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. 2012 Dec;16(Suppl 2):S450-2.
doi: 10.4103/2230-8210.104128.

Vascular calcification in diabetic foot and its association with calcium homeostasis

Jayshree Swain  1 , Shalbha Tiwari, Dd Pratyush, Awanindra Dwivedi, Balram Gupta, R C Shukla, S K Singh
Affiliations

Vascular calcification in diabetic foot and its association with calcium homeostasis

Jayshree Swain et al. Indian J Endocrinol Metab. 2012 Dec.

Abstract

Introduction: Vascular calcification (VC), long thought to result from passive degeneration, involves a complex process of biomineralization resembling osteogenesis, frequently observed in diabetes and is an indicator of diabetic peripheral vascular disease with variable implications.

Aim and objective: To study the association between vascular calcification and calcium homeostasis in diabetic patients with foot ulcers without stage 4, 5 chronic kidney disease.

Materials and methods: A total of 74 patients with diabetic foot ulcer were enrolled, and VC was detected by X-ray and Doppler methods. Serum calcium, phosphate, alkaline phosphatase (ALKP), fasting and post-prandial glucose levels, and glycosylated hemoglobin (HbA1C) were recorded. Serum iPTH and 25 (OH) vitamin D were estimated by immune radiometric assay and radioimmunoassay, respectively. Data was analyzed by SPSS 16.0.

Results: Vascular calcification was present in 42% of patients. Significant difference in the mean (±SD) of vitamin D, HbA1C, and eGFR was observed in VC +ve compared to VC -ve. There was no significant association of age, duration, BMI, PTH, Ca, PO4, ALKP with that of VC incidence. Severe vitamin D deficiency was more common in VC +ve (51.6%) compared to in VC -ve (18.6%). Sub-group analysis showed that the risk of VC was significantly higher (RR = 2.4, P < 0.05, 95% C.I. = 0.058-2.88) in patients with vitamin D < 10 ng/ml compared to others.

Conclusion: Vitamin D deficiency could be a risk for vascular calcification, which possibly act through receptors on vascular smooth muscle cells or modulates osteoprotegerin/RANKL system like other factors responsible for VC in diabetic foot patients.

Keywords: Diabetic foot; calcium homeostasis; vascular calcification.

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Conflict of interest statement

Conflict of Interest: None declared

Figures

Figure 1
Figure 1
Distribution of diabetic foot patients with respect to their vitamin D status and presence of vascular calcification
See this image and copyright information in PMC

References

    1. Jeffcoate WJ, Rasmussen LM, Hofbauer LC, Game FL. Medial arterial calcification in diabetes and its relationship to neuropathy. Diabetologia. 2009;52:2478–88. - PubMed
    1. Hofbauer LC, Heufelder AE. Clinical review 114: Hot topic. The role of receptor activator of nuclear factor-kappaB ligand and osteoprotegerin in the pathogenesis and treatment of metabolic bone diseases. J Clin Endocrinol Metab. 2000;85:2355–63. - PubMed
    1. Hsu JJ, Tintut Y, Demer LL. Vitamin D and osteogenic differentiation in the artery wall. Clin J Am Soc Nephrol. 2008;3:1542–7. - PMC - PubMed
    1. Chonchol M, Cigolini M, Targher G. Association between 25-hydroxyvitamin D deficiency and cardiovascular disease in type 2 diabetic patients with mild kidney dysfunction. Nephrol Dial Transplant. 2008;23:269–74. - PubMed
    1. de Boer IH, Kestenbaum B, Shoben AB, Michos ED, Sarnak MJ, Siscovick DS. 25-hydroxyvitamin D levels inversely associate with risk for developing coronary artery calcification. J Am Soc Nephrol. 2009;20:1805–12. - PMC - PubMed