Vitamin D and bone health in the elderly

Relationship between serum carotenoids and osteoarthritis or degenerative arthritis: A cross-sectional study using the National Health and Nutrition Examination Survey

BACKGROUND

Carotenoids possess essential antioxidant and anti-inflammatory properties; however, the relationships between carotenoids and osteoarthritis or degenerative arthritis (OA) remain inadequately understood. This study aimed to investigate the correlation between diverse serum carotenoid concentrations and OA in a large American cohort and to examine the influence of various factors on the association between carotenoids and OA.

METHODS

Data from the 2001-2006 and 2017-2018 National Health and Nutrition Examination Surveys were utilized. In our analysis, we utilized a directed acyclic graph to identify potential confounding variables. The associations between serum carotenoids (including total carotenoid, trans-lycopene, β-cryptoxanthin, lutein/zeaxanthin, α-carotene, and β-carotene) and OA were comprehensively evaluated via a weighted generalized linear model (GLM) and restricted cubic spline models. Threshold effect analyses were used to identify potential cutoff points, subgroup analyses were used to explore heterogeneity, interaction analyses were used to examine potential modifiers, and sensitivity analyses were used to validate the robustness of the findings.

RESULTS

The weighted GLM results revealed that, overall, the concentrations of various serum carotenoids did not exhibit a significant linear correlation with the probability of OA. Dose‒response curves and threshold effect analysis revealed a significant nonlinear relationship (P for overall = 0.027; P for nonlinearity = 0.019; P for likelihood ratio = 0.0128) between trans-lycopene (threshold effect) and OA, with an inflection point at 19.49 µg/dl. Further subgroup weighted linear regression analysis indicated that when the serum trans-lycopene concentration exceeded 19.49 µg/dl, there was a significant association [odds ratio (OR) = 0.89 (0.80-0.99); P = 0.027] between the per standard deviation trans-lycopene increase and a lower probability of OA after adjusting for other variables. Moreover, individuals with elevated trans-lycopene [0.70 (0.52-0.94); P = 0.018] in the fifth quintile had notably reduced odds of OA compared with those in the first quintile. When the trans-lycopene level is less than 19.49 µg/dl, no correlation exists between the two variables. Linear subgroup and interaction analyses revealed that when the concentration of carotenoids exceeded 19.49 µg/dl, various categorical factors did not significantly influence the relationship between trans-lycopene and OA overall. However, pairwise comparisons revealed that lower serum trans-lycopene concentrations are more closely associated with a greater probability of OA in elderly individuals [OR (95% CI) = 0.270 (0.112-0.654); P = 0.005; P for trend = 0.003] than in younger individuals [0.973 (0.385-2.463); P = 0.954; P for trend = 0.61] (P for interaction = 0.007).

CONCLUSIONS

In the American population, trans-lycopene rather than other types of carotenoids may exhibit a significantly negative correlation with OA, displaying a nonlinear pattern with a threshold point of approximately 19.49 µg/dl. This relationship may become more pronounced with increasing age.

Comparison of the Serum Total 25-Hydroxyvitamin D Concentrations Using Chemiluminescent Immunoassay and Liquid Chromatography-Tandem Mass Spectrometry in Children

We aimed to assess the difference and agreement between the CL-series Vitamin D Total assay (Mindray), which was a kind of chemiluminescent immunoassay (CLIA) and liquid chromatography-tandem mass spectrometry (LC-MS/MS) in the measurement of serum 25-hydroxyvitamin D [25(OH)D] concentrations in children. We compared the 25(OH)D concentrations of 92 children using the CLIA and LC-MS/MS. Paired samples t-test was used to compare the two groups. Linear regression was used to show the correlation between CLIA and LC-MS/MS. The difference and bias between 2 methods were revealed in Bland-Altman plot. Agreement in classification of deficiency between CLIA and LC-MS/MS was assessed using Cohen's Kappa. p value<0.05 was considered statistically significant. Using Shapiro-Wilk Test to assess whether the data follows a normal distribution. Using 95% children's serum 25(OH)D concentrations by LC-MS/MS as the reference interval. The regression equation was CLIA=1.185×LC-MS/MS-3.328. The fitness adjusted r² was 0.589. The CLIA showed positive bias compared to LC-MS/MS, p<0.05, bias=(1.94±16.56) ng/mL. Cohen's Kappa=0.53, p<0.001. The agreement of 2 methods in diagnosing "deficiency" was good. According to Shapiro-Wilk Test, the data followed a normal distribution (W=0.99). The reference interval of children's serum 25(OH)D concentrations by LC-MS/MS was 11.35-44.57 ng/mL. In measuring 25(OH)D concentration of children, CLIA represented higher levels than LC-MS/MS. The two methods were consistent in diagnosing vitamin D deficiency. The reference interval of children's serum 25(OH)D concentrations by LC-MS/MS was 11.35-44.57 ng/mL in our area in summer.

Joint Associations between Plasma 25-Hydroxyvitamin D, Glycemic Status, and First Stroke in General Hypertensive Adults: Results from the China Stroke Primary Prevention Trial (CSPPT)

BACKGROUND

Associations between vitamin D and stroke remain inconsistent. One major risk factor for stroke is high blood glucose, but the role it plays in this association is not well studied.

OBJECTIVES

We aimed to evaluate the individual association between plasma 25-hydroxyvitamin D [25(OH)D] and risk of first stroke stratified by fasting blood glucose (FBG), and the joint associations between plasma 25(OH)D, glycemic status, and first stroke in hypertensive adults.

METHODS

This study was a nested, case-control design utilizing data from the China Stroke Primary Prevention Trial (CSPPT). This analysis included 591 first stroke cases (of which 475 were ischemic stroke, 114 were hemorrhagic stroke, and 2 were uncertain type) and 591 matched controls. The age range of the study population was 45-75 y. The normal FBG (NFG) group had FBG <5.6 mmol/L,  and the impaired FBG (IFG) group had FBG ≥5.6 mmol/L and <7.0 mmol/L. Diabetes was defined as participants with FBG ≥7 mmol/L or who were receiving treatment with hypoglycemic agents. ORs (95% CIs) were calculated using unconditional logistic regression models.

RESULTS

Multivariable adjusted models revealed an inverse association between quartiles of 25(OH)D and risk of first stroke among participants with NFG, but the opposite trend was observed for those with IFG or diabetes. The largest ORs (>2) were observed among patients with diabetes, compared with the reference group of NFG and high 25(OH)D. Those with NFG and low 25(OH)D (OR = 1.73, 95% CI: 1.22 to 2.44) or those with IFG and high 25(OH)D (OR = 1.74, 95% CI: 1.14 to 2.67) both had a higher risk of total stroke. There was a significant interaction between 25(OH)D and a combined group of IFG and diabetes (P = 0.001). Similar results were observed for ischemic stroke.

CONCLUSIONS

In a hypertensive population, the relation between plasma 25(OH)D and risk of first stroke was significantly modified by FBG. This trial was registered at https://www.clinicaltrials.gov as NCT00794885.

Prevalence and Predictors of Vitamin D Inadequacy: A Sample of 2,547 Patients in a Mediterranean Country

Background The aim of this retrospective study was to identify prevalence and risk factors for vitamin D inadequacy in a sunny Mediterranean country. Methods Results of 2,547 patients aged 19 to >60 years were included in this study. Data were derived from the laboratory database at Rafik Hariri University Hospital, Beirut, Lebanon, over a period of two years (2016-2017). Data included patient's age, gender, date of test, and vitamin D level. Females were questioned through phone call for marital status, parity, and veiling. Results The prevalence of vitamin D inadequacy was 83.5% overall, 86.4% in males, and 82.3% in females. At a cut-off of 20 ng/mL, vitamin D deficiency affected 63% of the studied population. A significant association was observed between vitamin D and age. The highest prevalence (71.2%) was found in females in the age group of 19-39 years, while no significant correlation with age was observed in males. Vitamin D levels were lower in veiled women (mean 25(OH)D = 17.9 ng/mL) compared to non-veiled women, although this difference was not significant. In addition, vitamin D inadequacy does not show a significant association with gender, parity, marital status, and season of the year. Conclusion The high prevalence of vitamin D inadequacy in our study in both males and females of all age groups calls for urgent actions at the national level to increase awareness in the population and to prevent the serious complications of vitamin D deficiency in all patients, especially those who are at a high risk.

Associations Between Vitamins C and D Intake and Cartilage Composition and Knee Joint Morphology Over 4 Years: Data From the Osteoarthritis Initiative

OBJECTIVE

To determine the cross-sectional and longitudinal associations of vitamin C and D intake with magnetic resonance imaging (MRI) measures of cartilage composition (T2) and joint structure (cartilage, meniscus, and bone marrow) using data from the Osteoarthritis Initiative (OAI) cohort.

METHODS

A total of 1,785 subjects with radiographic Kellgren/Lawrence knee grades 0-3 in the right knee were selected from the OAI database. Vitamins C and vitamin D intake (diet, supplements, and total) were assessed using the Block Brief 2000 Food Frequency Questionnaire at baseline. The MRI analysis protocol included 3T cartilage T2 quantification and semiquantitative joint morphology gradings (Whole-Organ Magnetic Resonance Imaging Score [WORMS]) at baseline and 4 years. Linear regression was used to assess the association between standardized baseline vitamin intake and both baseline WORMS scores and standardized cartilage T2 values.

RESULTS

Higher vitamin C intake was associated with lower average cartilage T2 values, medial tibia T2 values, and medial tibia WORMS scores (standardized coefficient range -0.07 to -0.05, P < 0.05). Higher vitamin D intake was associated with a lower cartilage WORMS sum score and medial femur WORMS score (standardized coefficient range -0.24 to -0.09, P < 0.05). Consistent use of vitamin D supplements of 400 IU at least once a week over 4 years was associated with significantly less worsening of cartilage, meniscus, and bone marrow abnormalities (odds ratio range 0.40-0.56, P < 0.05).

CONCLUSION

Supplementation with vitamin D over 4 years was associated with significantly less progression of knee joint abnormalities. Given the observational nature of this study, future longitudinal randomized controlled trials of vitamin D supplementation are warranted.

Low serum 25-hydroxyvitamin D is associated with low grip strength in an older Japanese population

Positive associations between vitamin D levels and hand grip strength have been reported worldwide, but the results are not consistent and few studies on East Asian populations have been published. The aim of this study was to determine whether such an association is present in a community-dwelling Japanese population, including elderly and middle-aged individuals. This study used a cross-sectional design. Participants were 492 community-dwelling individuals aged ≥ 40 years living in Yuzawa Town, Japan. The health check examination was conducted in 2015, and serum 25-hydroxyvitamin D [25(OH)D, an index of vitamin D levels], and hand grip strength were measured. Covariates were serum albumin concentration, body mass index, and physical activity level. The associations of serum 25(OH)D concentrations with hand grip strength and low grip strength (< 26 kg for men and < 18 kg for women) were analyzed using analysis of covariance and multiple logistic regression. Mean (standard deviation) age and serum 25(OH)D were 75.4 (9.0) years and 30.9 (9.1) ng/mL, respectively. The prevalence of serum 25(OH)D < 20, 20-29, and ≥ 30 ng/mL was 7.3%, 37.8%, and 54.9%, respectively. Mean hand grip strength in the 25(OH)D < 20 ng/mL group was significantly lower than that in the ≥ 30 ng/mL group (adjusted P ≤ 0.001). The 25(OH)D < 20 ng/mL group was significantly more likely to have low grip strength than the 25(OH)D ≥ 30 ng/mL group (odds ratio = 4.12). In conclusion, low serum 25(OH)D concentration (< 20 ng/mL) is associated with low grip strength in an older Japanese population.

Bilateral spontaneous simultaneous femoral neck occult fracture in a middle-aged man due to osteoporosis and vitamin D deficiency osteomalacia: A case report and literature review

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Physicians should take spontaneous femoral neck occult fracture into consideration if they report groin pain or difficulty in walking, even when findings from plain X-ray are normal.

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In a patient with spontaneous femoral neck occult fracture, diagnosing and treating the underlying etiology of osteoporosis and osteomalacia are essential for improving prognosis.

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This is the first report of a case of bilateral spontaneous simultaneous occult fracture of the femoral neck caused by osteoporosis and osteomalacia in a middle aged man.

Introduction

Bilateral stress fracture of the femoral neck is very rarely seen in healthy young patients who are neither athletes nor military recruits.

Presentation of case

The present report describes a 51-year-old male patient, not an athlete and with no previous history of disease, who developed bilateral stress fracture of the femoral neck without displacement.

Discussion

Simultaneous bilateral femoral neck fracture is a rare injury. In the present case, two factors predisposed to bilateral occult fracture of the femoral neck. The first was osteoporosis due to the patient’s smoking and alcohol abuse. The second was vitamin D deficiency osteomalacia associated with inadequate sun exposure.

Conclusion

All patients who present with spontaneous hip pain should be evaluated for osteoporosis and osteomalacia and assessed for underlying occult fracture if they report groin pain or difficulty in walking, even when findings from plain X-ray are normal, to improve prognosis in this rare and serious condition.

Quantitation of serum 25(OH)D2 and 25(OH)D3 concentrations by liquid chromatography tandem mass spectrometry in patients with diabetes mellitus

Vitamin D has been considered to regulate calcium and phosphorus homeostasis and to preserve skeletal integrity. Serum 25-hydroxyvitamin D (25(OH)D) is the best indicator of vitamin D levels. The association of serum 25(OH)D deficiency with increased risk of type 1 diabetes (T1DM) and type 2 diabetes (T2DM) is controversial. We investigated serum 25(OH) D₂ and 25(OH)D₃ levels in diabetes patients by using liquid chromatography tandem mass spectrometry (LC-MS/MS). Serum 25(OH)D2 and 25(OH)D3 levels were measured with liquid chromatography tandem mass spectrometry in electrospray ionization positive mode. Chromatograms were separated using an ACE5 C18 column on a gradient of methanol. The total 25(OH)D levels were calculated as the sum of 25(OH)D3 and 25(OH)D2 levels. A total of 56 patients with T1DM and 41 patients with T2DM were enrolled in this study. There were 42 and 28 non-diabetic, age-matched volunteers who participated as the T1DM controls and the T2DM controls, respectively. The total 25(OH)D levels were lowest in the 21–40 age group. The levels of both 25(OH)D3 and the total 25(OH)D were significantly higher in the T1DM and T2DM groups than in the controls (p < 0.01 in T1DM and p < 0.05 in T2DM group, respectively). The 25(OH)D2 levels were only significantly higher in T1DM patients than in the controls. The percentages of vitamin D deficiency (total 25(OH)D less than 20 ng/mL) in the T1DM, T2DM, the T1DM controls and the T2DM controls were 7.1%, 0%, 14.3% and 3.6%, respectively. The percentages of vitamin D insufficiency (total 25(OH)D less than 30 ng/mL) in the T1DM, T2DM, the T1DM controls and the T2DM controls were 26.8%, 7.3%, 54.8% and 17.9%, respectively. The percentages of vitamin D deficiency and insufficiency were significantly lower in the T1DM patients than in the T1DM controls (p < 0.01). In the present study, both type 1 and type 2 diabetes patients had higher serum 25(OH)D levels and lower percentages of vitamin D deficiency/insufficiency.

Laboratory trend in vitamin D status in Ireland: Dual concerns about low and high 25OHD

Serum 25-hydroxyvitamin D (25OHD) is the pre-eminent estimate of vitamin D status that we have been measuring in a hospital laboratory setting since the 1970s. We previously evaluated the trend in 25OHD results in our laboratory from 1993 to 2013. Using a time series analysis of monthly average 25OHD results the trend was modelled, and this was used to forecast monthly average 25OHD from 2014 to 2016. In this study, all 25OHD results from 2014 to 2016 were retrieved (n = 67,922) and trimmed to 40,307 results after duplicates were excluded. The average monthly actual 25OHD was almost identical to the average monthly forecast 25OHD (p = 0.028) with a strong correlation between the actual 25OHD and forecast 25OHD (r = 0.69, p < 0.001). This upward trend is attributed to higher oral intake of vitamin D. We have a dual concern: policies to prevent hypovitaminosis D must be offset by strategies to avert hypervitaminosis D.

Pathophysiology of the Risk Factors Associated with Osteoporosis and their Correlation to the T-score Value in Patients with Osteopenia and Osteoporosis in the United Arab Emirates

Introduction:

Osteoporosis is a growing major health problem with medical, social, and economic burden. The pathogenesis of osteoporosis involves excessive bone resorption by osteoclasts and decreased new bone formation by osteoblasts. Early diagnosis is the key to minimize the impact of osteoporosis on patients. Dual-energy X-ray absorptiometry at the hip or spine is the main standard test for measuring bone mineral density, and according to the World Health Organization, the T-score value of –2.5 or less determines osteoporosis.

Aim:

In this work, we aimed to study the risk factors associated with osteoporosis among a population sample of osteoporotic and controls in the United Arab Emirates (UAE) and relate them to the T-score value.

Material and Methods:

Two hundred male and female participants were recruited in the study. A questionnaire was used and data were correlated with the T-score value of the participants.

Results:

Results showed a positive correlation between the T-score value of the patients with osteoporosis and their calcium intake, exercise duration, and the age at menopause of female patients, whereas a negative correlation was evident between the T-score value and both caffeine and nicotine consumption. Results also revealed that patients with osteoporosis have significantly low body mass index, low calcium intake, and shorter duration of exposure to the sun than the control group.

Conclusion:

In conclusion, more intervention should be directed toward changing the modifiable risk factors in patients with osteoporosis and more studies should be directed toward osteoporosis in the UAE.

Effect of vitamin D supplementation on depressive symptoms and psychological wellbeing in healthy adult women: a double-blind randomised controlled clinical trial

Epidemiological evidence has linked low vitamin D status to a range of mood disorders. However, studies examining whether vitamin D supplementation can improve mood-related outcomes in healthy populations are limited. We investigated whether vitamin D supplementation over winter is beneficial for improving mood-related outcomes in healthy women. A total of 152 healthy women (18–40 years) in Dunedin, New Zealand were randomly assigned to receive 50 000 IU (1·25 mg) of oral vitamin D₃ or placebo once per month for 6 months. They completed the Center for Epidemiologic Studies Depression Scale, the anxiety subscale of the Hospital Anxiety and Depression Scale and the Flourishing Scale every month. Additionally, they reported their positive and negative mood each day for three consecutive days every 2 months. Participants provided a blood sample at the beginning and at the end of the study for 25-hydroxyvitamin D₃ analysis. ANCOVA was used to compare the outcome measures between the groups, controlling for baseline. We found no evidence of lower depression (P = 0·339), lower anxiety (P = 0·862), higher flourishing (P = 0·453), higher positive moods (P = 0·518) or lower negative moods (P = 0·538) in the treatment group compared with the control group at follow-up. Mood outcomes over the study period were similar for the two groups. We found no evidence of any beneficial effect of monthly vitamin D₃ supplementation on mood-related outcomes in healthy premenopausal women over the winter period, so recommendations for supplementations are not warranted in this population for mood-related outcomes.

Dysequilibrium of the PTH-FGF23-vitamin D axis in relapsing remitting multiple sclerosis; a longitudinal study

Background

Parathyroid glands of people with relapsing remitting multiple sclerosis (RRMS) fail to respond to low serum 25-hydroxyvitamin D (25OHD) and low serum calcium, which are stimuli for parathyroid hormone (PTH) secretion. This led us to hypothesise: that there is suppression of PTH in RRMS due to higher than normal serum concentrations of fibroblast growth factor 23 (FGF23). We therefore sought evidence for dysregulation of the PTH-FGF23-vitamin D axis in RRMS.

Methods

Longitudinal study (winter to summer) with fasting venepunctures. For RRMS subjects who recruited a healthy control (HC) friend, pairs analyses were performed. For each pair, the within-pair difference of the variable of interest was calculated (RRMS minus HC). Then, the median of the differences from all pairs was compared against a median of zero (Wilcoxon) and the 95% confidence interval of that median difference (CI) was calculated (Sign Test).

Results

RRMS had lower winter PTH than HC, P = 0.005, (CI -2.4 to 0.5 pmol/L, n = 28 pairs), and lower summer PTH, P = 0.04, (CI -1.8 to 0.5, n = 21 pairs). Lower PTH associates physiologically with lower intact FGF23 (iFGF23), yet RRMS had higher iFGF23 than HC in winter, P = 0.04, (CI -3 to 15 pg/mL, n = 28 pairs) and iFGF23 levels comparable to HC in summer, P = 0.14, (CI -5 to 13, n = 21 pairs). As PTH stimulates and FGF23 reduces, renal 1-alpha hydroxylase enzyme activity, which synthesises serum 1,25-dihyroxyvitamin D (1,25(OH)₂D) from serum 25OHD, we examined the ratio of serum 1,25(OH)₂D to serum 25OHD. In winter, this ratio was lower in RRMS versus HC, P = 0.013, (CI -1.2 to - 0.3, n = 28 pairs).

Conclusions

This study revealed a dysequilibrium of the PTH-FGF23-vitamin D axis in RRMS, with lower plasma PTH, higher plasma iFGF23 and a lower serum 1,25(OH)₂D to 25OHD ratio in RRMS compared with HC subjects. This dysequilibrium is consistent with the study hypothesis that in RRMS there is suppression of the parathyroid glands by inappropriately high plasma concentrations of iFGF23. Studying the basis of this dysequilibrium may provide insight into the pathogenesis of RRMS.

Vitamin D in Vascular Calcification: A Double-Edged Sword?

Vascular calcification (VC) as a manifestation of perturbed mineral balance, is associated with aging, diabetes and kidney dysfunction, as well as poorer patient outcomes. Due to the current limited understanding of the pathophysiology of vascular calcification, the development of effective preventative and therapeutic strategies remains a significant clinical challenge. Recent evidence suggests that traditional risk factors for cardiovascular disease, such as left ventricular hypertrophy and dyslipidaemia, fail to account for clinical observations of vascular calcification. Therefore, more complex underlying processes involving physiochemical changes to mineral balance, vascular remodelling and perturbed hormonal responses such as parathyroid hormone (PTH) and fibroblast growth factor 23 (FGF-23) are likely to contribute to VC. In particular, VC resulting from modifications to calcium, phosphate and vitamin D homeostasis has been recently elucidated. Notably, deregulation of vitamin D metabolism, dietary calcium intake and renal mineral handling are associated with imbalances in systemic calcium and phosphate levels and endothelial cell dysfunction, which can modulate both bone and soft tissue calcification. This review addresses the current understanding of VC pathophysiology, with a focus on the pathogenic role of vitamin D that has provided new insights into the mechanisms of VC.

Low levels of 25-hydroxyvitamin D in children and adolescents with type 1 diabetes mellitus: a single center experience

PURPOSE

Low vitamin D level is common in adults with diabetes mellitus (DM). We assessed vitamin D level and its associated factors in Korean youth with type 1 DM.

METHODS

Type 1 DM cases (n=85) and healthy controls (n=518) aged <20 years were included and grouped into 3 categories according to vitamin D level: deficiency (<20 ng/mL), insufficiency (20-30 ng/mL), or sufficiency (≥30 ng/mL).

RESULTS

The mean serum vitamin D level was significantly lower (21.6±8.5 ng/mL vs. 28.0±12.0 ng/mL, P<0.001) and vitamin D deficiency prevalence was significantly higher (48% vs. 26%, P<0.001) in type 1 DM cases than in healthy controls. Logistic regression analysis revealed that type 1 DM cases were more likely to have vitamin D deficiency (P=0.004), independent of sex, age, and body mass index. Type 1 DM cases with vitamin D deficiency/insufficiency were mainly diagnosed in winter (November to April) (P=0.005), and the duration of diabetes was longer than in those with vitamin D sufficiency (P=0.046). However, season of diagnosis, duration of diabetes, prescribed daily insulin dose, and glycosylated hemoglobin and C-peptide levels were not associated with 25-hydroxyvitamin D (25(OH)D) level in type 1 DM cases after adjustment for other factors.

CONCLUSIONS

We recommend assessment of serum 25(OH)D level in type 1 DM cases and to treatment if findings indicate insufficiency. Further studies investigating the mechanisms underlying vitamin D deficiency in youth with type 1 DM are needed.

Serum parathyroid hormone is associated with increased cortical porosity of the inner transitional zone at the proximal femur in postmenopausal women: the Tromsø Study

Serum parathyroid hormone (PTH) was associated with increased bone turnover markers and cortical porosity of the inner transitional zone at the proximal femur. These results suggest that PTH through increased intracortical bone turnover leads to trabecularisation of inner cortical bone in postmenopausal women.

INTRODUCTION

Vitamin D deficiency leads to secondary hyperparathyroidism and increased risk for fractures, whereas its association with cortical porosity is less clear. We tested (i) whether serum 25-hydroxyvitamin D (25(OH)D) and PTH were associated with cortical porosity and (ii) whether the associations of 25(OH)D) and PTH with fracture risk are dependent on cortical porosity.

METHODS

This case-control study included 211 postmenopausal women, 54-94 years old, with prevalent fractures and 232 controls from the Tromsø Study. Serum 25(OH)D, PTH, and bone turnover markers (procollagen type I N-terminal propeptide [PINP] and C-terminal cross-linking telopeptide of type I collagen [CTX]) were measured. Femoral subtrochanteric cortical and trabecular parameters were quantified using computed tomography, and femoral neck areal bone mineral density (FN aBMD) was quantified using dual-energy X-ray absorptiometry.

RESULTS

Compared with controls, fracture cases exhibited reduced serum 25(OH)D and increased PTH, PINP, and CTX, increased femoral subtrochanteric cortical porosity, and reduced cortical thickness and FN aBMD (all, p < 0.05). Serum 25(OH)D was not associated with cortical parameters (all, p > 0.10). PTH was associated with increased PINP, CTX, and cortical porosity of the inner transitional zone and reduced trabecular bone volume/tissue volume and FN aBMD (p ranging from 0.003 to 0.054). Decreasing 25(OH)D and increasing PTH were associated with increased odds for fractures, independent of age, height, weight, calcium supplementation, serum calcium, cortical porosity, and thickness.

CONCLUSIONS

These data suggest that serum PTH, not 25(OH)D, is associated with increased intracortical bone turnover resulting in trabecularisation of the inner cortical bone; nevertheless, decreasing 25(OH)D) and increasing PTH are associated with fracture risk, independent of cortical porosity and thickness.

Vitamin D in adolescents: Are current recommendations enough?

Vitamin D is essential for bone development during adolescence and low vitamin D status during this critical period of growth may impact bone mineralization, potentially reducing peak bone mass and consequently increasing the risk of osteoporosis in adulthood. Therefore, the high prevalence of vitamin D inadequacy and deficiency in adolescent populations is of great concern. However, there is currently a lack of consensus on the 25-hydroxyvitamin D [25(OH)D] concentration, the widely accepted biomarker of vitamin D status, that defines adequacy, and the vitamin D intake requirements to maintain various 25(OH)D thresholds are not well established. While the current intake recommendations of 10-15μg/day may be sufficient to prevent vitamin D deficiency (25(OH)D<25-30nmol/l), greater intakes may be needed to achieve the higher threshold levels proposed to represent adequacy (25(OH)D>50nmol/l). This review will address these concerns and consider if the current dietary recommendations for vitamin D in adolescents are sufficient.

Change in serum level of vitamin D and associated factors at early phase of bone healing among fractured adult patients at University of Gondar teaching hospital, Northwest Ethiopia: a prospective follow up study

Introduction

Currently, Vitamin D deficiency is a major public health problem and it affects more than one billion people worldwide. Vitamin D is crucial for bone mineralization and ossification. Patients with fractures need Vitamin D for the healing of their fractured bone. The current study was carried out to determine if there is change in the serum level of Vitamin–D associated with factors at early phase of fractured bone healing (ossification) process among adult fractured patients at University of Gondar teaching hospital, Northwest Ethiopia.

Methods

This facility-based prospective follow up study was conducted from March to June 2016. Data was collected by an interviewer, and pretested and structured questionnaires were used. Biological samples were collected to determine the serum level of vitamin–D in all subjects. In addition, X–Ray findings were used to determine the early phase of bone healing process. Data was entered into EPI INFO version 3.5.3 and analyzed using the Statistical Package for Social Sciences (SPSS) version 20. Both bivariate and multivariate logistic regression analysis was done to screen for factors associated with decreased serum levels of Vitamin–D. In the Multivariate regression analysis, those variables which had a P–value of <0.05 were considered as independently associated with change in serum level of Vitamin–D.

Results

A total of 118 adult patients with fractures participated in this study. The prevalence of patients’ with decreased serum levels of vitamin–D at post-test was 63.6% [95% CI; (0.551–0.720)]. Inadequate intake of milk and milk products in the 1st week of fracture [AOR = 95%CI: 0.20 (0.05–0.90)], Poor Dietary Diversity Score [AOR = 95% CI: 29.1 (2.27–371.65)], and ossified bone [AOR =95% CI: 4.10 (1.12–14.95)] showed statistically significant association with decreased serum level of Vitamin–D.

Conclusion and recommendations

Decreased serum level of Vitamin–D at early phase of fractured bone healing process was found in the majority of patients (>63%) raising concern for Vitamin D deficiency to be a significant public health problem in the study population. It was statistically associated with: poor dietary diversity score, in adequate intake of milk and milk products in the 1^stone week of fracture and ossified (healed) bone. Introducing hospital based Vitamin–D supplementation and integrated with health and nutritional education is a vital intervention needed to improve serum levels of Vitamin–D.

Prevalence and Risk Factors of Osteoporosis Among Jordanian Postmenopausal Women Attending the National Center for Diabetes, Endocrinology and Genetics in Jordan

To assess the prevalence of osteoporosis and osteopenia among Jordanian postmenopausal women attending the National Center for Diabetes, Endocrinology, and Genetics (NCDEG), and to determine the potential associated risk factors. A cross-sectional study was conducted at (NCDEG) in Amman, Jordan. A total of 1079 Jordanian postmenopausal women aged between 45 and 84 years were included in this study that was conducted during the period between April 2013 and December 2014. All patients underwent bone mineral density measurement through dual-energy X-ray absorptiometry (DEXA) scan. DEXA scan was interpreted in terms of T score as per World Health Organization guidelines. The overall prevalence of osteoporosis and osteopenia was 37.5% and 44.6%, respectively. The maximum prevalence of osteoporosis was observed at the lumbar spine (32.4%) followed by the left femoral neck (14.4%), while the maximum prevalence of osteopenia was observed at the left femoral neck (56.1%) followed by the lumbar spine (41.3%). Patients with longer menopausal duration, normal or overweight body mass index, high parity, physical inactivity, positive family history of osteoporosis, inadequate sun exposure, high daily caffeine intake, low daily calcium intake, and delay in the age of menarche were all positively associated with osteoporosis. On the other hand, women with type 2 diabetes mellitus had lower risk of osteoporosis. There is a high prevalence of osteoporosis and osteopenia among Jordanian postmenopausal women. Necessary steps are needed for more public education and a wider dissemination of information about osteoporosis and its prevention.

Seasonality and autoimmune diseases: The contribution of the four seasons to the mosaic of autoimmunity

Autoimmune diseases (ADs) are a heterogeneous groups of diseases that occur as a results of loss of tolerance to self antigens. While the etiopathogeneis remain obscure, different environmental factors were suggested to have a role in the development of autoimmunity, including infections, low vitamin D levels, UV radiation, and melatonin. Interestingly, such factors possess seasonal variation patterns that could influence disease development, severity and progression. Vitamin D levels which reach a nadir during late winter and early spring is correlated with increased disease activity, clinical severity as well as relapse rates in several disease entities including multiple sclerosis (MS), non-cutaneous flares of systemic lupus erythematosus (SLE), psoriasis, and rheumatoid arthritis (RA). Additionally, immunomodulatory actions of melatonin secretion ameliorate the severity of several ADs including MS and SLE. Melatonin levels are lowest during spring, a finding that correlates with the highest exacerbation rates of MS. Further, melatonin is postulated to be involved in the etiopathogenesis of inflammatory bowel diseases (IBD) through it influence on adhesion molecule and therefore transcription factor expression. Moreover, infections can mount to ADs through pro-inflammatory cytokine release and human antigen mimicry. Seasonal patterns of infectious diseases are correlated with the onset and exacerbation of ADs. During the winter, increased incidence of Epstein-Barr virus (EBV) infectious are associated with MS and SLE flares/onset respectively. In addition, higher Rotavirus infections during the winter precedes type 1 diabetes mellitus onset (T1DM). Moreover, Escherichia coli (E. coli) infection prior to primary biliary cirrhosis (PBC) and T1DM disease onset subsequent to Coxachievirus infections are seen to occur during late summer, a finding that correlate with infectious agents' pattern of seasonality. In this review, the effects of seasonality on the onset, relapses and activity of various ADs were discussed. Consideration of seasonal variation patterns of ADs can possibly provide clues to diseases pathogenesis and lead to development of new approaches in treatment and preventative care.

Vitamin D and Parathyroid Hormone Status in Female Garment Workers: A Case-Control Study in Bangladesh

Despite the abundant sunlight, vitamin D deficiency is prevalent in South Asian countries including Bangladesh. Information on vitamin D level is insufficient in adults particularly in female garment workers in Bangladesh. This study was designed to evaluate the status of vitamin D, parathormone (PTH), calcium, and alkaline phosphatase (ALP) among the female garment workers in Bangladesh. Blood samples were collected from female garment workers (n = 40, case group) and general female workers (n = 40, control group) in Dhaka. Serum vitamin D, PTH, calcium, and ALP were measured by chemiluminescence microparticle immunoassay. The mean level of vitamin D was significantly (p < 0.001) lower in case (14.2 ± 2.6 ng/mL) than in the control (22.4 ± 2.4 ng/mL) group. No significant difference was found at mean of PTH and calcium between case (33.9 ± 17.2 pg/mL; 9.1 ± 0.6 mg/dL, resp.) and control (35.9 ± 16.3 pg/mL; 9.3 ± 0.6 mg/dL, resp.) group. The mean ALP in case (117.2 ± 14.4 U/L) group was significantly (p < 0.001) higher than the control group (80.5 ± 30.6 U/L). Overall, PTH level did not show significant correlation with vitamin D. However, calcium and ALP levels showed a significant positive (p < 0.05) and negative (p < 0.001) correlation with vitamin D, respectively. This study indicates a high prevalence of vitamin D deficiency in the female garment workers in Bangladesh.

Assessment of vitamin D levels, awareness among Lebanese pharmacy students, and impact of pharmacist counseling

Vitamin D inadequacy, frequently underdiagnosed, affects people of all age groups worldwide. This prospective study aims at determining the percentage of inadequate vitamin D levels among students and evaluating the impact of pharmacist counseling on raising the awareness of the importance of sun exposure and adequate vitamin D intake. A total of 160 university students were recruited. Blood samples were taken to check the vitamin D, calcium, and phosphorous levels. Vitamin D levels ⩽30 ng/mL were defined as inadequate. Scores were given to the questions and aimed at gathering patient knowledge about vitamin D before and after pharmacist counseling. A total of 115 (71.87%) patients had vitamin D levels <30 ng/mL, with a mean vitamin D serum level of 16.80 ± 5.85 ng/mL. The mean level of calcium was 9.51 ± 1.23 mg/dL and, of phosphorus 3.62 ± 0.95 mg/dL. The mean difference in the knowledge score of the recommended daily amount of vitamin D before and after pharmacist counseling was 2.81 versus 5.88 (p < 0.001). Concerning patient education for diseases and drugs that affect vitamin D levels, pharmacist counseling was effective in raising the awareness (p < 0.001). Given that vitamin D inadequacy is linked to many disease progressions, it is important that health professionals provide interventional strategies and education measures to correct inadequate levels in patients of all age groups.

High levels of serum vitamin D are associated with a decreased risk of metabolic diseases in both men and women, but an increased risk for coronary artery calcification in Korean men

BACKGROUND

There are conflicting results for relationships between serum vitamin D levels and metabolic diseases. The aim of this study was to investigate whether serum vitamin D levels were associated with various metabolic diseases including insulin resistance (IR), metabolic syndrome (MS), fatty liver (FL), and coronary artery calcification (CAC), along with assessing gender differences for these relationships in Korean adults.

METHODS

A total of 180,918 subjects (98,412 men and 82,506 women) who participated in a comprehensive health examination in the 2012-2013 period at Kangbuk Samsung Hospital, College of Medicine, Sungkyunkwan University were included. Serum vitamin D and metabolic markers were analyzed and CAC was estimated. Subjects were divided according to quartile groups of serum vitamin D. To examine the relationships of serum vitamin D to metabolic diseases and metabolic factors, multivariate logistic analysis was conducted.

RESULTS

High levels of serum vitamin D was associated with lower ORs for MS, IR and FL both in men and women (all p < 0.05). For men, ORs for CAC were significantly higher in third and the highest quartile groups for serum vitamin D in all the analyzed models (all p < 0.05). However, women showed no significant results between serum vitamin D and CAC.

CONCLUSIONS

High levels of serum vitamin D were associated with lower risk of MS, IR and FL in both Korean men and women, but were associated with higher risk of CAC only in men, and not in women.

Analysis of 25-Hydroxyvitamin D Status According to Age, Gender, and Seasonal Variation

BACKGROUND

The effects of age, gender, and seasonal variation on human levels of 25-hydroxyvitamin D (25(OH)D) are not well understood. In this study, we aimed to investigate 25(OH)D status according to these factors in a Korean population.

METHODS

A total of 303,943 serum 25(OH)D levels were measured using an electrochemiluminescence immunoassay between October 2011 and May 2014. Potential participants were ineligible for the study if they had significant renal, hepatic, or thyroid dysfunction, as well as any major ongoing disease that could influence serum 25(OH)D levels.

RESULTS

A total of 95,137 subjects (49,662 men and 45,475 women) were included in this study. The mean 25(OH)D levels were higher in men (42.4 nmol/l) than in women (32.9 nmol/l, P < 0.001). Among the men and women, 73.0% and 88.9%, respectively, had 25(OH)D levels <50 nmol/l, whereas only 3.8% of men and 1.4% of women had levels >75 nmol/l. The highest mean 25(OH)D value was noted in individuals aged ≥70 for both genders. The proportion of those with 25(OH)D levels <50 nmol/l appeared to be higher among younger subjects (P < 0.001). Lastly, there were significant differences between 25(OH)D levels in individuals during summer to fall and winter to spring in both genders, indicating seasonal periodicity (P < 0.001).

CONCLUSIONS

Serum 25(OH)D status varied according to gender, age, and season. Therefore, analyses of vitamin D status require individualized gender, age, and seasonally adjusted thresholds. Clinicians should consider these factors when determining optimal serum 25(OH)D levels in clinical practice.

A systematic review of pediatric clinical trials of high dose vitamin D

Background. Due to inadequate UV exposure, intake of small quantities of vitamin D is recommended to prevent musculoskeletal disease. Both basic science and observational literature strongly suggest that higher doses may benefit specific populations and have non-musculoskeletal roles. Evaluating the evidence surrounding high dose supplementation can be challenging given a relatively large and growing body of clinical trial evidence spanning time, geography, populations and dosing regimens. Study objectives were to identify and summarize the clinical trial literature, recognize areas with high quality evidence, and develop a resource database that makes the literature more immediately accessible to end users. Methods. Medline (1946 to January 2015), Embase (1974 to January 2015), and Cochrane databases (January 2015), were searched for trials. All pediatric (0-18 years) trials administering doses higher than 400 IU (<1 year) or 600 IU (≥1 year) were included. Data was extracted independently by two of the authors. An online searchable database of trials was developed containing relevant extracted information (http://www.cheori.org/en/pedvitaminddatabaseOverview). Sensitivity and utility were assessed by comparing the trials in the database with those from systematic reviews of vitamin D supplementation including children. Results. A total of 2,579 candidate papers were identified, yielding 169 trials having one or more arms meeting eligibility criteria. The publication rate has increased significantly from 1 per year (1970-1979) to 14 per year (2010-2015). Although 84% of the total trials focused on healthy children or known high risk populations (e.g., renal, prematurity), this proportion has declined in recent years due to the rise in trials evaluating populations and outcomes not directly related to the musculoskeletal actions of vitamin D (27% in 2010s). Beyond healthy children, the only pediatric populations with more than 50 participants from low risk of bias trials evaluating a clinically relevant outcome were prematurity and respiratory illness. Finally, we created and validated the online searchable database using 13 recent systematic reviews. Of the 38 high dose trials identified by the systematic review, 36 (94.7%) could be found within the database. When compared with the search strategy reported in each systematic review, use of the database reduced the number of full papers to assess for eligibility by 85.2% (±13.4%). Conclusion. The pediatric vitamin D field is highly active, with a significant increase in trials evaluating non-classical diseases and outcomes. Despite the large overall number there are few high quality trials of sufficient size to provide answers on clinical efficacy of high-dose vitamin D. An open access online searchable data should assist end users in the rapid and comprehensive identification and evaluation of trials relevant to their population or question of interest.

Low vitamin D, and bone mineral density with depressive symptoms burden in menopausal and postmenopausal women

BACKGROUND

The reported association between vitamin D level and loss of Bone mineral densitometry measurements (BMD) has been controversial.

OBJECTIVE

The objectıve of the current study was to determine whether low vitamin D level and BMD are associated with depresive symptoms as burden in Arab women during the menopausal and postmenopausal period.

DESIGN AND SETTING

A cross-sectional descriptive study design was used at the Primary Health Care (PHC) Centers in Qatar.

SUBJECTS

A multi-stage sampling design was used and a representative sample of 1436 women aged 45-65 years were included during July 2012 and November 2013 and 1106 women agreed to participate (77.2%) and responded to the study.

MATERIALS AND METHODS

BMD (g/m(2)) was assessed at the BMD unit using a Lunar Prodigy DXA system (Lunar Corp., Madison, WI). The antero-posterior lumbar spine (L2-L4) and the mean of the proximal right and left femur were be measured by two technician and then reviewed by one radiologist. Data on body mass index (BMI), clinical biochemistry variables including serum 25-hydroxyvitamin D were collected. The Beck Depression Inventory (BDI) was administered for depression purposes.

RESULTS

Of the 1436 women living in urban and rural areas, 1106 women agreed to participate (77.0%) and responded to the study. The mean age and standard deviation of the subjects was 53.8 ± 3.2. The median age of natural menopausal in the present study was 49 years (mean and standard deviation 49.5 ± 3.1 and postmenopausal was 58.1 ± 3.3). There were statistically significant differences between menopausal stages with regards to ethnicity, education level, systolic and dialostic blood pressure, parity, sheesha smoking and depressive symptoms. Overall 30.4% of women were affected with osteopenia/osteoporosis in premenopausal and postmenopausal (24.4% vs 35.7%; P = 0.0442). Osteopenia in premenopausal and postmenopausal (18.7% vs 29.3%; P = 0.030) and Osteoporosis (9.9% vs 15.9%; P = 0.049) were significantly higher in post-menopausal women than in premenopausal women (P = 0.046). Similarly, vitamin D deficiency was more prevalent among postmenopausal women than menopausal women. Overall, only 15.1% of women had optimum vitamin D level and 15.5% had severe, 33.2% had moderate vitamin D insufficiency and 36.3% had mild vitamin D insufficiency in menopausal and post menopausal women (P = 0.021). The study revealed that vitamin D level, hemoglobin level, serum iron fasting plasma glucose, calcium, triglycerides, high density lipid (HDL) cholesterol, low density lipid (LDL) Cholesterol, alkaline phosphate and magnesium were considerably lower in postmenopausal compared to menopausal women (P < 0.001).

CONCLUSION

The current study revealed that there was a strong association between vitamin D level and BMD in Arab women during the menopausal and post-menopausal period.

The human environment and the vitamin D compromise: Scotland as a case study in human biocultural adaptation and disease susceptibility

Year-round human habitation of environments with highly seasonal regimes of ultraviolet B radiation (UVB) depended on adaptive complexes of biological and cultural traits to ensure adequacy of vitamin D. Perturbations of such adaptive complexes resulting from changes in the physical environment, human behavior and culture, or both have had unexpected and untoward consequences for health. Scotland is an excellent case study of the changing nature of human biocultural adaptation to low-UVB environments. Occupation of Scotland after the last Pleistocene glaciation event about 14,000 YBP was made possible by maximally depigmented skin, which facilitated cutaneous biosynthesis of vitamin D3, and by a diet that emphasized foods rich in vitamin D. Changes in human subsistence and diet began with the introduction of agriculture and grazing about 5,000 YBP and accelerated greatly in the last 200 years through industrialization and urbanization. The resulting changes in domiciles, patterns of daily activity and behavior, and diet have led to reduced exposure to UVB and reduced consumption of vitamin D-rich foods. This has perturbed the "vitamin D compromise," an adaptive complex established in Scotland during the Mesolithic and Neolithic. We describe the UVB environment of Scotland from remotely sensed data and combine these data with information from the archaeological record to describe the vitamin D compromise in Scotland. Changes in human exposure to UVB and vitamin D consumption, which occurred as the result of urbanization and the dietary shift away from the consumption of oily fish, are traced. Vitamin D deficiency contributes to increased disease prevalence in Scotland, including that of the autoimmune disease multiple sclerosis, a debilitating neurodegenerative disease caused by demyelination of the central nervous system. These conditions have created an "imperfect storm" of poor health that should command the attention of public health experts and policy makers.

Bropirimine inhibits osteoclast differentiation through production of interferon-β

Bropirimine is a synthetic agonist for toll-like receptor 7 (TLR7). In this study, we investigated the effects of bropirimine on differentiation and bone-resorbing activity of osteoclasts in vitro. Bropirimine inhibited osteoclast differentiation of mouse bone marrow-derived macrophages (BMMs) induced by receptor activator of nuclear factor κB ligand (RANKL) in a concentration-dependent manner. Furthermore, it suppressed the mRNA expression of nuclear factor of activated T-cells, cytoplasmic, calcineurin-dependent 1 (NFATc1), a master transcription factor for osteoclast differentiation, without affecting BMM viability. Bropirimine also inhibited osteoclast differentiation induced in co-cultures of mouse bone marrow cells (BMCs) and mouse osteoblastic UAMS-32 cells in the presence of activated vitamin D3. Bropirimine partially suppressed the expression of RANKL mRNA in UAMS-32 cells induced by activated vitamin D3. Finally, the anti-interferon-β (IFN-β) antibody restored RANKL-dependent differentiation of BMMs into osteoclasts suppressed by bropirimine. These results suggest that bropirimine inhibits differentiation of osteoclast precursor cells into osteoclasts via TLR7-mediated production of IFN-β.

May osteoarticular infections be influenced by vitamin D status? An observational study on selected patients

Background

Vitamin D deficiency has been associated with a high number of health outcomes, and its role on the immune system has been deeply investigated in recent years, although poor data are still available on vitamin D status in orthopedic infections including those of prosthetic implants.

Methods

We focused on preoperative values of 25(OH)D in selected groups of patients with septic (Group A) or aseptic (Group B) prosthetic loosening, infective bone disease such as septic arthritis and osteomyelitis (Group C) and other orthopedic pathologies (Group D) to evaluate differences in the vitamin D status.

Results

A high prevalence of vitamin D deficiency was recorded among the study population (16.5 ± 5.4 ng/mL, mean ± SD). Interestingly, all patients with an infection presented a higher 25(OH)D concentration (17.7 ± 5.3 ng/mL) in respect to uninfected ones (15.1 ± 5.6 ng/mL). Significantly higher levels of 25(OH)D were observed in patients with prosthetic joint infection (18.5 ± 6.5 ng/mL), when compared with those presenting an aseptic loosening (13.6 ± 9.4 ng/mL).

Conclusions

Deficiency in vitamin D levels have been found in orthopaedic patients. Prosthetic joint infections seems to be associated to higher values of vitamin D in respect to other bone infections or to other orthopaedic conditions requiring surgery.

More studies are needed to improve the knowledge on vitamin D status in these patients and to better clarify the role of vitamin D in relation to osteoarticular infections.

The risks and benefits of calcium supplementation

The association between calcium supplementation and adverse cardiovascular events has recently become a topic of debate due to the publication of two epidemiological studies and one meta-analysis of randomized controlled clinical trials. The reports indicate that there is a significant increase in adverse cardiovascular events following supplementation with calcium; however, a number of experts have raised several issues with these reports such as inconsistencies in attempts to reproduce the findings in other populations and questions concerning the validity of the data due to low compliance, biases in case ascertainment, and/or a lack of adjustment. Additionally, the Auckland Calcium Study, the Women's Health Initiative, and many other studies included in the meta-analysis obtained data from calcium-replete subjects and it is not clear whether the same risk profile would be observed in populations with low calcium intakes. Dietary calcium intake varies widely throughout the world and it is especially low in East Asia, although the risk of cardiovascular events is less prominent in this region. Therefore, clarification is necessary regarding the occurrence of adverse cardiovascular events following calcium supplementation and whether this relationship can be generalized to populations with low calcium intakes. Additionally, the skeletal benefits from calcium supplementation are greater in subjects with low calcium intakes and, therefore, the risk-benefit ratio of calcium supplementation is likely to differ based on the dietary calcium intake and risks of osteoporosis and cardiovascular diseases of various populations. Further studies investigating the risk-benefit profiles of calcium supplementation in various populations are required to develop population-specific guidelines for individuals of different genders, ages, ethnicities, and risk profiles around the world.

A pediatric critical care perspective on vitamin D

The mechanisms of action of vitamin D are the subject of intense investigation. Evidence now suggests vitamin D affects immune function and cell proliferation, prompting interest in its role in critical illness and cardiac disease. Multiple studies demonstrate strong associations between vitamin D deficiency and severity of illness including need for higher inotrope support, more fluid resuscitation, and longer intensive care unit stay. The pediatric cardiac population may be at even more risk and nearly twice as likely to be deficient compared to the noncardiac population. Low vitamin D levels have been found in postoperative cardiac patients, where investigators speculate cardiopulmonary bypass alters levels directly or indirectly. Patients with congestive heart failure who are deficient also seem to benefit from vitamin D supplementation. This review summarizes recent studies in children that investigate the relation between vitamin D status and clinical outcomes in the critically ill including those with cardiac disease.

Periodontitis associated with osteomalacia

Osteomalacia is a metabolic bone disorder characterized by an alternation of bone mineralization, bone pain, increased bone fragility and fractures. A 23-year-old female patient reported with short stature and depressed nasal bridge with oral manifestation showing partial anodontia and periodontitis. This case report attempt to highlights clinical, radiographic, biochemical features of osteomalacia and periodontitis.

Ultraviolet radiation exposure and serum vitamin D levels in young children

AIM

Health benefits of adequate vitamin D levels in the blood include better bone health and a reduced incidence of a range of chronic diseases and infections. Ultraviolet (UV) radiation exposure from the sun is the main source of vitamin D; however, such exposure, especially from a young age, is also a potential risk factor for skin cancer. The current study examined the association of UV exposure with vitamin D production in young children to determine the period of weekly exposure prior to blood testing that affected serum 25-hydroxyvitamin D (25(OH)D) levels.

METHODS

Between 2009 and 2011, healthy children aged 3, 6 and 9 years were recruited from the community for a cross-sectional study of nutritional factors and DNA damage. Parents of 464 children provided information on the children's average weekly sun exposure and level of sun protection during each of the 16 weeks before blood sample collection by a domiciliary phlebotomist.

RESULTS

Serum 25(OH)D levels were best predicted from UV exposure during the week before blood collection for samples drawn in autumn, summer or spring. For samples drawn in winter, serum 25(OH)D levels were best predicted by UV exposure during the 2 weeks before blood collection.

CONCLUSIONS

Consistent weekly sun exposure may be beneficial for young children, especially in winter, to maintain healthy vitamin D levels in the blood. However, confirmation of these results is needed before their public health significance can be fully evaluated.

Effects of high doses of cholecalciferol in normal subjects: a randomized double-blinded, placebo-controlled trial

BACKGROUND

Vitamin D repletion with high doses of vitamin D is often recommended to patients and healthy subjects. The safety, especially concerning changes in urinary calcium excretion is of great importance.

METHODS

In a double-blinded, placebo-controlled study in 40 healthy volunteers, we examined the changes in mineral metabolism during supplementation with 3000 IU of oral cholecalciferol daily during 4 months.

RESULTS

Both 25(OH)vitamin D and 1,25(OH)2vitamin D increased significantly in the active treated group as compared to the placebo group (186% versus 14% (P<0.001) and 28% versus -8% (P<0.001)). No change was observed in urinary calcium excretion in the active group compared to the placebo group (P = 0.891). Fibroblast growth factor 23 increased significantly by 10% (P<0.018) in the active group. However, there was no difference in changes in FGF23 between treatment groups (P = 0.457).

CONCLUSION

High dose cholecalciferol significantly increases 25(OH)vitamin D and 1,25(OH)2vitamin D levels compared to placebo. No changes in urinary calcium excretion or other measured components of the mineral metabolism were found between groups.

TRIAL REGISTRATION

ClinicalTrials.gov NCT00952562.

Effect of simvastatin and atorvastatin on serum vitamin d and bone mineral density in hypercholesterolemic patients: a cross-sectional study

Background. Besides lipid-lowering effect of statins, they have been shown to have nonlipid lowering effects, such as improving bone health. An improvement in bone mineral density (BMD) has been indicated in some studies after the use of statins, in addition to an increase in 25-hydroxyvitamin D (25OHD) level. The aim of this study is to explore the association between statins and bone health taking into consideration 25OHD level and BMD. Methods. This is a randomized, cross-sectional comparative study. Subjects were divided into two groups, hypercholesterolemic participants taking simvastatin or atorvastatin as the study group and a matched control group not taking statins. All participants were assessed for serum 25OHD and BMD at lumbar spine and femoral neck. Results. A total of 114 participants were included in the study, 57 participants in each group. Results of serum 25OHD showed no significant difference between study and control groups (P = 0.47), while BMD results of lumbar spine and femoral neck showed significant difference (P = 0.05 and 0.03, resp.). Conclusion. Simvastatin and atorvastatin, at any dose for duration of more than one year, have no additive effect on 25OHD level but have a positive effect on the BMD.

Influence of external, intrinsic and individual behaviour variables on serum 25(OH)D in a German survey

The objective of the present study was to identify external, intrinsic or behavioural factors that significantly influenced serum 25-hydroxyvitamin D (25(OH)D) concentrations in a German survey. Data from 3061 participants in the Cooperative Health Research in the Region of Augsburg, Germany (KORA) F4 survey were used to relate potential determinants to measured mean serum 25(OH)D concentrations using multivariable regression models. The factors significantly associated with hypovitaminosis D (defined as 25(OH)D<25 nmolL(-1)) were season (winter, spring and autumn), urban environment and high body mass index. In contrast, times spent in sunny regions, hours per day spent outdoors in the summer as well as additional oral intake were associated with higher 25(OH)D concentrations. These results suggest that mainly ambient UV exposure but also individual behaviour are the most important determinants for personal 25(OH)D concentrations. The analyses further showed that in winter 43% of subjects were vitamin D deficient and 42% insufficient. Even in summer over half the population has insufficient vitamin D status with 8% deficient and 47% insufficient. Therefore measures to mitigate widespread vitamin D insufficiency such as regular short-term sun exposure and/or improved dietary intake/supplementation recommendations by public health bodies need to be considered.

[Vitamin D supply of patients with hip fracture]

INTRODUCTION

Vitamin D deficiency is an important risk factor for fractures. However, there are few data available only on the relationship between serum 25-hydroxyvitamin D levels and recovery after surgery for hip fracture.

AIM

The authors investigate the vitamin D supply of patients with hip fractures.

METHOD

Between February and September 2013, serum 25-hydroxyvitamin D and parathyroid hormone levels were determined in 203 patients with hip fracture (74.8±11.5 ys; 67 men and 136 women) and in 74 control subjects.

RESULTS

Vitamin D deficiency and secondary hyperparathyroidism occurred significantly more frequently in patients with hip fracture than in control subjects (72% vs. 45%, and 33% vs. 17%, respectively). Patients with better condition after surgery showed higher 25-hydroxyvitamin D levels (p<0.001) than those with poor condition. Serum 25-hydroxyvitamin D were lower in the 31 patients who died [median of survival time: 19 (5-52) days] compared to those who survived [22.6 (9.5-45.0) vs. 33.0 (16.5-56.6) nmol/l].

CONCLUSIONS

The association between vitamin-D deficiency and mortality as well as the positive correlation between serum 25-hydroxyvitamin D levels and better postoperative condition confirm the importance of proper vitamin D supply in the prevention and cure of hip fractures, what is more in the increase of the chance of survival.

Vitamin D and PTH status among adolescent and young females with severe dysmenorrhea

OBJECTIVE

To investigate Vitamin D and parathyroid hormone (PTH) status among adolescent and young females with severe and very severe dysmenorrhea.

DESIGN

Cross-sectional study in specific selected sample.

SETTING

One Jordanian university.

PARTICIPANTS

Fifty-six females, ages between 17 and 24 years, with severe and very severe dysmenorrhea were surveyed regarding demographics, pain with menstruation, and dietary intake of dairy products. Plasma Vitamin D, PTH levels were measured.

RESULTS

About 61% of the studied population experience very severe dysmenorrhea. Half of participants had dairy intake less than 1 serving per day. The majority of participants (80%) had insufficient plasma vitamin D and 48% of them had hyperparathyroidism.

CONCLUSION

A high prevalence of vitamin D insufficiency and secondary hyperparathyroidism and/or low dietary calcium intake among adolescent and young adult females who experience severe and very severe dysmenorrhea may negatively affect bone metabolism during achievement of peak bone mass at a young age and adverse bone health at older age.

Vitamin D at the onset of type 1 diabetes in Italian children

Low vitamin D levels have been reported in multiple immune disorders such as type 1 diabetes mellitus (T1DM). The purpose of our study was to determine vitamin D levels in children at the onset of T1DM compared with children with other diseases and to test the hypothesis that low vitamin D may increase the odds for developing diabetes. All the children (n = 58) that were consecutively admitted to our clinic at T1DM onset between May 2010 and July 2012 were compared with a control group of children (n = 166) hospitalized for other diseases, matched for sex, season of visit, and age. For each subject, we considered clinical and anthropometric data, the season at time of hospitalization, and serum 25-hydroxyvitamin D (25(OH)D), which were analyzed and compared using multivariable conditional logistic regression. Median 25(OH)D was significantly lower in the diabetic patients (36.2 nmol/l, range = 7.5-121.0 nmol/l) than in controls (48.7 nmol/l, range = 7.5-190.2 nmol/l), p = 0.010. Low 25(OH)D levels seem to increase the odds for developing T1DM (odds ratio (OR) = 3.45 for 25(OH)D 51-74 nmol/l, OR = 5.56 for 25(OH)D ≤ 50 nmol/l). There was no seasonal effect on the risk of developing T1DM. Median 25(OH)D level was significantly lower in patients admitted with diabetic ketoacidosis (30.2 nmol/l, range = 7.5-101.8 nmol/l) than in patients without ketoacidosis (40.7 nmol/l, range = 15.2-121.1 nmol/l), p = 0.019; but when adjusted for season, the p value was 0.116.

CONCLUSIONS

Children at onset of T1DM have lower vitamin D serum levels than those with other diseases. Further longitudinal studies on children before the onset of T1DM will allow clinicians to explore the causal relationship between vitamin D and T1DM.

Predictors of vitamin D deficiency and insufficiency in adult Bahrainis: a cross-sectional study

OBJECTIVE

High prevalence of hypovitaminosis D has been reported to be common in different regions of the Middle East. The objective of the present study was to examine the predictors of vitamin D deficiency and insufficiency in Bahrainis.

DESIGN

A cross-sectional study.

SETTING

Blood transfusion volunteers at a blood bank.

SUBJECTS

Serum levels of total 25-hydroxyvitamin D, bone markers and other parameters such age, sex, season and clothing style in the 500 healthy Bahrainis were investigated.

RESULTS

In the entire cohort the prevalence of vitamin D deficiency was 49.4% and the relative risk of vitamin D deficiency increased significantly by 1.1, 1.2, 1.5, 1.7 and 1.2 fold with younger age group (P = 0.03), hyperparathyroidism (P = 0.01), low serum Ca (P < 0.001), warm and hot months of the year (P < 0.0001) and female sex (P = 0.002), respectively. In females the prevalence of vitamin D deficiency was 67.6% and the relative risk of vitamin D deficiency increased significantly by 1.1, 1.2, 1.2, 1.2 and 1.4 fold with younger age group (P = 0.04), hyperparathyroidism (P = 0.03), low serum Ca (P = 0.001), warm and hot months of the year (P = 0.001) and conservative clothing style (P = 0.04), respectively. In contrast, in males the prevalence of vitamin D deficiency was 31.2% and the relative risk of vitamin D deficiency was increased by 1.6 fold in warm and hot months of the year (P < 0.0001).

CONCLUSIONS

High prevalence of low circulating levels of vitamin D and the relative risk factors associated with vitamin D deficiency and insufficiency observed in the present study suggest an urgent need for public health interventions including vitamin D food fortification in Bahrain.

Individuals with exceptional longevity manifest a delayed association between vitamin D insufficiency and cognitive impairment

OBJECTIVES

To define vitamin D levels and their association with cognition in subjects with exceptional longevity.

DESIGN

Cross-sectional.

SETTING

Community and long-term care facilities.

PARTICIPANTS

Ashkenazi Jewish subjects (n = 253) with exceptional longevity, with comparison made to the Third National Health and Nutrition Examination Survey (NHANES III) participants aged 70 and older.

MEASUREMENTS

Serum 25-hydroxyvitamin D levels were measured using liquid chromatography/tandem mass spectrometry analysis. Cognitive function was assessed using the Mini-Mental State Examination (MMSE) and clock drawing test (CDT: command and copy).

RESULTS

The median age of the Ashkenazi subjects was 97 (interquartile range (IQR) 95-104). Age-associated rise in the prevalence of vitamin D insufficiency, defined as a serum vitamin D level of less than 30 ng/mL, was noted in NHANES III (P = .001). In the Ashkenazi group with longevity, the rate of vitamin D insufficiency was comparable with that of the NHANES III participants, who were up to 25 years younger. In the cohort with exceptional longevity, 49% demonstrated cognitive impairment as assessed according to MMSE score (impaired cognition, median 9.5 IQR 0-24); normal cognition, median 29 (IQR 18-30) P < .001). Vitamin D insufficiency was more prevalent in those with impaired cognition, defined according to the MMSE (71.8% vs 57.7%, P = .02) and the CDT copy (84.6% vs. 50.6%, P = .02), than in those with normal cognition. This association remained significant after multivariable adjustment in logistic regression models for cognitive assessments made using the MMSE (odds ratio (OR) = 3.2, 95% confidence interval (CI) = 1.1-9.29, P = .03) and the CDT copy (OR = 8.96, 95% CI = 1.08-74.69, P = .04).

CONCLUSION

Higher vitamin D levels may be a marker of delayed aging, because they are associated with better cognitive function in people achieving exceptional longevity.

25-Hydroxyvitamin D insufficiency is associated with cardiometabolic risk in Korean adolescents: the 2008-2009 Korea National Health and Nutrition Examination Survey (KNHANES)

OBJECTIVE

Vitamin D insufficiency is known to be related to cardiometabolic disorders; however, the associations among serum 25-hydroxyvitamin D (25(OH)D) concentration and metabolic syndrome and cardiometabolic risk factors in children and adolescents have not yet been clearly delineated. For this reason, we investigated the relationship among serum 25(OH)D concentration and metabolic syndrome and cardiometabolic risk factors among Korean adolescents.

DESIGN

We performed a cross-sectional analysis and used hierarchical multivariate logistic regression analysis models to adjust for confounding variables.

SETTING

We used the data gathered during the 2008-2009 Korea National Health and Nutrition Examination Survey (KNHANES).

SUBJECTS

Our subjects included 1504 Korean adolescents aged 12-18 years who participated in the KNHANES.

RESULTS

Vitamin D insufficiency, defined as 25(OH)D concentration <50 nmol/l, was found in 75·3% of Korean adolescents and was associated with an increased risk of the prevalence of metabolic syndrome. Waist circumference and BMI were the most closely correlated cardiometabolic components of metabolic syndrome according to serum 25(OH)D status, but no significant relationship was found between serum 25(OH)D concentration and insulin resistance or for the risks for high blood pressure, hyperglycaemia, reduced HDL-cholesterol or hypertriacylglycerolaemia, with or without adjustment for confounding variables.

CONCLUSIONS

Low serum 25(OH)D concentration appears to be associated with several cardiometabolic risk factors and an increased risk of the prevalence of metabolic syndrome in Korean adolescents.

Does vitamin D affect femoral cartilage thickness? An ultrasonographic study

This study aims to investigate the association between vitamin D levels and distal femoral cartilage thickness in healthy subjects. Eighty patients who were admitted to our outpatient clinic between May and July 2013 were classified into three subgroups according to their 25-OH vitamin D levels of <10, 10-20, and ≥20 ng/mL. Distal femoral cartilage thickness was measured from the midpoints of the right medial condyle (RMC), right lateral condyle (RLC), right intercondylar area (RIA), left medial condyle (LMC), left lateral condyle (LLC), and left intercondylar area (LIA) by using musculoskeletal ultrasound (US). The group with severe vitamin D deficiency (<10 ng/mL) had thinner femoral cartilage thickness at LMC (p = 0.005). Positive correlations were determined only between vitamin D levels and US measurements in the severe vitamin D deficiency group at RLC (r = 444, p = 0.020), LMC (r = 357, p = 0.067), and LLC (r = 568, p = 0.002). Low levels of vitamin D seem to affect the femoral cartilage thickness, adversely. Further studies are necessary to ascertain the clinical relevance of this change in cartilage thickness and whether vitamin D supplementation can reverse the cartilage thinning process or the allied clinical symptoms in the course of knee osteoarthritis.

[The role of vitamin D deficiency in the pathogenesis of falls and fractures]

The diverse effects of vitamin D in human body became known during the last years. Vitamin D deficiency causes many problems in medical care. Important roles of vitamin D are the regulation of calcium metabolism and the effect on bone metabolism. The authors review literature data on vitamin D deficiency recognized as an important risk factor in the pathogenesis of falls and fractures and they call attention of Hungarian physicians to the importance of vitamin D substitution. Supplementation of vitamin D deficiency is particularly important in the elderly age-group.

Osteoporosis and metabolic syndrome according to socio-economic status, contribution of PTH, vitamin D and body weight: The Canarian Osteoporosis Poverty Study (COPS)

BACKGROUND

Poverty is associated with a great number of diseases, but the prevalence of vitamin D deficiency, secondary hyperparathyroidism and the potential association of osteoporosis, osteoporotic fractures and metabolic syndrome in this situation are less well known.

OBJECTIVE

To evaluate the associations between poverty, bone density, fragility fractures and metabolic syndrome in a population of southern European postmenopausal women. Also, to assess the potential role of vitamin D and parathyroid hormone (PTH) levels in these associations.

METHOD

Cross-sectional study was carried out in 1 250 postmenopausal Caucasian Spanish women. The socio-economic status of the participants was determined after a personal interview, according to the criteria of the Spanish Institute of Statistics. Participants were divided into two socio-economic levels: low (poverty) and medium or high socioeconomic level. The study protocol included a health questionnaire, a complete physical examination, lateral radiograph of the dorsal and lumbar spine and measurement of bone mineral density (BMD) at the lumbar spine (L2-L4) and proximal femur. Fasting blood was obtained to measure 25-hydroxy-vitamin D (25-OHD), intact PTH and selected biochemical variables.

RESULTS

Low socio-economic status was associated with 25-OHD insufficiency, higher values of PTH, higher body weight and body mass index (BMI), lower values of BMD at the lumbar spine and a higher prevalence of fragility fractures, both vertebral and nonvertebral. Poverty was also associated with higher prevalence of metabolic syndrome, but this association was driven mainly by the higher BMI and not by poverty itself. Both vitamin D insufficiency and elevated PTH were consistently related to poverty and osteoporotic fractures.

CONCLUSIONS

Poor postmenopausal women in southern Europe have a high prevalence of metabolic syndrome and osteoporotic fractures. Poverty was associated with higher BMI and metabolic syndrome on the one hand and, on the other, with 25OHD insufficiency, higher PTH levels and osteoporosis. 25OHD insufficiency and/or secondary hyperparathyroidism do not have a significant influence on the presence of metabolic syndrome in this population.