The influence of vitamin D on handgrip strength in elderly trauma patients

After exclusion of all unsuitable patients, a total of 94 (62 females, 32 males) patients remained. In this study, the enrolled patients had a mean age of 78.5 (± 8.6) years. Detailed demographic data and patients` characteristics are displayed in Table 1. There was no significant influence on the outcomes by type of attendance (inpatients or outpatients), treatment method (operation or conservative), length of stay or possible ICU treatment. The means of patients` age, VDC and HGS are shown in Table 2.

Table 1 Demographic data and patients` characteristicsTable 2 Mean, standard deviation (SD) and 95% confidence interval (CI) of age, serum vitamin D concentration (VDC) and handgrip strength (HGS) in 94 included elderly trauma patientsInfluence of age and sex on HGS and VDC

A clear influence on the HGS was found for age and sex. Men has a significant higher HGS than women (meanmale = 27.31 kg, meanfemale = 15.62 kg, p < 0.001). The higher the age of the patients, the lesser the HGS (βage = − 0.58, p < 0.001). In addition, the VDC was significantly influenced by sex (meanmale = 20.19 ng/ml, meanfemale = 28.34 ng/ml, p < 0.008), but not to the age of the patients.

HGS and VDC

In total, a significant negative correlation was found between the HGS and the VDC (βVDC = − 0.27, pVDC = 0.008). The higher the VDC, the lower the HGS and vice versa (Fig. 1). This relationship becomes even more clear when adjusted for age (pVDC = 0.004).

Fig. 1figure 1

Handgrip strength (HGS) and serum 25-hydroxy-vitamin-D concentration (VDC) in 62 female and 32 male elderly traumatological patients; added fitted regression model lines with 95% confidence region (gray)

However, when sex is added as cofounder, the correlation between HGS and VDC is not significant (pVDC = 0.08). Furthermore, there is no correlation if separately analyzed in sex-specific subgroups, neither in men (βHGS = − 0.08, pVDC = 0.49) nor in women (βHGS = − 0.06, pVDC = 0.20).

Influence of vitamin D substitution

Under vitamin D substitution were 54.8% of the included women, compared to 31.3% of the male patients. Substituted patients had a significant higher VDC than non-substituted patients (meanfemale_vit_d_substituted = 37.15 ng/ml, meanfemale_not_vit_d_substituted = 17.65 ng/ml, pfemale < 0.001; meanmale_vit_d_substituted = 30.21 ng/ml, meanmale_not_vit_d_substituted = 15.63 ng/ml, pmale < 0.0013) (Fig. 2). The percentage increase in the VDC in substituted individuals compared to the VDC in non-substituted individuals was about the same in men, women and the overall sample (+ 93%, + 110%, + 112%).

Fig. 2figure 2

Serum 25-hydroxy-vitamin-D concentration (VDC) in vitamin D substituted and not substituted women and men in 94 elderly traumatological patients; box goes from 25 to 75th percentiles of the data, median = line, mean = diamond

As mentioned above, women in this study had a higher VDC. Considering that they also had a higher percentage of substituted individuals, there were no statistically significant differences in the VDC between men and women when analyzed in substitution- or non-substitution subgroups (meanvit_d_substituted_males = 30.21 ng/ml, meanvit_d_substituted_females = 37.15 ng/ml; meannot_vit_d_substituted_males = 15.63 ng/ml, meannot_vit_d_substituted_females = 17.65 ng/ml). Furthermore, a notable lower HGS was found in the substituted group compared to the non-substituted patients (meanvit_d_substituted = 17.43 kg, meannot_vit_d_substituted = 21.52 kg, p < 0.02). This finding persists when adjusted for age (βsubstitution_yes/no = − 0.23, βage = − 0.57, psubstitution_yes/no < 0.006), but is not significant anymore when sex is included (p < 0.08).

When taking a closer look at the non-substitution group, there is no significant correlation between HGS and VDC, even if adjusted to age and/or sex. Whereas the results in the substitution group are similar to the ones in the complete sample: In this group, HGS and VDC have a negative relationship (βVDC = − 0.35, p = 0.02), which still remains significant if adjusted by age (βVDC = -0.69, βage = − 0.50, pVDC < 0.04), but not if sex is added or the correlation is analyzed separately in women and men, respectively.

Influence of functional variables on HGS

This study found a statistically significant negative relationship between the HGS and a history of multiple falls (meanfalls = 15.76 kg (± 6.49), meanno_falls = 21.23 kg (± 8.88), p < 0.004) (Fig. 3A) or frequent stumbling (meanstumbling = 15.43 kg (± 5.61), meanno_stumbling = 20.80 kg (± 8.94), p < 0.01) (Fig. 3B) in the last 12 months.

Fig. 3figure 3

Handgrip strength (HGS) in patient cohorts with frequent falls (A), stumbling (B) or dizziness (C) in 94 elderly trauma patients and HGS in patients with early and late onset of menopause in 59 female elderly traumatological patients (D); box goes from 25 to 75th percentiles of the data, median = line, mean = diamond

Likewise, the HGS was less if the patients reported frequent dizziness (meandizziness = 16.55 kg (± 5.89), meanno_dizziness = 20.83 kg (± 9.21), p < 0.009) (Fig. 3C), especially among the male patients (meanmale_dizziness = 20.46 kg (± 3.98), meanmale_no_dizziness = 31.43 kg (± 7.12), p < 0.001).

Besides, a weak but nevertheless significant negative correlation between the HGS and the age at onset of menopause was found (βmenopause = − 0.26, pmenopause < 0.04). If separated into groups depending on the reported age at onset of menopause (meanage_at_menopause = 48.9 y (± 6.0)), patients who got an earlier menopause (before 50 years of age), had a notable higher HGS (meanmenopause_before_50 = 18.23 kg (± 5.73), meanmenopause_≥50 = 14.06 kg (± 4.78), p < 0.004) (Fig. 3D).

The more anxious and depressed the patients felt in the moment of measurement, recorded by the EQ-5D-5L, the lower their HGS was (βanxiety+depression = − 0.26, panxiety+depression < 0.01) (Fig. 4). A clear tendency can be seen not only for the depression item, but also for all others. The poorer values in EQ-5D-5L are associated with reduced HGS. This effect becomes even more obvious if adjusted by age and sex (βanxiety+depression = − 0.18, βage = − 0.48, βsex = 0.50, panxiety+depression < 0.008).

Fig. 4figure 4

Handgrip strength (HGS) in the different EQ-5D5L values for 92 elderly trauma patients; box goes from 25 to 75th percentiles of the data, median = line, mean = diamond

Analysis of other additional information collected on subjects' demographic and medical data, their past and present physical activity, daily living skills, and leisure-time activities, measured with Barthel Index, Parker Mobility Score, Short Physical Performance Battery, SARC-F did not reveal any new significant associations (See also: Additional file 1: Figs. S1 and S2).

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