الفهرس 
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Abstract
Osteoporosis is a metabolic bone disorder characterized by decreased bone mass, enhanced bone fragility, and increased susceptibility to bone fractures.
The discovery of the receptor activator of nuclear factor Κb (RANK) ligand (RANKL) pathway, a transmembrane protein belonging to the tumour necrosis factor (TNF) superfamily, and its inhibition by osteoprotogerin (OPG) has had important implications for bone physiology as well as inflammation research.
Aging, even in healthy elderly people, is accompanied by a reduction in muscle mass and muscle strength. The gradual loss of muscle strength results in functional impairment the need for assistance in the performance of daily activities and an increased risk of falling and non vertebral fractures.
Vitamin D metabolites have been found to affect muscle metabolism.
Older people are prone to develop vitamin D deficiency.
Muscle weakness due to vitamin D deficiency is predominantly of the proximal muscle groups.
In the absence of adequate dietary calcium, vitamin D will mobilize skeletal stores of calcium and phosphorus to ensure serum levels are maintained, at the expense of bone health.
Functional limitations such as inability to perform activities of daily living (ADLs) and problems with mobility may indicate an increased fall risk.
Falls are often the cause of hip fracture, which may result in death, morbidity, and admission to a nursing home. Clearly muscle strength, in particular lower extremity muscle strength, should be one of the factors assessed and treated in older persons at risk for falls.
A scientifically-based standardized locomotor assessment should be an essential part of a medical examination in research and clinical practice.
The aim of the work is to study the relation between 25 hydroxyvitamin D blood level and musculoskeletal frailty in the elderly with accidental falls.
The present work included 100 individuals divided into2 groups:
Group I: 50 elderly individuals subjected to accidental falls.
Group II: 50 elderly individuals with no history of accidental falls.
All patients and control group were subjected to:
1. Thorough history taking Complete physical examination with stress on:
a. Nutritional states by mini nutritional assessment.
b. Cognitive assessment by mini mental status examination (MMSE).
c. Diagnosis of depression by geriatric depression scale (GDS).
d. Locomotor assessment:
- Self-selected gait velocity.
- Chair rise test.
- Tandem standing and tandem walking.
- Timed up and go test.
- Clinical gait analysis.
2. Laboratory investigations:
a. Serum calcium level.
b. Serum phosphorus level.
c. Serum Parathormone level.
d. 25-hydroxyvitamin D level.
e. Serum osteoprotogerin.
3. Bone Mineral Density.
The Gender in group (I) 30 (60%) male while 20(40%) female while in group (II) 41 (81%) male while 9(19%) female and there was statistically significant difference between the two studied groups regarding the gender (P = 0.027) where (p < 0.05).
The Dietary Habits in group (I) 28(56%) decrease and 22(44%) N while in group (II) there was no decrease patient and 50(100%) N and there was statistically significant difference between the two studied groups regarding the Dietary Habits (P = 0.000) where (p < 0.05).
The Sun exposure in group (I) 17(34%) Negative and 33(66%) positive while in group (II) 3(6%) negative and 47(94%) positive and there was statistically significant difference between the two studied groups regarding the sun exposure (P = 0.001) where (p < 0.05).
The mean minimental assessment of patients in group (I) was 26.66±2.745; minimental assessment ranged between (18 – 31) while the mean minimental assessment in the group (II) was 27.38±3.458, minimental assessment ranges between (18 – 32 ) and there was no statistically significant difference between the two studied groups regarding the minimental assessment (P = 0.084) where (p ˃ 0.05).
The mean mininutritional assessment of patients in group (I) was 20.92±3.174; mininutritional assessment ranged between (14 – 26) while the mean mininutritional assessment in the group (II) was 22.88±3.342, mininutritional assessment ranges between (17 – 29 ) and there was statistically significant difference between the two studied groups regarding the mininutritional assessment (P = 0.002) where (p < 0.05).
The mean geriatric depression score of patients in group (I) was 5.44±2.287; geriatric depression score ranged between (0 – 9) while the mean geriatric depression score in the group (II) was 5.76±2.638, geriatric depression score ranges between (0-9) and there was no statistically significant difference between the two studied groups regarding the geriatric depression score (P = 0.348) where (p < 0.05).
The mean Walking Speed of patients in group (I) was 0.798±0.2095 m/sec; Walking Speed ranged between (0.4 – 1.2 m/sec) while the mean Walking Speed in the group (II) was 1.208±0.1469 m/sec, Walking Speed ranges between (1 – 1.5 m/sec) and there was statistically significant difference between the two studied groups regarding the Walking Speed (P = 0.000) where (p < 0.05).
The mean Timed up and go of patients in group (I) was 18.98±3.951 sec Timed up and go ranged between (11 – 26 sec) while the mean Timed up and go in the group (II) was 12.88±3.293 sec, Timed up and go ranges between (9 – 22 sec) and there was statistically significant difference between the two studied groups regarding the Timed up and go (P = 0.000) where (p < 0.05).
The mean Chair rise test of patients in group (I) was 18.14±3.785 sec CRT ranged between (11 – 26 sec) while the mean CRT in the group (II) was 12.18±1.935 sec, CRT ranges between (8 – 16 sec) and there was statistically significant difference between the two studied groups regarding the CRT (P = 0.000) where (p < 0.05).
The Tandam stand in group (I)14(28%) N and 36(72%) Awhile in group (II) 38(76%) N and 12(24%) A and there was statistically significant difference between the two studied groups regarding the Tandam stand(P = 0.000) where (p < 0.05).
The mean dynamic gait index of patients in group (I) was 12.20±3.499 ; DGI ranged between (6 – 22 ) while the mean DGI in the group (II) was 18.78±3.787 , DGI ranges between (11 – 24 ) and there was statistically significant difference between the two studied groups regarding the DGI (P = 0.000) where (p < 0.05).
The mean serum Ca of patients in group (I) was 7.214±0.8631 mg/dl; Ca ranged between (6 – 9 mg/dl) while the mean Ca in the group (II) was 9.948±0.6541 mg/dl, Ca ranges between (9 – 11 mg/dl) and there was statistically significant difference between the two studied groups regarding the Ca (P = 0.000) where (p < 0.05).
The mean serum P of patients in group (I) was 8.070±0.6993 mg/dl; P ranged between (7 –9 mg/dl) while the mean P in the group (II) was 3.504±0.5771 mg/dl, P ranges between (2.5 – 4.5 mg/dl) and there was statistically significant difference between the two studied groups regarding the P (P = 0.000) where (p < 0.05).
The mean Vit D of patients in group (I) was 21.42±4.495 pg/ml; Vit D ranged between (11 –29 pg/ml) while the mean Vit D in the group (II) was 23.62±4.607 m/dl, Vit D ranges between (11 – 30 pg/ml) and there was statistically significant difference between the two studied groups regarding to the Vit D (P = 0.014) where (p < 0.05).
The mean Parathormone of patients in group (I) was 48.18±18.889 pg/ml; Parathormone ranged between (18 – 113 pg\ml) while the mean Parathormone in the group (II) was 45.36±13.605 pg/ml, Parathormone ranges between (18 – 70 pg/ml) and there was statistically significant difference between the two studied groups regarding to the Parathormone (P = 0.023) where (p < 0.05).
The mean OPG of patients in group (I) was 4.542±0.4786 pmol/l; OPG ranged between (3.8 – 5.6 pmoi/l) while the mean OPG in the group (II) was 4.884±0.6132 pmol /l, OPG ranges between (3.8 – 5.9 pmol/l) and there was statistically significant difference between the two studied groups regarding to the OPG (P = 0.006) where (p < 0.05).
The mean BMD of patients in group (I) was -2.030±0.5571; BMD ranged between
(-3 – -1) while the mean BMD in the group (II) was 0.760±0.9105, BMD ranges between (-1.5 – 2) and there was statistically significant difference between the two studied groups regarding the BMD (P = 0.000) where (p < 0.05).