Abstract
Background: Complications of non-traumatic fractures and osteoporosis, which reduce mobility and
quality of life, should not be ignored in patients with neurological impairment (NI).
Aim: To diagnose osteoporosis in adult patients with NI, a readily available and easily obtained index,
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
between August 2020 and June 2022. Patient data regarding (1) patient information, (2) blood data, including
the prognostic nutrition index (PNI), which predicts outcomes of various diseases, (3) body composition, (4)
T-score by BMD, (5) nutritional measures, and (6) outcome measures were collected. Enrolled patients were
divided into two groups, with or without osteoporosis, according to their T-score. The data were analyzed by
three methods: (1) comparison of all collected data between the two groups to analyze the factors influencing
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
Vitamin D insufficiency (71% vs. 31%, P = 0.031). PNI was the strongest influencing factor, and its
cutoff value for osteoporosis was 50.
Conclusion: The PNI is the strongest determinant of osteoporosis in patients with NI. Therefore, PNI
can potentially be used as a surrogate for BMD instead of serum Vitamin D levels in institutionalized
and homebound patients who do not have BMD measurement devices.
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.
DOI: https://doi.org/10.36922/jctr.00110
Author affiliation
1. Administration Food Sciences and Nutrition Major (Doctoral Program), Graduate School of Human Environmental Sciences, Mukogawa Women’s
University, Hyogo, Japan
2. Department of Clinical Nutrition, Kitauwa Hospital, Ehime, Japan
3. Department of Clinical Nutrition, Kindai University
Hospital, Osaka, Japan
4. Department of Clinical Nutrition, Takarazuka Dai-Ichi Hospital, Hyogo, Japan
5. Department of Pediatrics, Asahigawasou South
Ehime Hospital, Ehime, Japan
6. Department of Clinical Engineering, Faculty of Health Sciences, Jikei University of Health Care Sciences, Osaka, Japan
*Corresponding author:
Teruyoshi Amagai
Department of Clinical Engineering, Faculty
of Health Sciences, Jikei University of Health
Care Sciences, Osaka, Japan
Email: amagait@yahoo.co.jp
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