Nutrition, mild hyperparathyroidism, and bone mineral density in young Japanese women

Secular changes in bone mineral density of adult Japanese women from 1995 to 2013

Introduction:

Secular changes in hip fracture incidence have been reported in the last few decades in Japan, but whether long-term bone mineral density (BMD) is also changing is unclear. This study aimed to determine whether BMD of Japanese women has changed over time.

Methods:

Subjects were 10,649 adult women who underwent BMD measurement in a health check-up population in Niigata, Japan, between 1995 and 2013. BMD of the distal, non-dominant forearm was measured by dual-energy X-ray absorptiometry. Demographic information and BMI were also obtained. Secular trends were determined by linear regression analysis.

Results:

BMD of subjects in their 40’s decreased significantly in the age-adjusted model (P for trend=0.0162), but not in the age- and BMI-adjusted model (P for trend=0.2171). BMD of subjects in their 50’s decreased marginally in the age-adjusted model (P for trend=0.0535), but not in the age- and BMI-adjusted model (P for trend=0.6601). BMDs of subjects in their 30’s and 60’s did not significantly change, while BMIs of subjects in their 40’s-60’s decreased significantly.

Conclusions:

A secular decrease in BMD, partly attributed to decreases in BMI, was observed in middle-aged Japanese women from 1995 to 2013. Measures to help maintain suitable BMI will be necessary to prevent a decrease in BMD among women.

A 2-year prospective densitometric study on the influence of Fok-I gene polymorphism in young patients with thalassaemia major

This study is to estimate the degree of genetic contribution of Fok-I gene polymorphism of Vitamin D receptor to bone mass in patients with thalassaemia. Results indicate a protective role of the f allele of the Fok-I gene polymorphism when found in homozygosity on bone mineral density of young thalassemic patients.

INTRODUCTION

The purpose of this study is to estimate prospectively the degree of genetic contribution of Fok-I gene polymorphism of vitamin D receptor (VDR) to the evolution of bone mass in patients with beta-thalassemia major (b-TH).

METHODS

Sixty-four children and young adults (33 males and 31 females) with mean decimal age of 23.20 ± 5.41 (range 9.25-32.41 years) were recruited in this study. All patients were genotyping for Fok-I gene polymorphism and were assessed with dual energy X-ray absorptiometry (DXA) at baseline and 2 years after. Z-scores were calculated based on normal age and sex matched Caucasian population. Metabolites of vitamin D, intact PTH, total calcium, inorganic phosphorous, and alkaline phosphatase were measured at the serum pre-transfusion.

RESULTS

A moderate proportion of patients had decreased DXA Z-scores (Z-score ≤-2) predominately in total hip (31 %) and secondary in lumbar spine (15.6 %). Patients being homozygous for the f allele had apparently higher BMD Z-scores compared with those carrying the F allele in homo- or heterozygosity, however, with a difference that did not reached significance. Interestingly enough, a significant deterioration in BMD Z-scores measured at femur (FF: P = 0.004 Ff: P < 0.001, ff: P = 0.024) and total hip (FF: P = 0.022, Ff: P = 0.005) was recorded for all type of genotypes, except for ff genotype and with regard to the total hip DXA values. An increased prevalence of serum 25(OH)D3 deficiency (59.4 %) and 25(OH)D3 borderline (12.5 %) was recorded.

CONCLUSION

Our study indicates a protective role of the f allele of the Fok-I gene polymorphism when found in homozygosity on bone mineral density of young patients with b-TM.

Increases in pre-hospitalization serum 25(OH)D concentrations are associated with improved 30-day mortality after hospital admission: A cohort study

CONTEXT

Pre-hospital vitamin D status may be a modifiable risk factor for all-cause mortality among hospitalized patients.

OBJECTIVE

To examine the association between increases in serum 25-hydroxyvitamin D [25(OH)D] levels during the year before hospitalization and risk of 30-day all-cause mortality after hospital admission.

DESIGN

Retrospective cohort study.

SETTING

Two Boston teaching hospitals.

PATIENTS OR OTHER PARTICIPANTS

We studied 4344 adults hospitalized between 1993 and 2011 who had serum 25(OH)D concentrations measured at least twice within 7-365 days before the index hospitalization.

INTERVENTION(S)

None.

MAIN OUTCOME MEASURE(S)

The exposure of interest was change in pre-hospital serum 25(OH)D concentrations. The main outcome was 30-day all-cause mortality. We used mixed-effects logistic regression to describe how 30-day mortality differed with changes in pre-hospital 25(OH)D concentrations. Additionally, the odds of 30-day mortality in patients with pre-hospital 25(OH)D increases of ≥10 ng/mL was compared to that of patients with increases of <10 ng/mL.

RESULTS

In a mixed-effect logistic regression model adjusted for age, gender, race, type (medical/surgical), Deyo-Charlson Index, creatinine and hematocrit, 30-day all-cause mortality rate was 8% (95%CI: 1-15) lower for each 10 ng/mL increase in pre-hospital 25(OH)D (P = 0.025) compared with the 30-day all-cause mortality rate in the entire cohort. In an adjusted logistic regression model, absolute changes of ≥10 ng/mL in patients with initial 25(OH)D concentrations < 20 ng/mL (n = 1944) decreased the odds of 30-day all-cause mortality by 48% (adjusted OR 0.52; 95%CI 0.30-0.93; P = 0.026) compared to patients with changes of <10 ng/mL.

CONCLUSIONS

In patients with initial 25(OH)D < 20 ng/mL, subsequent improvements in vitamin D status before hospitalization are associated with decreased odds of 30-day all-cause mortality after hospital admission. A causal relation may not be inferred from this observational study.

A sequence variation: 713-8delC in the transforming growth factor beta 1 gene polymorphism in thalassemia major patients

Osteoporosis remains an important cause of morbidity in β-thalassemia major. Although several factors have been implicated to play an important role in the pathogenesis of osteoporosis and several candidate gene polymorphisms have been found to regulate this process, its pathogenesis has not been completely elucidated. Deletion of a C in the fourth intron sequence 8 base before exon 5 (713-8delC) of transforming growth factor beta 1 (TGF-β1) gene which has been reported significantly higher in the osteoporotic group was studied for its prevalence and association with bone mineral density (BMD) in thalassemia major patients. The aim of this study was to find out the distribution of TGF-β1 (713-8delC) sequence variation and its relationship with BMD in thalassemia major patients. 713-8delC Sequence variation polymorphism was detected in 150 β-thalassemia major patients and their BMD was measured by dual-energy X-ray absorptiometry. Biochemical levels were estimated by enzyme-linked immunosorbent assay. We have found a remarkable incidence (90%) of osteopenia and osteoporosis among regularly transfused patients. We have found no association of 713-8delC variant of TGF-β1 gene with Z-score of BMD at lumbar spine (p = 0.061) and hips (p = 0.773). However, Cc genotype of TGF-β1 gene was found as a risk factor (odds ratio: 3.3) for low bone density in these patients.

Prevalence of osteoporosis in otherwise healthy Indian males aged 50 years and above

Bone mineral density was studied in 200 healthy Indian men above 50 years age, without fractures or osteoporosis. Mean vitamin D was 18.96 ng/ml; other biochemical evaluations were normal. Bone density (femur neck) decreased with age; there was osteoporosis in 8.5 %, osteopenia in 42 %, while 49.5 % were normal. Vitamin D deficiency may have caused osteoporosis.

PURPOSE

Osteoporosis is recognized as the disease of females; however, males are also affected and have serious consequences thereof. The present study aimed at studying the prevalence of osteoporosis in otherwise healthy Indian males aged 50 years or more and studying the factors affecting bone mineral density (BMD).

METHODS

With informed consent, 200 healthy males aged 50 years or more without the history of fractures or diseases affecting the BMD were evaluated clinically (including anthropometry) and biochemically (serum calcium, phosphate, alkaline phosphatase, creatinine, albumin, 25-OH Vitamin D, intact parathyroid hormone (iPTH), and testosterone). The BMD was measured by single observer on Lunar DPX-NT at right proximal femur for least effects of artifacts. Calculation of T score and categorization as osteoporosis, osteopenia, and normal BMD was done as per WHO classification.

RESULTS

The mean age was 62.61 ± 7.64 years, and BMI was 23.90 ± 3.73 kg/m(2). The testosterone levels were normal in 84 % subjects. The mean 25-OH vitamin D level was 18.96 ± 10.23 ng/ml; only 13.5 % subjects had normal levels. The mean iPTH level was 72.60 ± 43.77 pg/ml; 57 % subjects had normal iPTH (12-72 pg/ml). The other parameters studied were normal. The osteoporosis and osteopenia were more prevalent when BMD was evaluated at neck of femur (osteoporosis 8.5 vs 8 % at trochanter and 7.5 % at total right hip; osteopenia 42 vs 37 % at trochanter and 41 % at total right hip). The BMD deteriorated with age.

CONCLUSION

The osteoporosis affects 8.5 % of otherwise healthy males aged 50 years and above. Vitamin D deficiency is common in such group and maybe responsible for osteoporosis.

Vitamin D and prevention of osteoporosis: Japanese perspective

Vitamin D insufficiency or a low vitamin D status, is a prevalent condition worldwide. However, there have been no studies addressing this public health issue until recently. In this review article, a summary of a series of studies conducted by the author and his colleagues to determine whether the vitamin D status of Japanese people is adequate and how their vitamin D status affects bone mass and bone metabolism is presented. The observational studies conducted by our group revealed that vitamin D insufficiency does not seem to be a serious problem among active elderly people, but that elderly people with a low level of activities of daily living (ADL) are at a very high risk of vitamin D insufficiency. In young adults, a high intact PTH concentration due to vitamin D insufficiency, which adversely affects their bone mass, is common, suggesting that vitamin D nutrition, as well as dietary calcium intake, should be improved. However, the effects of vitamin D insufficiency among elderly Japanese on bone metabolism, bone mass, and fractures have not been clarified, and should be studied further to determine whether specific preventive strategies, such as vitamin D supplementation, are required for this high-risk group. Intervention studies targeting Japanese populations are required to further address this issue.

Effects of 25-hydroxyvitamin D level and its change on parathyroid hormone in premenopausal Chinese women

Optimal levels of 25-hydroxyvitamin D [25(OH)D] were investigated in premenopausal Chinese women. Parathyroid hormone (PTH) change at 3 months was associated with change in 25(OH)D but not with baseline levels, and PTH fell even when starting levels of 25(OH)D were >40 nmol/L, consistent with optimal values for 25(OH)D of ≥40 nmol/l.

INTRODUCTION

The upper level of 25-hydroxyvitamin D [25(OH)D] which constitutes a long-term bone health risk by causing elevated PTH levels is uncertain. Although many studies have addressed this question using cross-sectional data, the present study is one of few employing a prospective approach to determine 25(OH)D levels required to minimize PTH.

METHODS

Relationships among baseline values and 3-month changes (Δ) in PTH and 25(OH)D were assessed in 221 Chinese women, aged 28.0±4.4 years (mean±SD), taking part in a placebo-controlled dairy product intervention delivering 200 IU vitamin D(3)/day.

RESULTS

Baseline 25(OH)D was 34±11 nmol/L and was inversely related to baseline PTH (r=-0.18, P=0.007), with a plateau in PTH levels when 25(OH)D was >40 nmol/L. After 3 months intervention, PTH fell 11% and neither Δ25(OH)D nor ΔPTH differed between treatment and control groups. ΔPTH was inversely related to Δ25(OH)D (P<0.001) but not to baseline 25(OH)D. Similarly, ΔPTH differed between quartiles of Δ25(OH)D (P<0.001), but not between quartiles of baseline 25(OH)D and no interaction was observed between quartiles of baseline 25(OH)D and Δ25(OH)D. Even in the highest quartile of baseline 25(OH)D (>40 nmol/L), PTH fell 0.4±0.1 pmol/L (mean±SEM; P=0.008).

CONCLUSIONS

We conclude that vitamin D deficiency is common in young women in Hong Kong. The cross-sectional analysis indicates that optimal 25(OH)D is >40 nmol/L, and the longitudinal data is consistent with a higher optimal value which is not defined in this study's results.

Effects of lifestyle and diet on bone health in young adult Chinese women living in Hong Kong and Beijing

BACKGROUND

Dietary and lifestyle variations may be too small to detect possible associations with bone mineral density (BMD) within a community. Pooled data from communities with different diets and lifestyle but of the same ethnicity may help explore these associations.

OBJECTIVE

To examine the effects of dietary and lifestyle factors on BMD in young Chinese women.

METHODS

Baseline data were analyzed from 441 women aged 20 to 35 years in Hong Kong and Beijing who were participating in a longitudinal study evaluating the effect of milk supplementation on bone health. Data on demographic characteristics, lifestyle, use of oral contraceptives, diet, physical activity, and BMD of total hip, femoral neck, and total spine measured by dual-energy x-ray absorptiometry were pooled for analysis.

RESULTS

Hong Kong subjects had significantly lower BMD and higher body-size-adjusted dietary intakes of protein, fat, fiber, vitamins, potassium, sodium, and selenium than Beijing subjects. Multivariate regression of pooled data showed that body mass index was the most important determinant of BMD at all sites. Age was negatively associated and use of oral contraceptives was positively associated with femoral neck BMD. Carbohydrate intake was positively associated with total hip BMD. Fiber intake was negatively associated with BMD at total hip and total spine. Increased vitamin E intake was associated with greater total spine BMD. None of the nutrients were associated with BMD at the femoral neck.

CONCLUSIONS

Diet, lifestyle, and BMD differed greatly between young women from Hong Kong and Beijing. Body mass index was the most important determinant of BMD in young Chinese women, whereas age, use of oral contraceptives, and diet had less pronounced effects.

Positive association between the course of vitamin D intake and bone mineral density at 36 years in men

INTRODUCTION

Studies on the association of vitamin D and bone mineral density (BMD) in adolescence and young adults have shown contrasting results. None of these studies have examined the course and baseline in vitamin D intake. The purpose of this study was to examine the association between baseline and the course of dietary vitamin D intake on the BMD.

METHODS

Vitamin D intake was assessed 3-8 times between the age of 13 and 36 years in 152 men and 168 women from the Amsterdam Growth and Health Longitudinal Study. The BMD of the femoral neck, lumbar spine, total hip and total body was measured at the age of 36 years with dual-energy X-ray absorptiometry. Linear regression analyses were used to determine the vitamin D intake pattern in time for each subject. The models provide a baseline, course and fluctuation of the vitamin D intake for each subject. These were used in separate regression analyses with the dependent variable BMD.

RESULTS

Mean baseline vitamin D was 6.86 (SD: 2.18) microg/day for men and 4.90 (1.19) microg/day for women. Mean course of vitamin D was -0.10 (0.12) microg/day/year and -0.05 (0.18) microg/day/year for men and women respectively. After adjustment for potential confounders and correcting for the other parameters of vitamin D intake, the associations between baseline vitamin D intake and BMD were significant in the total hip (0.018 g/cm(2) per -1 microg/day; 95% CI 0.001-0.035) and total body (0.015 per -1 microg/day; 0.001-0.029). The course of vitamin D intake was associated with BMD in the lumbar spine (0.50 g/cm(2) per -1 microg/day/year; 0.130-0.867), femoral neck (0.42 g/cm(2) per -1 microg/day/year; 0.10-0.743), total body (0.34 g/cm(2) per -1 microg/day/year; 0.09-0.59) and total hip (0.44 g/cm(2) per -1 microg/day/year; 0.11-0.77) in men. No significant associations were found in women.

CONCLUSION

In men, the level of vitamin D intake in adolescence and the course of vitamin D intake from adolescence into adulthood are positively related with BMD in adulthood. In women, however, no significant associations are found.

Effects of antiepileptic drug therapy on vitamin D status and biochemical markers of bone turnover in children with epilepsy

Reports of decreased serum 25-hydroxyvitamin D (25-OHD) and altered bone metabolism associated with antiepileptic drug (AED) treatment are inconsistent and predominantly restricted to adults. In this cross-sectional observational study, the aim was to evaluate the influence of AED treatment on vitamin D status and markers of bone turnover in children with epilepsy. In 38 children taking AEDs and 44 healthy control subjects, blood samples were collected to determine the levels of serum 25-OHD, intact parathyroid hormone (iPTH), calcium (Ca), phosphate (P), bone alkaline phosphatase (BAP), osteocalcin (OC) and C terminal telopeptide of type I collagen (ICTP). More than 75% of the patients were vitamin D deficient (serum 25-OHD<20 ng/mL) and 21% of the patients had an insufficient vitamin D status (serum 25-OHD=20-30 ng/mL). In the patients, the serum levels of OC (p = 0.002) and BAP (p < 0.001) were significantly increased, but ICTP (p = 0.002) concentrations were significantly decreased compared with the control group. When patients where divided into two groups according to their medication (mono- or polytherapy), significantly lower 25-OHD (p = 0.038) and ICTP (p = 0.005) levels and elevated BAP (p = 0.023) concentrations were found in patients under polytherapy. An association between 25-OHD and the measured bone markers could not be determined. Our results indicate that the prevalence of vitamin D deficiency in epilepsy patients under AED treatment is high, especially under polytherapy, and alteration markers of bone formation and resorption suggests an accelerated skeletal turnover. The routine monitoring of serum 25-OHD and vitamin D supplementation on an individual basis should be considered.

Relationship of nutrient intakes and bone mineral density of elderly women in Daegu, Korea

The purpose of this study was to examine the relationship between nutrient intake and bone mineral density (BMD) of elderly women in Daegu, Korea. In this study, the bone mineral densities of 101 elderly women in Daegu were measured, and their nutrient intake, dietary habits, and maternal factors were determined through a survey. The subjects were divided into the normal group, the osteopenia group, and osteoporosis group to find out if there is a correlation between bone mineral density and maternal factors, dietary habits, and nutrient intake through their T-scores, analyzed according to the standards of WHO. Classification by T-scores of the participants were the normal group 25.7%, the osteopenia group 39.6%, the osteoporosis group 34.7%. Menopause age of the osteoporosis group was lower, postmenopausal period was longer, and last delivery age was significantly higher than the normal group (p<0.05). Osteoporosis group had a lower percentage of 'everyday' fruit and vegetable intakes and higher percentage of 'never' dairy intake than of the normal group. Vitamin A, vitamin B₁, and vitamin B₂ intakes of participants in the osteoporosis group were lower than those in the normal group (p<0.05). In conclusion, nutritional education is necessary to encourage high intake of milk and vegetables and fruits along with calcium, vitamin A, B₁, and B₁ intakes and low intake of sodium for the prevention of elderly women's osteoporosis.

Beneficial Effect of Oral Bisphosphonate Treatment on Bone Loss Induced by Chronic Administration of Furosemide without Alteration of Its Administration and Urinary Calcium Loss

Bisphosphonate is widely used to treat patients with primary and secondary osteoporosis. The chronic administration of furosemide is considered a risk factor for osteoporosis mainly due to the increased urinary excretion of calcium, leading to a long-term negative balance of calcium. We describe two patients with mild heart failure who took furosemide for more than 5 yr and developed hyperparathyroidism and lumbago associated with low bone mineral density. Their serum levels of intact parathyroid hormone and bone mineral density (BMD) of the lumbar spine (L2-L4) were 180.8 and 144.3 pg/ml, and 71% and 80% of the mean of healthy women, respectively. The oral administration of alendronate or risedronate was effective for lumbago and improved BMD, although the urinary excretion of calcium and hyperparathyroidism were not changed. For the medical treatment of lumbago and decreased bone mass secondary to the long-term administration of furosemide, bisphosphonate is proposed when the dose of furosemide cannot be reduced. However, it may be important to give sufficient calcium and vitamin D to patients to improve secondary hyperparathyroidism.

Threshold value of serum 25-hydroxyvitamin D concentration in relation to elevated serum parathyroid hormone concentrations in elderly Japanese women

This study was designed to determine the threshold value for 25-hydroxyvitamin D [25(OH)D] concentration in relation to elevated serum parathyroid hormone (PTH) concentrations in elderly Japanese women. The subjects were 582 noninstitutionalized, ambulant women who lived in a community in Japan. Serum 25(OH)D concentrations were determined using the Nichols Advantage chemiluminescent assay, and serum intact PTH concentrations were determined with a two-site immunoradiometric assay. Demographic characteristics, calcium intake, and serum 1,25(OH)(2)D levels were also determined. The average age, body mass index (BMI), and calcium intake of the subjects were 74.5 years (SD 4.5), 23.3 kg/m(2) (SD 3.4), and 579 mg/day (SD 248), respectively. The serum log-transformed intact PTH concentration was significantly predicted by the serum 25(OH)D concentration (r = -0.147, P = 0.0004), but not by age, BMI, the serum log-transformed 1,25(OH)(2)D concentration, or the log-transformed calcium intake. Analysis of variance with Dunnett's multiple comparisons showed that mean serum intact PTH concentrations with serum 25(OH)D concentrations less than 30 nmol/l (mean intact PTH = 5.89 pmol/l, P < 0.0001) and in the range 30-39 nmol/l (mean intact PTH = 4.54 pmol/l, P = 0.0067) were significantly higher than mean intact PTH concentrations for serum 25(OH)D concentrations greater than 50 nmol/l (mean intact PTH = 3.65 pmol/l, the baseline level), but the mean serum intact PTH concentration for 25(OH)D concentrations in the range 40-49 nmol/l (mean intact PTH = 3.70 pmol/l, P = 0.9975) was not. We conclude that serum 25(OH)D for ambulant elderly Japanese women should be maintained at 40 nmol/l or higher.