title: Evidence for vitamin D deficiency and increased prevalence of fractures in autoimmune bullous skin diseases.
abstract: BACKGROUND
  Vitamin D deficiency plays a role in autoimmune diseases and risk of fractures. No data are available on vitamin D levels and vertebral fractures in autoimmune bullous skin diseases.
  
  
  OBJECTIVE
  To assess serum vitamin D levels and the prevalence of vertebral fractures in patients with pemphigus vulgaris (PV) and bullous pemphigoid (BP), potentially fatal autoimmune bullous disorders.
  
  
  METHODS
  We studied 13 consecutive inpatients with untreated active PV (six men and seven women, mean ± SD age 53·5 ± 14·3 years), 15 with BP (seven men and eight women, mean ± SD age 76·9 ± 12·4 years) and 28 age-, body mass index- and sex-matched controls. The 25-hydroxyvitamin D (25-OHD) levels and presence of vertebral fractures on spinal X-ray were assessed in all subjects.
  
  
  RESULTS
  In patients with PV, 25-OHD levels were lower (mean ± SD 12 ± 4·4 ng mL(-1) ) and prevalence of severe hypovitaminosis D higher (62%) than in controls (mean ± SD 22·2 ± 11·7 ng mL(-1) , P = 0·012; 23%, P = 0·0047, respectively). The prevalence of fractures was 54% and 31% in patients with PV and controls, respectively. Patients with BP showed lower 25-OHD levels (mean ± SD 9·6 ± 7·2 ng mL(-1) ) and higher prevalence of severe hypovitaminosis D (73%) than controls (mean ± SD 22·6 ± 18·7 ng mL(-1) , P = 0·022; 27%, P = 0·01, respectively). The prevalence of fractures tended to be higher in patients with BP than in controls (67% vs. 33%, respectively, P = 0·068).
  
  
  CONCLUSIONS
  The low 25-OHD levels found in PV and BP may suggest a role for this agent in their pathogenesis. The increased prevalence of fractures should be taken into consideration in patients who must be given corticosteroids.
authors.affiliation: Unità Operativa di Dermatologia, Dipartimento di Anestesiologia, Terapia Intensiva e Scienze Dermatologiche, Università degli Studi di Milano - IRCCS Ca' Granda - Ospedale Maggiore Policlinico, via Pace 9, 20122 Milan, Italy. angelovalerio.marzano@policlinico.mi.it
authors.forename: A V
authors.initials: AV
authors.lastname: Marzano
authors.forename: V
authors.initials: V
authors.lastname: Trevisan
authors.forename: C
authors.initials: C
authors.lastname: Eller-Vainicher
authors.forename: E
authors.initials: E
authors.lastname: Cairoli
authors.forename: L
authors.initials: L
authors.lastname: Marchese
authors.forename: V
authors.initials: V
authors.lastname: Morelli
authors.forename: P
authors.initials: P
authors.lastname: Beck-Peccoz
authors.forename: C
authors.initials: C
authors.lastname: Crosti
authors.forename: I
authors.initials: I
authors.lastname: Chiodini
mesh_terms: D015502:Absorptiometry, Photon; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015519:Bone Density / Q000502:physiology; D016022:Case-Control Studies; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010391:Pemphigoid, Bullous / Q000150:complications* / Q000503:physiopathology; D012307:Risk Factors; D016103:Spinal Fractures / Q000209:etiology* / Q000503:physiopathology; D014807:Vitamin D / Q000031:analogs & derivatives / Q000097:blood; D014808:Vitamin D Deficiency / Q000150:complications* / Q000503:physiopathology
chemical_list: D014807:Vitamin D; C104450:25-hydroxyvitamin D