, As a result, fewer samples are tested per day than for immunoassays
.
In general, because 25-hydroxyvitamin D2 levels are low in the normal population, immunization is an option when knowing a person's vitamin D status, but supplementation with vitamin D2 preparations such as vitamin D2 Gel pills or intramuscular vitaminD2 injection), mass spectrometry should be selected [4].
What are the diagnostic criteria for vitamin D deficiency?
At present, there is still some controversy over the diagnostic criteria for vitamin D deficiency, but most scholars recommend referring to the following diagnostic criteria [5].
Table 1 Diagnostic criteria
for vitamin D deficiency In general, people with vitamin D deficiency only need to insist on sun exposure, outdoor activities, and eat foods rich in vitamin D (such as marine fish, milk, eggs, and animal liver, etc.
); For patients with vitamin D deficiency, adequate doses of vitamin D preparations
are also required.
References:
[1] ZHANG Chenyang, BIAN Pingda, SHOU Zhangxuan, et al.
Current situation and countermeasures of vitamin D deficiency in the elderly[J].
Chinese Journal of New Drugs and Clinical Studies,2019,38(6):328-332.
)
[2] LIAO Xiangpeng, ZHANG Zengli, ZHANG Honghong, et al.
Guidelines for the application of vitamin D and bone health in adults (2014 standard edition)[J].
Chinese Journal of Osteoporosis,2014,20(9):1011-1025.
)
[3] Yu Songlin, Fang Huiling, Cheng Xinqi, et al.
Comparison of five automated immunological methods and liquid chromatography tandem mass spectrometry for the determination of 25-hydroxyvitamin D[J].
Chinese Journal of Laboratory Medicine,2015,38(7):475-479.
)
[4] Bian PD,Jin X,Shou Zh X,Effects of Monthly Intramuscular high-Dose vitamin D2 on serum 25-hydroxyvitamin D and immune parameters in very elderly Chinese patients with vitamin D deficiency[J].
Int J Endocrinology,2021,1343913.
[5] YUE Hua,ZHANG Keqin,ZHANG Zhenlin.
Vitamin D deficiency and its risk factors[J].
Chinese Journal of Osteoporosis and Bone Mineral Salt Diseases,2018,11(1):34-37.
)
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