Page 89 - JCTR-10-1

Journal of Clinical and Translational Research 2024; 10(1): 85-92

Journal of Clinical and Translational Research

Journal homepage: http://www.jctres.com/en/home

ORIGINAL ARTICLE

Prognostic nutritional index instead of serum Vitamin D levels as a

determinant of the presence of osteoporosis in adult male patients with
neurological impairment

Ayako Tsunou , Hiroyo Miyata , Yoko Hokotachi , Isaku Horiuchi , Teruyoshi Amagai *
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1,2
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1 Administration Food Sciences and Nutrition Major (Doctoral Program), Graduate School of Human Environmental Sciences, Mukogawa Women’s
University, Hyogo, Japan, Department of Clinical Nutrition, Kitauwa Hospital, Ehime, Japan, Department of Clinical Nutrition, Kindai University
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Hospital, Osaka, Japan, Department of Clinical Nutrition, Takarazuka Dai-Ichi Hospital, Hyogo, Japan, Department of Pediatrics, Asahigawasou South
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Ehime Hospital, Ehime, Japan, Department of Clinical Engineering, Faculty of Health Sciences, Jikei University of Health Care Sciences, Osaka, Japan
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ARTICLE INFO Abstract
Article history: Background: Complications of non-traumatic fractures and osteoporosis, which reduce mobility and
Received: September 12, 2023 quality of life, should not be ignored in patients with neurological impairment (NI).
Accepted: October 26, 2023 Aim: To diagnose osteoporosis in adult patients with NI, a readily available and easily obtained index,
Published online: February 7, 2024 instead of serum Vitamin D level or bone mineral density (BMD), was explored.
Methods: This was a single-center retrospective study. The participants were inpatients with NI admitted
Keywords: between August 2020 and June 2022. Patient data regarding (1) patient information, (2) blood data, including
Prognostic nutritional index the prognostic nutrition index (PNI), which predicts outcomes of various diseases, (3) body composition, (4)
Osteoporosis T-score by BMD, (5) nutritional measures, and (6) outcome measures were collected. Enrolled patients were
Neurological impairment divided into two groups, with or without osteoporosis, according to their T-score. The data were analyzed by
Bone mineral density three methods: (1) comparison of all collected data between the two groups to analyze the factors influencing
Vitamin D deficiency osteoporosis; (2) multiple logistic regression analysis; and (3) receiving operating characteristic curve analysis.
Results: Patients with osteoporosis had a significantly lower PNI (45 vs. 49, P = 0.045), and higher
*Corresponding author: Vitamin D insufficiency (71% vs. 31%, P = 0.031). PNI was the strongest influencing factor, and its
Teruyoshi Amagai cutoff value for osteoporosis was 50.
Department of Clinical Engineering, Faculty Conclusion: The PNI is the strongest determinant of osteoporosis in patients with NI. Therefore, PNI
of Health Sciences, Jikei University of Health can potentially be used as a surrogate for BMD instead of serum Vitamin D levels in institutionalized
Care Sciences, Osaka, Japan and homebound patients who do not have BMD measurement devices.
Email: amagait@yahoo.co.jp Relevance for Patients: Prognostic nutrition index, which is a simple blood test, outperforms serum
vitamin D concentration as a good indicator for early detection of osteoporosis.
© 2024 Author(s). This is an Open-Access
article distributed under the terms of the
Creative Commons Attribution-Noncommercial
License, permitting all non-commercial use, 1. Introduction
distribution, and reproduction in any medium,
provided the original work is properly cited. Patients with neurological impairments (NI), including cerebral palsy (CP), are often affected
by osteoporosis, associated fractures, and bone pain, which often result in reduced mobility. In
this context, these complications, which reduce quality of life (QoL), cannot be ignored. Bone
pain associated with osteoporosis occurs in 56.4% of patients, followed by deformity and fatigue
in 44.2% and 36.9% of patients, respectively [1]. Osteoporosis is a debilitating bone disease
characterized by low bone mass and poor bone quality. A major consequence of osteoporosis is
the increased risk of fragility and non-traumatic fractures (NTFx). These fractures are a major
cause of functional disability, morbidity, impaired QoL, and early mortality. Recent studies
reported that the prevalence of osteoporosis in patients with NI showed an odds ratio ranging
from 5.76 to 30.5 compared to those without NI [2,3], suggesting that NI is an osteoporosis
DOI: https://doi.org/10.36922/jctr.00110