Vitamin D inadequacy in Belgian postmenopausal osteoporotic women

Audrey Neuprez, Olivier Bruyère, Julien Collette, Jean-Yves Reginster, Audrey Neuprez, Olivier Bruyère, Julien Collette, Jean-Yves Reginster

Abstract

Background: Inadequate serum vitamin D [25(OH)D] concentrations are associated with secondary hyperparathyroidism, increased bone turnover and bone loss, which increase fracture risk. The objective of this study is to assess the prevalence of inadequate serum 25(OH)D concentrations in postmenopausal Belgian women. Opinions with regard to the definition of vitamin D deficiency and adequate vitamin D status vary widely and there are no clear international agreements on what constitute adequate concentrations of vitamin D.

Methods: Assessment of 25-hydroxyvitamin D [25(OH)D] and parathyroid hormone was performed in 1195 Belgian postmenopausal women aged over 50 years. Main analysis has been performed in the whole study population and according to the previous use of vitamin D and calcium supplements. Four cut-offs of 25(OH)D inadequacy were fixed : < 80 nmol/L, <75 nmol/L, < 50 nmol/L and < 30 nmol/L.

Results: Mean (SD) age of the patients was 76.9 (7.5) years, body mass index was 25.7 (4.5) kg/m2. Concentrations of 25(OH)D were 52.5 (21.4) nmol/L. In the whole study population, the prevalence of 25(OH)D inadequacy was 91.3 %, 87.5 %, 43.1 % and 15.9% when considering cut-offs of 80, 75, 50 and 30 nmol/L, respectively. Women who used vitamin D supplements, alone or combined with calcium supplements, had higher concentrations of 25(OH)D than non-users. Significant inverse correlations were found between age/serum PTH and serum 25(OH)D (r = -0.23/r = -0.31) and also between age/serum PTH and femoral neck BMD (r = -0.29/r = -0.15). There is a significant positive relation between age and PTH (r = 0.16), serum 25(OH)D and femoral neck BMD (r = 0.07). (P < 0.05)Vitamin D concentrations varied with the season of sampling but did not reach statistical significance (P = 0.09).

Conclusion: This study points out a high prevalence of vitamin D inadequacy in Belgian postmenopausal osteoporotic women, even among subjects receiving vitamin D supplements.

Figures

Figure 1
Figure 1
Percentage of subjects having serum 25(OH)D concentration below various thresholds in the different groups stratified according to their type of supplementation.
Figure 2
Figure 2
Effect of age on prevalence of vitamin D inadequacy.
Figure 3
Figure 3
Plot of serum intact PTH concentrations versus serum 25(OH)D concentrations.
Figure 4
Figure 4
Adjusted mean serum parathyroid hormone values according to serum 25-hydroxyvitamin D values and age group.

References

    1. Assessment of fracture risk and its application to screening for postmenopausal osteoporosis. Report of a WHO Study Group. World Health Organ Tech Rep Ser. 1994;843:1–129.
    1. Norman AW. Sunlight, season, skin pigmentation, vitamin D, and 25-hydroxyvitamin D: integral components of the vitamin D endocrine system. Am J Clin Nutr. 1998;67:1108–1110.
    1. Heaney RP, Dowell MS, Hale CA, Bendich A. Calcium absorption varies within the reference range for serum 25-hydroxyvitamin D. J Am Coll Nutr. 2003;22:142–146.
    1. Holick MF. High prevalence of vitamin D inadequacy and implications for health. Mayo Clin Proc. 2006;81:353–373.
    1. Reginster JY. The high prevalence of inadequate serum vitamin D levels and implications for bone health. Curr Med Res Opin. 2005;21:579–586. doi: 10.1185/030079905X41435.
    1. Melton LJ, 3rd, Atkinson EJ, O'Fallon WM, Wahner HW, Riggs BL. Long-term fracture prediction by bone mineral assessed at different skeletal sites. J Bone Miner Res. 1993;8:1227–1233.
    1. Bischoff-Ferrari HA, Dietrich T, Orav EJ, Hu FB, Zhang Y, Karlson EW, Dawson-Hughes B. Higher 25-hydroxyvitamin D concentrations are associated with better lower-extremity function in both active and inactive persons aged > or =60 y. Am J Clin Nutr. 2004;80:752–758.
    1. Bischoff-Ferrari HA, Conzelmann M, Dick W, Theiler R, Stahelin HB. [Effect of vitamin D on muscle strength and relevance in regard to osteoporosis prevention] Z Rheumatol. 2003;62:518–521. doi: 10.1007/s00393-003-0561-4.
    1. Flicker L, Mead K, MacInnis RJ, Nowson C, Scherer S, Stein MS, Thomasx J, Hopper JL, Wark JD. Serum vitamin D and falls in older women in residential care in Australia. J Am Geriatr Soc. 2003;51:1533–1538. doi: 10.1046/j.1532-5415.2003.51510.x.
    1. MacLaughlin J, Holick MF. Aging decreases the capacity of human skin to produce vitamin D3. J Clin Invest. 1985;76:1536–1538.
    1. Holick MF, Matsuoka LY, Wortsman J. Age, vitamin D, and solar ultraviolet. Lancet. 1989;2:1104–1105. doi: 10.1016/S0140-6736(89)91124-0.
    1. Holick MF. Environmental factors that influence the cutaneous production of vitamin D. Am J Clin Nutr. 1995;61:638S–645S.
    1. Fassbender WJ, Stumpf UC, Jockenhovel F. [Pharmacotherapy of osteoporosis: evidence-based clinical practice] Med Klin (Munich) 2006;101 Suppl 1:173–177.
    1. Boonen S, Body JJ, Boutsen Y, Devogelaer JP, Goemaere S, Kaufman JM, Rozenberg S, Reginster JY. Evidence-based guidelines for the treatment of postmenopausal osteoporosis: a consensus document of the Belgian Bone Club. Osteoporos Int. 2005;16:239–254. doi: 10.1007/s00198-004-1812-1.
    1. Compston J. Guidelines for the management of osteoporosis: the present and the future. Osteoporos Int. 2005;16:1173–1176. doi: 10.1007/s00198-005-1894-4.
    1. Holick MF. The role of vitamin D for bone health and fracture prevention. Curr Osteoporos Rep. 2006;4:96–102.
    1. Holick MF. The use and interpretation of assays for vitamin D and its metabolites. J Nutr. 1990;120 Suppl 11:1464–1469.
    1. Holick MF. Evolution and function of vitamin D. Recent Results Cancer Res. 2003;164:3–28.
    1. Binkley N, Krueger D, Cowgill CS, Plum L, Lake E, Hansen KE, DeLuca HF, Drezner MK. Assay variation confounds the diagnosis of hypovitaminosis D: a call for standardization. J Clin Endocrinol Metab. 2004;89:3152–3157. doi: 10.1210/jc.2003-031979.
    1. Carter GD, Carter CR, Gunter E, Jones J, Jones G, Makin HL, Sufi S. Measurement of Vitamin D metabolites: an international perspective on methodology and clinical interpretation. J Steroid Biochem Mol Biol. 2004;89-90:467–471. doi: 10.1016/j.jsbmb.2004.03.055.
    1. Heaney RP. The Vitamin D requirement in health and disease. J Steroid Biochem Mol Biol. 2005;97:13–19. doi: 10.1016/j.jsbmb.2005.06.020.
    1. Dawson-Hughes B, Heaney RP, Holick MF, Lips P, Meunier PJ, Vieth R. Estimates of optimal vitamin D status. Osteoporos Int. 2005;16:713–716. doi: 10.1007/s00198-005-1867-7.
    1. Bischoff-Ferrari HA, Giovannucci E, Willett WC, Dietrich T, Dawson-Hughes B. Estimation of optimal serum concentrations of 25-hydroxyvitamin D for multiple health outcomes. Am J Clin Nutr. 2006;84:18–28.
    1. Chapuy MC, Preziosi P, Maamer M, Arnaud S, Galan P, Hercberg S, Meunier PJ. Prevalence of vitamin D insufficiency in an adult normal population. Osteoporos Int. 1997;7:439–443. doi: 10.1007/s001980050030.
    1. Muscarella S, Filabozzi P, D'Amico G, Mascia ML, Annese MA, Scillitani A, Carnevale V. Vitamin D status in inpatients admitted to an internal medicine department. Horm Res. 2006;66:216–220. doi: 10.1159/000094989.
    1. Lips P, Wiersinga A, van Ginkel FC, Jongen MJ, Netelenbos JC, Hackeng WH, Delmas PD, van der Vijgh WJ. The effect of vitamin D supplementation on vitamin D status and parathyroid function in elderly subjects. J Clin Endocrinol Metab. 1988;67:644–650.
    1. Souberbielle JC, Cormier C, Kindermans C, Gao P, Cantor T, Forette F, Baulieu EE. Vitamin D status and redefining serum parathyroid hormone reference range in the elderly. J Clin Endocrinol Metab. 2001;86:3086–3090. doi: 10.1210/jc.86.7.3086.
    1. Dixon T, Mitchell P, Beringer T, Gallacher S, Moniz C, Patel S, Pearson G, Ryan P. An overview of the prevalence of 25-hydroxy-vitamin D inadequacy amongst elderly patients with or without fragility fracture in the United Kingdom. Curr Med Res Opin. 2006;22:405–415. doi: 10.1185/030079906X89810.
    1. Gaugris S, Heaney RP, Boonen S, Kurth H, Bentkover JD, Sen SS. Vitamin D inadequacy among post-menopausal women: a systematic review. Qjm. 2005;98:667–676. doi: 10.1093/qjmed/hci096.
    1. Lamberg-Allardt CJ, Outila TA, Karkkainen MU, Rita HJ, Valsta LM. Vitamin D deficiency and bone health in healthy adults in Finland: could this be a concern in other parts of Europe? J Bone Miner Res. 2001;16:2066–2073. doi: 10.1359/jbmr.2001.16.11.2066.
    1. Lips P, Hosking D, Lippuner K, Norquist JM, Wehren L, Maalouf G, Ragi-Eis S, Chandler J. The prevalence of vitamin D inadequacy amongst women with osteoporosis: an international epidemiological investigation. J Intern Med. 2006;260:245–254. doi: 10.1111/j.1365-2796.2006.01685.x.
    1. Lips P, Duong T, Oleksik A, Black D, Cummings S, Cox D, Nickelsen T. A global study of vitamin D status and parathyroid function in postmenopausal women with osteoporosis: baseline data from the multiple outcomes of raloxifene evaluation clinical trial. J Clin Endocrinol Metab. 2001;86:1212–1221. doi: 10.1210/jc.86.3.1212.
    1. Reginster JY, Deroisy R, Pirenne H, Frederick I, Dewe W, Albert A, Collette J, Zheng SX, Gosset C. High prevalence of low femoral bone mineral density in elderly women living in nursing homes or community-dwelling: a plausible role of increased parathyroid hormone secretion. Osteoporos Int. 1999;9:121–128. doi: 10.1007/s001980050124.
    1. Bouillon R, Carmeliet G, Boonen S. Ageing and calcium metabolism. Baillieres Clin Endocrinol Metab. 1997;11:341–365. doi: 10.1016/S0950-351X(97)80332-1.
    1. Barragry JM, France MW, Corless D, Gupta SP, Switala S, Boucher BJ, Cohen RD. Intestinal cholecalciferol absorption in the elderly and in younger adults. Clin Sci Mol Med. 1978;55:213–220.
    1. Nordin BE, Need AG, Morris HA, O'Loughlin PD, Horowitz M. Effect of age on calcium absorption in postmenopausal women. Am J Clin Nutr. 2004;80:998–1002.
    1. Lips P. Vitamin D deficiency and secondary hyperparathyroidism in the elderly: consequences for bone loss and fractures and therapeutic implications. Endocr Rev. 2001;22:477–501. doi: 10.1210/er.22.4.477.
    1. Benhamou CL, Tourliere D, Asselin F. [Influence of aging on vitamin D metabolism] Rev Rhum Ed Fr. 1993;60:445–449.
    1. von Muhlen DG, Greendale GA, Garland CF, Wan L, Barrett-Connor E. Vitamin D, parathyroid hormone levels and bone mineral density in community-dwelling older women: the Rancho Bernardo Study. Osteoporos Int. 2005;16:1721–1726. doi: 10.1007/s00198-005-1910-8.
    1. Reginster JY, Frederick I, Deroisy R, Dewe W, Taquet AN, Albert A, Collette J, Pirenne H, Zheng SX, Gosset C. Parathyroid hormone plasma concentrations in response to low 25-OH vitamin D circulating levels increases with age in elderly women. Osteoporos Int. 1998;8:390–392. doi: 10.1007/s001980050080.
    1. Malavolta N, Pratelli L, Frigato M, Mule R, Mascia ML, Gnudi S. The relationship of vitamin D status to bone mineral density in an Italian population of postmenopausal women. Osteoporos Int. 2005;16:1691–1697. doi: 10.1007/s00198-005-1883-7.
    1. Bischoff-Ferrari HA, Dietrich T, Orav EJ, Dawson-Hughes B. Positive association between 25-hydroxy vitamin D levels and bone mineral density: a population-based study of younger and older adults. Am J Med. 2004;116:634–639. doi: 10.1016/j.amjmed.2003.12.029.
    1. Sigurdsson G, Franzson L, Steingrimsdottir L, Sigvaldason H. The association between parathyroid hormone, vitamin D and bone mineral density in 70-year-old Icelandic women. Osteoporos Int. 2000;11:1031–1035. doi: 10.1007/s001980070024.
    1. Bhattoa HP, Bettembuk P, Ganacharya S, Balogh A. Prevalence and seasonal variation of hypovitaminosis D and its relationship to bone metabolism in community dwelling postmenopausal Hungarian women. Osteoporos Int. 2004;15:447–451. doi: 10.1007/s00198-003-1566-1.
    1. Avenell A, Gillespie WJ, Gillespie LD, O'Connell DL. Vitamin D and vitamin D analogues for preventing fractures associated with involutional and post-menopausal osteoporosis. Cochrane Database Syst Rev. 2005:CD000227.
    1. Dawson-Hughes B, Harris SS, Krall EA, Dallal GE. Effect of calcium and vitamin D supplementation on bone density in men and women 65 years of age or older. N Engl J Med. 1997;337:670–676. doi: 10.1056/NEJM199709043371003.
    1. Bischoff-Ferrari HA, Dawson-Hughes B, Willett WC, Staehelin HB, Bazemore MG, Zee RY, Wong JB. Effect of Vitamin D on falls: a meta-analysis. Jama. 2004;291:1999–2006. doi: 10.1001/jama.291.16.1999.
    1. Bischoff-Ferrari HA, Willett WC, Wong JB, Giovannucci E, Dietrich T, Dawson-Hughes B. Fracture prevention with vitamin D supplementation: a meta-analysis of randomized controlled trials. Jama. 2005;293:2257–2264. doi: 10.1001/jama.293.18.2257.
    1. Di Daniele N, Carbonelli MG, Candeloro N, Iacopino L, De Lorenzo A, Andreoli A. Effect of supplementation of calcium and vitamin D on bone mineral density and bone mineral content in peri- and post-menopause women; a double-blind, randomized, controlled trial. Pharmacol Res. 2004;50:637–641.
    1. Chapuy MC, Arlot ME, Duboeuf F, Brun J, Crouzet B, Arnaud S, Delmas PD, Meunier PJ. Vitamin D3 and calcium to prevent hip fractures in the elderly women. N Engl J Med. 1992;327:1637–1642.
    1. Prince RL, Devine A, Dhaliwal SS, Dick IM. Effects of calcium supplementation on clinical fracture and bone structure: results of a 5-year, double-blind, placebo-controlled trial in elderly women. Arch Intern Med. 2006;166:869–875. doi: 10.1001/archinte.166.8.869.
    1. Jackson RD, LaCroix AZ, Gass M, Wallace RB, Robbins J, Lewis CE, Bassford T, Beresford SA, Black HR, Blanchette P, Bonds DE, Brunner RL, Brzyski RG, Caan B, Cauley JA, Chlebowski RT, Cummings SR, Granek I, Hays J, Heiss G, Hendrix SL, Howard BV, Hsia J, Hubbell FA, Johnson KC, Judd H, Kotchen JM, Kuller LH, Langer RD, Lasser NL, Limacher MC, Ludlam S, Manson JE, Margolis KL, McGowan J, Ockene JK, O'Sullivan MJ, Phillips L, Prentice RL, Sarto GE, Stefanick ML, Van Horn L, Wactawski-Wende J, Whitlock E, Anderson GL, Assaf AR, Barad D. Calcium plus vitamin D supplementation and the risk of fractures. N Engl J Med. 2006;354:669–683. doi: 10.1056/NEJMoa055218.
    1. Boonen S, Bischoff-Ferrari HA, Cooper C, Lips P, Ljunggren O, Meunier PJ, Reginster JY. Addressing the musculoskeletal components of fracture risk with calcium and vitamin D: a review of the evidence. Calcif Tissue Int. 2006;78:257–270. doi: 10.1007/s00223-005-0009-8.
    1. Okuizumi H, Harada A. [Effect of vitamin D on bone mineral density; bone strength and fracture prevention] Clin Calcium. 2006;16:31–37.
    1. Hayashi Y. [Active vitamin D metabolite and prevention of falls] Clin Calcium. 2005;15:655–660.

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