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Vitamin D Deficiency and the Risk of Osteoporosis in Elderly Women

Suppasin sccotrapa', Sukree Soontrapa2,
Department of Orthopaedics, • 2Department of OB-GYN,
I

Charoonsak scmbccoccm', Woraluk Sombocnporn!

JOepartment of Radiology, Faculty of medicine, Khon Kaen University.

Background: Vitamin 0 deficiency lead to elevations In 1JVI'I.h: rl11'l1iJ11m~U~4l:::u"l11.1~I11'l::: secondary hvperpaparathyroid hormone levels, resulting In Increased bone vhtlX;:jn"l1tlfl1tln1:::'.ln~~~;uiiJ1tl~11'V'4"l:::n1:::'.ln resorption and reduced BMD, especially cortical bone, and ~d'flm.i'U (cortical bone) vhtlX~n",i1f11m·:::'.ln'V'4t'U n1:::'.ln~1;rf1J ..I .. J! .. caused skeletal osteoporosis. Up to now there are very eJM1:::V11J~1nVlqiJ1f11'flfll'fln":::'.ln"I'U'lJ1femoral neck) "lun~ ( few studies to show the effect of vitamin 0 deficiency on iJ"l,tr'Uniln1,;1nb'1~tltl~1n~LLtl"'03t,x~~un~eJfln':::V11J'lJtl~n11 bone minerai density. The level of vitamin 0 deficiency 'lJ1"'~IJl"l~'U;j~tl"h~'lM1:::'.ln ,:::IK1J'lJtl~calcidiol ~Utl"'~n~n1' vary considerably with latitude, also the variability In the 'IJ"l"'il'l1~'U;jilfli1ulJlnI'l103rrutlth~~1ntun1,.~m~11'1"l~1 t"'tlil " 10-40ng/ml "l1nn1,.~nb'1'IJ'fl03"N:::rd'S(tl'V'41J~"l":::IK1J'IJ'fl~ different vitamin 0 ~ssays, that varies from 10-40 ng/ml. fli11Ji'03~L,j From our previous study about prevalence of vitamin 0 calcidiol 'IJ'fl03tl"i'f~~tl1~~'fl1Ktl'fl~tUL'lJl'lLVlI'I1J1flLij'fl~(~~1'", deficiency, It being found that the level of calcldiol < 35 ngl 'IJ'fl'Uuriu ~ti'fl~1"'1"'1tJl1~u;l'fl~~ < 35 ng/ml . ml was the level of vitamin 0 deficiency. -ltJl'l1.1'lt~03Pi':~"lfll'l1~Litl~,j'fln1"Ln'" i"flln":::'.ln'V'4tu'IJtl~ lumbar ObJeQtlve: Todetermine the risk of osteoporosis In lumbar spine, proximal femur and the distal radius, between the spine. proximal femur Ufl::: distal radius 'lunq~fltJl1~~tl1~~il ,.:::IJi'1J'IJ'fl~ serum calcidiol < 35 ng/ml LYltl1Jn1JtltJl1~~'fl1~~il":::IK1J elderly women with and without vitamin 0 deficiency. pel'go: Cross-sectional descriptive study. serum calcidiol > 35 ng/ml $ettlog: Municipality of Khon Kaen province, Thailand. Z1.1LL1J1Jn1'lPin1:t1:Cross-sectional descriptive study Outcome Mealurem.ots: Serum calcidlol and PTH fttl1uillvi1n1fPimn vi1n11~nb'''ltw'IJtJl~V11'11J1fl~jj'fl~(~~1'Pl levels and bone mineral density of the lumbar spine, 'IJ'flULLriU 1.11::LVlf'l1V1tl proximal femur and distal forearm. n"lf-l"'eJfl: 1'Pl1::1Ji'1J'IJ'fl~ serum calcidiol. iPTH LLfl:::1Plf'hI'l'l1~ Beaulls: No any significant difference In age, weight, V\J1L~~U'IJ'fl-3n":::'.ln1J1L'lru lumbar spine. proximalfemur ~Lfl::: distal height, BMI and the alkaline phosphatase level between forearm both groups, There was only PTH level that showed eJfln1fPin~1: hl'V'41J1'I'l1~LLlJlnrn1-3'flth~i:lumi"l~rvVl1~tlCi~'IJ'fl~ significant difference between both groups. A calcidioi level " 'fl1tJ tl"l~un ti'lU~.:J BMI LLfl:::1:::IK1J'IJ'£l-3 alkaline phosphatase of < 35 ng/ml was associated with an increased In the risk of osteoporosis of femoral neck with the odds ratio (95%CI) ,.:::wj1-3tllJl1~~'fl1~tun~~~'IJ"l"LLfl:::1"''lJ1'''~lJl1~U~i:lLVitwh PTH of 2.87 (1.15;7.15), p=0_02. But no any risks in other IYhJu~;:jfll'l1~L~lJlnI'l1~nU'Cl!h~i:lumh~'Cl!Vl"l~t\Ci~ (p<O.OOl) u 1 parts of the skeletons.
rathyroidism

154

qnflfu1

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110:::01)1::; •

Suppuslu SOOnll'lp",

~'I :11.

J03t'lfl03nq'-JLLfl:::Yi'U5:i~'l1'-JL~tmi'iln'11Ln"t1I'1n1:::.~nYitu'U1L'lN
femoral neck tunq'-JVI'lJ1"~~1ijU;\'-J1nn~1nq'-JVl1,j'IJ1"~~1iju

~flrJ1-35:iU!Jfhp)tlJttJl!J5:i1'i1 odds ~atio (950/0CIl=2;87 (.1.15-7.15). p"O.02 'ltA'IIN:::~n1:::~n'U;'L'lN~uhjv~'UPl'l1'-JL~!J-3V1IJi1-3nutu '~.Jl'ltl.Jn~).J ~n!: 111'l:::'111"~miju~"l:::~11~5:i1'l'l1).JL~!J-3Pi1.ln17Ln"hl'l m'::(jnYitU'IJ'il-3 femoral neck LYi).J'lJU

Conclyslon: Vitamin 0 deficiency increased the risk of osteoporosis of the femoral neck. Key words: Vitamin 0 deficiency, elderly women, odds ratio, femoral neck,

r!;Ufl;Un111'11ff11 254.5: 17(3).1.54·159 • Srinugurind Med J 2002; 17(3). 154·159

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155

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0

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> 35

ng/ml

Vitamin D denclency(n-64) (calcldlollevel

tl1~ (il)

Normal vitamin (calcldlollevel

D (0-84)

< 85 ng/ml)

> 86 nglml)
± 11.80

" 1l1~,rn m.ru

ri'lU~~ (L),J(J11)

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68.88 ± 5.04
51.12

1.47 93.32

± 0.06 ± 23.54 .

BMI

(kg/m2)

23.52 ± 5.34 21.07 :t 13.86"

Alkaline phosphatase (U/L) Serum PTH (pg/mll

± 17.95*

156

mun;\.l11frnltm

2545; 17(J) • Srinllglll'ind Me" J 2002; 17(3)

Suppasin Soonrrapu, et al,

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..

Vitamin D denclency(n·64) (calcldlollevel

Vertebral osteoporosis

Normal vitalnln D (n-84) (calcldlollevel

< 86 nalml)

> 86 nalml)

(L2-4)

60.94% 46.88%" 81.25%

52.94% 23.53% • 91.18%

Femoral neck osteoporosis Osteoporosis of distal end radius p<O.03 911~1-3~ 3

IJ11nHLi'l~W';I'\..1'l'\..l~~-:lt11~~'IJ1Ci11IJ11ij'\..l~ (calcidiol < 35 ng/mI)LLfl~'l")'llI,,,iSl'11ij'\..l~ (calcidiol

>

35 ng/mll ~

It!ULLfl::;hJLij'\..lt"fIln1::;P.lnWt'\..l'IJtl~n"::P.lnlu~fl~ (lumbar spine)

Lumbar spine (L2·4)

Calcidiol level !S 35 ng/ml Calcidiol level >35 ng/ml Total

Osteoporosis 39 18 57

Non-osteoporosis 25 16 41

Total 64 34 98

Site
Lumbar spine (L2-4) Femoral neck Wards triangle Trochanter Total femur Ultradistal end of radius Distal one-third of radius

Odds ratio (95% CI) 1.38 (0.6-3.19) 2.87 (1.15-7.15) 1.15 (0.46·2.86) 2.03 (0.64-6.4) 0.75 (0.28-2.01) 0.42 (0.12-1.51) 1.32(0.54-3.24)

Chi.square (p·value) 0.58 (p.0.441 5.10 (p<o.o31 0.09 (p.0.761 1.37 (p.0.24) 0.31 (p...0.58) 1.69 (p.0.19) 0.36 (peO.55)

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oawson·Hughes B, Harris SS, Krall EA, Dallal GE. Effect of calcium and vitamin 0 supplementation on bone density In men and women 65 years of age or older. N Engl J Med 1997;337:670-6. Chapuy MC, Arlot ME, Duboeuf F,Brun J, Crouzet B, Arnaud S, et al. Vitamin 03 and calcium to prevent hlp fractures In elderly women. N Engl J Med 1992;327:1637-42. Ooms ME, Roos JC, Bezemer PO,Van der vljgh WJF, Bouter I.M. Lips P. Prevention of bone loss by vitamin 0 supplementationInelderlywomen:A randomizeddouble-blind trial. J Clin Endocrlnol Metab 1995;80:1052-8. Van der Wlelen RPJ, I.owlk MRH, Van den berg H, de Groot CPGM, Halter J, Morelras O. et al. Serum vitamin 0 concentration among elderly people In Europe. Lancet 1995; 346:207-10. AguadOP,Del Campo MT,Garces MV,Gonzllez-Casaus MI., Bernad M. Gijin-Banos J, et al. Low vitamin 0 levels In outpatientpostmenopausalwomenfrom a rheumatologyclinic in Madrid, Spain: Their relationshipwith bone minerai density. Osteoporos Int 2000;11:739-44. Utiger RD. The need for more vitamin D. N Engl J Med 1998;338:828-9. . Haden ST,Fulelhan GEH, Angell Jt:, Cotrsn NM, l.eBoff MS. Calcldiol and PTH levels Inwomen attending an osteoporosis program. Calclf llsaue Int 1999;64:275'9. McKenna MJ, Freaney R. Secondary hyperparathyroidism in the Elderly: Means to defhllng hypovitaminosis O. Osteoporos Int 1998;Suppl.8:S3-6. McKenna MJ. Oifferences In vitamin 0 status between countries in young adults and the elderly. Am J Med
1992;93:69-n.

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1. Holick MF. Vitamin 0 Requirements for humans of all ages: New Increased requirements for women and men 50 years and older. Osteoporos Int 1998; suppl. 8:S24-9. 2. Meunier PJ. Calcium and vitamin 0 are effective In preventing fractures in elderly people by reversing senile secondary hyperparathyroidism (Editorial). Osteoporos Int 1998; suppl, 8:S1-2. 3. Leboff MS, Kohlmeier L, Hurwitz S, Franklin J, Wright J, Glowacki J. Occult vitamin 0 deficiency In postmenopausal US women with acute hip fracture. JAMA 1999;281:1505-11. 4. Ups P, Van Girikel FC, Jongen MJM, Rubertus F, Van der Vijgh WJF, Netelenbos JC. Determinants of vitamin 0 status in patients with hip fracture and in elderly control subjects. Am J Clin Nutr 1987;46:1005-10.

14 Thomas MK, Lloyd·Jones OM. Thadhani RI, Shaw AC, Oeraska OJ, Kitch BT. Hypovitaminosis 0 In medical inpatients. N Engl J Med 1998;338:m·83. 15. Chapuy MC, Preziosi P, Maamer M, Arnaud S, Galan P, Hercberg S, et al. Prevalence of vitamin 0 Insufficiency In an adult normal population. Osteoporoslnt 1997;7:439-43. 16. Lips P. Chapuy MC, Dawson_Hughes B, Pols HAP, Holick MF. An International comparison of seru 25-hydroxyvltamin o measurements. Osteoporos Inl 1999;9:394-7. 17. Soontrapa Sp, Soontrapa Sk, Chailurkll I.. The prevalence and the calcldlol level of vitamin 0 deficiency In the elderly women In municipality of Khon Kaen province Thailand. Srlnagarlnd Med J. In press 2001. 18. Cummings SR, Browner WS, Bauer D. Stone K, Ensrud K, Jamal S, et al. Endogenous hormones and the risk of hip and vertebral fractures among older women. N Engl J Med 1998;339:733·8. 19. World Health Organization. Assessment of fracture risk and Its application to screening for postmenopausalosteoporosis. Geneva: WHO Technical Report Series 1994;843:5·6.

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