An Asian viewpoint on the use of vitamin D and calcium in osteoporosis treatment: physician and patient attitudes and beliefs

Vitamin D Status among Women of Different Asian Subgroups Initiating Osteoporosis Therapy

Among 1866 Asian women (901 Filipina women, 654 Chinese women, and 311 Japanese women) who had vitamin D assessment prior to initiation of osteoporosis therapy, Filipina women had a lower prevalence of vitamin D deficiency compared to Chinese women, despite higher body mass index. In multivariable analyses that adjusted for age, body mass index, and smoking status, the relative risk of low vitamin D was significantly higher for Chinese women (relative risk 1.4, 95% confidence interval 1.1-1.7) but not Japanese women (relative risk 1.2, 95% confidence interval 0.9-1.6). The 40% higher risk of low Vitamin D in Chinese compared to Filipina women emphasizes the importance of disaggregating Asian race when examining nutritional health attributes.

Hyperkyphosis among the Elderly in a Community: A Descriptive Cross-sectional Study

Introduction

Aging brings progressive changes in the physiology of the musculoskeletal system that leads to postural changes and degenerative diseases in elderly. The most common postural change is hyperkyphosis which decreases physical performance, ability to perform daily activities, overall quality of life, and increases the risk of falls in elderly. The aim of the study was to find out the prevalence of hyperkyphosis among the elderly in a community.

Methods

A descriptive cross-sectional study was done in a local community from 26 May 2019 to 8 June 2019 after obtaining ethical approval from the Institutional Review Committee (Protocol approval number: 138/19). Participants above 60 years of age were included in the study. Convenience sampling was done. A bubble inclinometer was used to measure the degree of kyphosis. Point estimate and 95% Confidence Interval were calculated.

Results

Among 144 elderly participants, hyperkyphosis was present in 90 (62.50%) (54.59-70.41, 95% Confidence Interval) with the mean hyperkyphosis being 47.07±4.83˚. The elderly in the age group of 70-75 years had a higher degree of hyperkyphosis with a mean value of 47.77±4.92˚. The mean hyperkyphosis was 48.18±5.30˚ and 45.31±3.36˚ in female and male participants respectively.

Conclusions

The prevalence of hyperkyphosis was found to be higher in our study compared to other studies conducted in similar settings. Early identification and interventions of hyperkyphosis are thus warranted to prevent the detrimental consequences in the later stages of life.

Keywords

aging; hyperkyphosis; posture.

Response regarding the importance of vitamin D and calcium among undergraduate health sciences students in Al Kharj, Saudi Arabia

BACKGROUND

Vitamin D and calcium are essential dietary components for human body, and their deficiency is linked to poor bone health and osteoporosis. Adequate knowledge of health staff regarding vitamin D and calcium is critical for general population awareness. The current work was to evaluate the awareness regarding the importance of vitamin D and calcium among undergraduate health science students in Al Kharj.

METHODS

A self-distributed validated questionnaire-based cross-sectional study was conducted. Undergraduate health science students in Prince Sattam bin Abdulaziz University from the College of Medicine, College of Pharmacy, College of Dentistry, and College of Applied Medical Science were included in the study. Students between the age of 18 and 25 years have participated in the study.

RESULTS

Four hundred fifty-seven undergraduate health science students participated in the study. The vast majority of students knew about the importance of calcium (96.7%) and vitamin D (95.4%), whereas only 89.4% knew about osteoporosis. The participant students reported in their answers that the sources of knowledge were the Internet (42.8%), physicians (41.5%), textbooks (21.2%), teachers (19.1%), family and relatives (18.3%), and/or other sources (6.1%). The overall attitude was poor in about (54%) of the participants showing gender differences regarding sun-exposure duration and supplementation of calcium and vitamin D.

CONCLUSION

The study revealed that both male and female undergraduate health science students in Al Kharj were familiar with the importance of vitamin D and calcium; however they reported improper attitude that warrants further health guidance and educational programs.

Associated Factors for Osteoporosis and Fracture in Chinese Elderly

Background

The factors associated with osteoporosis are poorly understood in the Chinese population. This study aimed to examine the factors associated with osteoporosis and with fractures in a Chinese elderly population.

Material/Methods

This was a cross-sectional study of elderly people living in Tianjin between 2012 and 2014. Bone mineral density was measured by dual X-ray absorptiometry. The subjects completed a questionnaire about lifestyle habits, personal and family medical history, calcium intake, and exercising. Data were gathered on occurrence of fracture at 5 years or August 2018, whichever occurred first.

Results

There were 298 individuals with osteoporosis (18.5% male, median age 67 years) and 397 without (46.3% male, median age 62 years). Male sex (OR=0.051, 95% CI: 0.021–0.126), age (OR=1.049, 95% CI: 1.099–1.202), being divorced/widowed (OR=2.445, 95% CI: 1.219-4.904), digestive ulcer history (OR=3.805, 95% CI: 1.539–9.405), family history of hunchback (OR=2.659, 95% CI: 1.145–6.175), family history of osteoarthropathy (OR=4.222, 95% CI: 2.128–8.375), fracture history (OR=2.138, 95% CI: 1.307–3.496), drinking green tea (OR=0.352, 95% CI: 0.217–0.574), and exercising (OR=0.303, 95% CI: 0.193–0.475) were independently associated with osteoporosis. Digestive ulcer history (OR=3.183, 95% CI: 1.178–8.5992), exercising (OR=0.354, 95% CI: 0.139–0.903), and taking calcium supplements during follow-up (OR=0.262, 95% CI: 0.112–0.611) were independently associated with fractures in patients with osteoporosis.

Conclusions

Female sex, age, marital status, history of digestive ulcer and fracture, and family history of hunchback and osteoarthropathy are associated with osteoporosis among elderly subjects, while drinking green tea and exercising are inversely associated. Among the patients with osteoporosis, a history of digestive ulcer is associated with fractures, while exercising and taking calcium supplements are inversely associated.

Determinants of Serum 25-Hydroxyvitamin D Concentrations and a Screening Test for Moderate-to-Severe Hypovitaminosis D in Chinese Patients Undergoing Total Joint Arthroplasty

BACKGROUND

Hypovitaminosis D is associated with adverse surgical outcomes. We quantified the environmental, demographic, and modifiable determinants of serum 25-hydroxyvitamin D (25-OHD) concentration and assessed the potential impact of a preoperative screening questionnaire for moderate-to-severe hypovitaminosis D (25-OHD <30 nmol/L).

METHODS

In a retrospective cohort study of 227 Chinese patients (69 males and 158 females) undergoing 261 joint arthroplasty, we collected information on recent sun exposure, dietary vitamin D intake, vitamin D supplementation, and Western Ontario and McMaster Universities osteoarthritis index using a questionnaire and measured a fasting 25-OHD concentration using a liquid chromatography-tandem mass spectrometry before surgery.

RESULTS

The multiple regression model on the determinants of 25-OHD concentration described 14% of the total variance, with the greatest relative contribution from ambient ultraviolet radiation (42%). A 4-item screening test for moderate-to-severe hypovitaminosis D had acceptable discrimination (area under receiver operating characteristic curve = 0.76, 95% CI, 0.65-0.87), good calibration (Hosmer-Lemeshow goodness-of-fit; P = .93). Decision curve analysis showed that the screening test can potentially reduce unnecessary 25-OHD testing by 390 per 1000 patients at a threshold probability of 10%.

CONCLUSION

The screening test appears moderately useful in avoiding a substantial number of unnecessary 25-OHD testing in a setting where the prevalence of moderate-to-severe hypovitaminosis D is less than 10%.

Osteoporosis in East Asia: Current issues in assessment and management

The greatest burden of hip fractures around the world is expected to occur in East Asia, especially China. However, there is a relative paucity of information on the epidemiology and burden of fractures in East Asia. Osteoporosis is greatly under-diagnosed and under-treated, even among the highest-risk subjects who have already suffered fractures. The accessibility to bone densitometry, the awareness of the disease by professionals and the public, and the use and reimbursement of drugs are some of the areas which need improvement especially. Cost-effective analysis on screening strategy and intervention thresholds based on local epidemiology data and economic status are available only in Japan. In addition, clinical risk factor models for the assessment of fracture probability may be ethnic specific. Further research is needed to develop a cost-effective risk assessment strategy to identify high-risk individuals for screening and treatment based on local data. Moreover, inadequate calcium and vitamin D intake is still an issue faced by this region.

Awareness regarding the importance of calcium and vitamin D among the undergraduate pharmacy students in Bangladesh

Background

Calcium and vitamin D are two important micronutrients required for maintaining proper bone health. Previous works intended to determine the status of these micronutrients in local population have reported that the people in Bangladesh are at high risk of calcium insufficiency and hypovitaminosis D related health complications. Lack of awareness and insufficient knowledge of the essentiality of these two nutrients are assumed to cause this problem in Bangladesh. The present study was designed and conducted to establish a basic understanding on the level of gap of knowledge and awareness among pharmacy students at undergraduate level in Bangladesh.

Findings

A total of 713 students of Bachelor of Pharmacy course participated in the study. The students were asked about basic idea related to calcium and vitamin D and the disorders due to their deficiency, name of common foods containing calcium and vitamin D, their perception regarding the essentiality of the said nutrients etc. It was found that most of the students were familiar with the importance of calcium (98.9%) and vitamin D (99.3%) in bone health. 82.2% students know about the term osteoporosis. Unfortunately, 10.7% and 18.8% students failed to mention at least one food that is rich in calcium and vitamin D, respectively. Most of the students got familiar about the nutrients from their teachers (48.9%) and textbooks (32.8%).

Conclusion

Being a student of pharmacy, the students should have more comprehensive knowledge about calcium and vitamin D. The present study indicates that the pharmacy students have lack of knowledge about calcium and vitamin D and thus it can be clearly predicted that the condition of general people may be worse.

Ability to follow drug treatment with calcium and vitamin D in postmenopausal women with reduced bone mass

OBJECTIVE

The aim of this study was to evaluate the ability of women with reduced bone mass to follow calcium/vitamin D treatment in relation to prescribed regimen, dose, indication, mode of intake, and the associated factors.

METHODS

A cross-sectional study of postmenopausal women taking medication after bone mineral density diagnosis of osteopenia or osteoporosis was conducted using the MedTake questionnaire. A total of 186 patients attending a menopause clinic were studied. Sociodemographic characteristics, history of comorbid conditions, concomitant use of medication, length of medication use, and ability to follow treatment in relation to prescribed regimen, dose, indication, and mode of ingestion were assessed.

RESULTS

The mean (SD) age of the women analyzed was 61.6 (8.21) years. The mean time since menopause was 16.8 years. Most women reported having difficulty reading, and 79% were white. The ability to follow treatment, evaluated using MedTake, was lower than 60% in most women. Taking the wrong dose was the most frequent error. The only factor associated with inadequate treatment was the use of concomitant medication (odds ratio, 2.32; 95% CI, 1.06-5.08).

CONCLUSIONS

The ability to follow adjuvant calcium and vitamin D treatment for decreased bone mass is low and associated with concomitant use of medication.

Osteoporosis management and the utilization of FRAX®: a survey amongst health care professionals of the Asia-Pacific

This survey investigated osteoporosis management practices in the Asia-Pacific region. While access to anti-osteoporotic medication is reasonable, screening for secondary contributors is performed insufficiently. FRAX® is well-known, but not used by many physicians. High costs of medication and unawareness about the disease are the biggest barriers to osteoporosis care.

PURPOSE

Osteoporosis is an increasing burden amongst countries of the Asia-Pacific. The fracture risk assessment tool FRAX® has recently been introduced in some Asian countries. This study aimed to identify attitudes about osteoporosis management in general and the utilization of FRAX® in particular amongst physicians in the Asia-Pacific region.

METHODS

A 26-item questionnaire was distributed to the participants of the first Asian regional osteoporosis meeting of the IOF in 2010. In total, 247 valid questionnaires representing 17 countries from the Asia-Pacific region were analyzed.

RESULTS

Most physicians make use of bone densitometry devices (94 %) and have access to at least one type of anti-osteoporotic medication (100 %). Central dual-energy X-ray absorptiometry was the most accessible device (87 %). Oral bisphosphonates were the only medication that was available to health care professionals in all surveyed Asia-Pacific countries. Seventy-six percent were aware of FRAX®; however, among these only 62 % used it. The main reason for not using FRAX® was the lack of country-specific models (46 %). Screening for secondary osteoporosis was performed by 36 % of the respondents. The high costs of medication and lack of awareness amongst physicians and patients about the disease were perceived as the most important barriers to osteoporosis care.

CONCLUSION

More FRAX® models should be established and implemented into the local guidelines. The necessity of screening for secondary contributors to osteoporosis should be emphasized, as easily treatable causes might be identified. To further improve osteoporosis diagnosis and treatment, the awareness of osteoporosis among doctors as well as patients needs to be raised.

Prevalence, awareness, and treatment of osteoporosis among Korean women: The Fourth Korea National Health and Nutrition Examination Survey

PURPOSE

This study aimed to assess the factors associated with the prevalence, awareness, and treatment of osteoporosis in a representative sample of Korean women.

METHODS

Data were obtained from dual energy X-ray absorptiometry measurement of the lumbar vertebrae and femoral neck, and from a standardized questionnaire in 2870 Korean women aged 50years and older who participated in the Fourth Korea National Health and Nutrition Examination Survey 2008-2009. Osteoporosis was defined by World Health Organization T-score criteria, and awareness and treatment were defined by self-report of an osteoporosis diagnosis and self-report of current anti-osteoporotic medication use, respectively. We assessed the relationship between multiple risk factors and prevalence, awareness, and treatment.

RESULTS

Osteoporosis was reported in 39.1% of Korean women. Among those with osteoporosis, only 37.5% were aware of their diagnosis and 23.5% received pharmacological treatment. Despite higher prevalence among respondents who were older, of lower body weight, calcium intake, physical activity, and education levels, the awareness and treatment rates of these groups were similar or lower than that of the low-risk controls in multivariate logistic regression models. Moreover, easily identifiable risk factors (e.g., history of fracture, falls, height loss, familial osteoporosis) were not associated with awareness and treatment. Participants who had undergone health screening in the previous 2years exhibited increased awareness and treatment rates independently of other demographic factors.

CONCLUSIONS

Osteoporosis was highly prevalent in this Korean study but was underdiagnosed and undertreated. Routine health screenings could be an effective strategy to increase osteoporosis awareness and treatment.

Is vitamin D status relevant to metabolic syndrome?

Review of the evidence on hypovitaminosis D as a risk factor for metabolic syndrome and its sequelae, T2DM and CVD, suggests long-term vitamin D repletion could reduce these risks. There is mechanistic evidence for protective effects for MetS and the balance of evidence, (cross-sectional and prospective), supports this postulate. Much of the data so far available from randomized controlled trials is weakened by inadequate power, low vitamin D dosages, starting supplementation too late in life or after MetS disorders have developed or, most importantly, by non-inclusion of many recognizable confounders. On balance, therefore, maintenance of US 2010 recommended intakes for bone protection has the potential to prove protective for MetS. Supplementation has been shown to increase survival in patients with cardiac disorders; whether higher doses would provide useful protection for apparently healthy people in the general population awaits the outcomes of ongoing randomized-controlled trials that, it is hoped, will prove or disprove causality for hypovitaminosis D in MetS and its long-term ill-effects.

Vitamin D Status in Israeli subjects before the initiation and after the cessation of vitamin D supplements

Vitamin D supplements are often recommended to restore sufficiency, although the adherence to treatment is low. This study assessed vitamin D status at different time intervals following the cessation of treatment. The database of Clalit-Health-Services (CHS), a not-for-profit HMO covering more than half of the Israeli population, was retrospectively searched for all members with available serum 25OHD test results in 2009 (245,493). We then identified those who filled any cholecalciferol prescription in 2008-2009 (121,817). Subjects were included in the final analysis only if they started treatment in 2009, had serum 25OHD < 50 nmol/l before the first prescription in 2009, and had at least one additional test result after the last dated prescription in 2009 (5,461). Serum 25OHD increased from 32 ± 11 nmol/l at baseline to 58.6 ± 22.3 nmol/l after treatment (P < 0.001). The proportion of subjects with sufficient vitamin D after treatment increased with increasing cholecalciferol daily dose and treatment duration (P < 0.001) and decreased with increasing time from cessation of treatment (P < 0.001). The effect of time from treatment cessation persisted after controlling for baseline serum 25OHD, daily cholecalciferol dose, treatment duration, seasonality, gender, age, ethnicity, and BMI; the ORs for sufficient vitamin D were 2.02 (95% CI 1.66-2.45), 1.67 (1.39-2.01), and 1.23 (1.04-1.47) for >30-60, 61-99, and 100-155 days compared to >155 days, respectively. Long-term vitamin D treatment is needed to maintain sufficient levels in those with baseline serum 25OHD below 50 nmol/l.