Skip to main content
Log in

Vitamin D status and parathyroid hormone levels in relation to bone mineral density in apparently healthy Syrian adults

  • Original Article
  • Published:
Archives of Osteoporosis Aims and scope Submit manuscript

Abstract

Summary

Vitamin D deficiency was highly prevalent in this study. More than half of the participants with vitamin D level less than 5 ng/mL had secondary hyperparathyroidism, which implicated a major bone health concern. After adjustment for potential predictors, parathyroid hormone (PTH) explained about 3 % of the variance in total hip bone mineral density (BMD).

Purpose

Bone mineral density (BMD) is known to be influenced by serum 25-hydroxyvitamin D (25OHD) and intact parathyroid hormone (PTH) levels. The relationship between 25OHD and PTH with BMD has not been well documented in Syrian adults. We aimed to determine how differences in serum 25OHD and PTH levels impacted hip and lumbar spine BMD among apparently healthy Syrian adults.

Methods

25OHD and PTH were measured in 156 participants aged 18–53 years from Damascus and its surroundings. Lumbar spine and hip BMD measurements were measured by dual-energy X-ray absorptiometry using Hologic Discovery Wi densitometer. Multivariate regression models were used to investigate the relationships between 25OHD, PTH, and BMD.

Results

All participants, except one male, had 25OHD <30 ng/mL (<75 nmol/L), and 89.1 % of them had 25OHD levels less than 20 ng/mL (50 nmol/L). Secondary hyperparathyroidism was significantly more prevalent in the lowest 25OHD quartile compared to that in the highest quartile (59 vs. 10.3 %, p < 0.0001). Mean bone mineral density at all sites in our participants was lower when compared to that of their Caucasian counterparts in Europe and North America. No significant correlation was found between 25OHD and BMD either at hip or at lumbar spine. In the multivariate analyses, after adjustment for potential predictors, PTH explained about 3 % of the variation in total hip BMD.

Conclusions

Low BMD was relatively frequent at all measured sites. PTH, but not 25OHD, was a predictor for total hip BMD in a young population.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Similar content being viewed by others

References

  1. Wahl DA, Cooper C, Ebeling PR et al (2012) A global representation of vitamin D status in healthy populations. Arch Osteoporos 7:155–172

    Article  CAS  PubMed  Google Scholar 

  2. Mithal A, Wahl DA, Bonjour JP, Burckhardt P, Dawson-Hughes B, Eisman JA, El-Hajj Fuleihan G, Josse RG, Lips P, Morales-Torres J (2009) Global vitamin D status and determinants of hypovitaminosis D. Osteoporos Int: J Estab Result Coop Eur Found Osteoporos Natl Osteoporos Found USA 20:1807–1820

    Article  CAS  Google Scholar 

  3. Fuleihan G-H, Rahme M, Bassil D (2013) Do desirable vitamin D levels vary globally? In: Burckhardt P, Dawson-Hughes B, Weaver CM (eds) Nutritional influences on bone health. Springer, London, pp 273–299

    Chapter  Google Scholar 

  4. Dawson-Hughes B, Mithal A, Bonjour JP, Boonen S, Burckhardt P, Fuleihan GE, Josse RG, Lips P, Morales-Torres J, Yoshimura N (2010) IOF position statement: vitamin D recommendations for older adults. Osteoporos Int: J Estab Result Coop Eur Found Osteoporos Natl Osteoporos Found USA 21:1151–1154

    Article  CAS  Google Scholar 

  5. Sayed-Hassan R, Abazid N, Alourfi Z (2014) Relationship between 25-hydroxyvitamin D concentrations, serum calcium, and parathyroid hormone in apparently healthy Syrian people. Arch Osteoporos 9:176

    Article  PubMed  Google Scholar 

  6. Holick MF (2007) Vitamin D deficiency. N Engl J Med 357:266–281

    Article  CAS  PubMed  Google Scholar 

  7. Lips P, van Schoor NM (2011) The effect of vitamin D on bone and osteoporosis. Best Pract Res Clin Endocrinol Metab 25:585–591

    Article  CAS  PubMed  Google Scholar 

  8. Rosen CJ (2011) Clinical practice. Vitamin D insufficiency. N Engl J Med 364:248–254

    Article  CAS  PubMed  Google Scholar 

  9. Holick MF, Binkley NC, Bischoff-Ferrari HA, Gordon CM, Hanley DA, Heaney RP, Murad MH, Weaver CM (2012) Guidelines for preventing and treating vitamin D deficiency and insufficiency revisited. J Clin Endocrinol Metab 97:1153–1158

    Article  CAS  PubMed  Google Scholar 

  10. Ross AC, Manson JE, Abrams SA et al (2011) The 2011 report on dietary reference intakes for calcium and vitamin D from the Institute of Medicine: what clinicians need to know. J Clin Endocrinol Metab 96:53–58

    Article  CAS  PubMed  Google Scholar 

  11. Mezquita-Raya P, Munoz-Torres M, Luna JD, Luna V, Lopez-Rodriguez F, Torres-Vela E, Escobar-Jimenez F (2001) Relation between vitamin D insufficiency, bone density, and bone metabolism in healthy postmenopausal women. J Bone Miner Res: Off J Am Soc Bone Miner Res 16:1408–1415

    Article  CAS  Google Scholar 

  12. Fradinger EE, Zanchetta JR (2001) Vitamin D and bone mineral density in ambulatory women living in Buenos Aires, Argentina. Osteoporos Int: J Estab Result Coop Eur Found Osteoporos Natl Osteoporos Found USA 12:24–27

    Article  CAS  Google Scholar 

  13. Khaw KT, Sneyd MJ, Compston J (1992) Bone density parathyroid hormone and 25-hydroxyvitamin D concentrations in middle aged women. BMJ (Clin Res Ed) 305:273–277

    Article  CAS  Google Scholar 

  14. Sahota O, Mundey MK, San P, Godber IM, Lawson N, Hosking DJ (2004) The relationship between vitamin D and parathyroid hormone: calcium homeostasis, bone turnover, and bone mineral density in postmenopausal women with established osteoporosis. Bone 35:312–319

    Article  CAS  PubMed  Google Scholar 

  15. Collins D, Jasani C, Fogelman I, Swaminathan R (1998) Vitamin D and bone mineral density. Osteoporos Int: J Estab Result Coop Eur Found Osteoporos Natl Osteoporos Found USA 8:110–114

    Article  CAS  Google Scholar 

  16. Bischoff-Ferrari HA, Dietrich T, Orav EJ, Dawson-Hughes B (2004) Positive association between 25-hydroxy vitamin D levels and bone mineral density: a population-based study of younger and older adults. Am J Med 116:634–639

    Article  CAS  PubMed  Google Scholar 

  17. Arya V, Bhambri R, Godbole MM, Mithal A (2004) Vitamin D status and its relationship with bone mineral density in healthy Asian Indians. Osteoporos Int:J Estab Result Coop Eur Found Osteoporos Natl Osteoporos Found USA 15:56–61

    Article  CAS  Google Scholar 

  18. Gutierrez OM, Farwell WR, Kermah D, Taylor EN (2011) Racial differences in the relationship between vitamin D, bone mineral density, and parathyroid hormone in the national health and nutrition examination survey. Osteoporos Int: J Estab Result Coop Eur Found Osteoporos Natl Osteoporos Found USA 22:1745–1753

    Article  CAS  Google Scholar 

  19. Hannan MT, Litman HJ, Araujo AB, McLennan CE, McLean RR, McKinlay JB, Chen TC, Holick MF (2008) Serum 25-hydroxyvitamin D and bone mineral density in a racially and ethnically diverse group of men. J Clin Endocrinol Metab 93:40–46

    Article  CAS  PubMed  Google Scholar 

  20. Garnero P, Munoz F, Sornay-Rendu E, Delmas PD (2007) Associations of vitamin D status with bone mineral density, bone turnover, bone loss and fracture risk in healthy postmenopausal women. OFELY Stud Bone 40:716–722

    Article  CAS  Google Scholar 

  21. Hosseinpanah F, Rambod M, Hossein-nejad A, Larijani B, Azizi F (2008) Association between vitamin D and bone mineral density in Iranian postmenopausal women. J Bone Miner Metab 26:86–92

    Article  CAS  PubMed  Google Scholar 

  22. Sigurdsson G, Franzson L, Steingrimsdottir L, Sigvaldason H (2000) The association between parathyroid hormone, vitamin D and bone mineral density in 70-year-old Icelandic women. Osteoporos Int: J Estab Result Coop Eur Found Osteoporos Natl Osteoporos Found USA 11:1031–1035

    Article  CAS  Google Scholar 

  23. Allali F, El Aichaoui S, Khazani H, Benyahia B, Saoud B, El Kabbaj S, Bahiri R, Abouqal R, Hajjaj-Hassouni N (2009) High prevalence of hypovitaminosis D in Morocco: relationship to lifestyle, physical performance, bone markers, and bone mineral density. Semin Arthritis Rheum 38:444–451

    Article  CAS  PubMed  Google Scholar 

  24. Maalouf G, Gannage-Yared MH, Ezzedine J et al (2007) Middle East and North Africa consensus on osteoporosis. J Musculoskelet Neuronal Interact 7:131–143

    CAS  PubMed  Google Scholar 

  25. El-Hajj Fuleihan G, Baddoura R, Awada H, Salam N, Salamoun M, Rizk P (2002) Low peak bone mineral density in healthy Lebanese subjects. Bone 31:520–528

    Article  CAS  PubMed  Google Scholar 

  26. World Health Organization (2010) Global recommendations on physical activity for health. WHO, Geneva

    Google Scholar 

  27. Figge J, Jabor A, Kazda A, Fencl V (1998) Anion gap and hypoalbuminemia. Crit Care Med 26:1807–1810

    Article  CAS  PubMed  Google Scholar 

  28. Cockcroft DW, Gault MH (1976) Prediction of creatinine clearance from serum creatinine. Nephron 16:31–41

    Article  CAS  PubMed  Google Scholar 

  29. Mosteller RD (1987) Simplified calculation of body-surface area. N Engl J Med 317:1098

    CAS  PubMed  Google Scholar 

  30. Looker AC, Orwoll ES, Johnston CC Jr, Lindsay RL, Wahner HW, Dunn WL, Calvo MS, Harris TB, Heyse SP (1997) Prevalence of low femoral bone density in older U.S. adults from NHANES III. J Bone Miner Res: Off J Am Soc Bone Miner Res 12:1761–1768

    Article  CAS  Google Scholar 

  31. Ghannam NN, Hammami MM, Bakheet SM, Khan BA (1999) Bone mineral density of the spine and femur in healthy Saudi females: relation to vitamin D status, pregnancy, and lactation. Calcif Tissue Int 65:23–28

    Article  CAS  PubMed  Google Scholar 

  32. Andersen R, Molgaard C, Skovgaard LT, Brot C, Cashman KD, Jakobsen J, Lamberg-Allardt C, Ovesen L (2008) Effect of vitamin D supplementation on bone and vitamin D status among Pakistani immigrants in Denmark: a randomised double-blinded placebo-controlled intervention study. Br J Nutr 100:197–207

    Article  CAS  PubMed  Google Scholar 

  33. Kuchuk NO, Pluijm SM, van Schoor NM, Looman CW, Smit JH, Lips P (2009) Relationships of serum 25-hydroxyvitamin D to bone mineral density and serum parathyroid hormone and markers of bone turnover in older persons. J Clin Endocrinol Metab 94:1244–1250

    Article  PubMed  Google Scholar 

  34. Arabi A, Baddoura R, El-Rassi R, El-Hajj Fuleihan G (2012) PTH level but not 25 (OH) vitamin D level predicts bone loss rates in the elderly. Osteoporos Int: J Estab Result Coop Eur Found Osteoporos Natl Osteoporos Found USA 23:971–980

    Article  CAS  Google Scholar 

  35. Hannan MT, Felson DT, Dawson-Hughes B, Tucker KL, Cupples LA, Wilson PW, Kiel DP (2000) Risk factors for longitudinal bone loss in elderly men and women: the Framingham Osteoporosis Study. J Bone Miner Res: Off J Am Soc Bone Miner Res 15:710–720

    Article  CAS  Google Scholar 

  36. Dennison E, Eastell R, Fall CH, Kellingray S, Wood PJ, Cooper C (1999) Determinants of bone loss in elderly men and women: a prospective population-based study. Osteoporos Int: J Estab Result Coop Eur Found Osteoporos Natl Osteoporos Found USA 10:384–391

    Article  CAS  Google Scholar 

  37. Cranney A, Horsley T, O'Donnell S, et al (2007) Effectiveness and safety of vitamin D in relation to bone health. Evid Rep Technol Assess 1-235

  38. Chung M, Balk EM, Brendel M, et al (2009) Vitamin D and calcium: a systematic review of health outcomes. Evid Rep Technol Assess 1-420

  39. Andersen R, Molgaard C, Skovgaard LT, Brot C, Cashman KD, Jakobsen J, Lamberg-Allardt C, Ovesen L (2008) Pakistani immigrant children and adults in Denmark have severely low vitamin D status. Eur J Clin Nutr 62:625–634

    Article  CAS  PubMed  Google Scholar 

  40. Bischoff-Ferrari HA, Giovannucci E, Willett WC, Dietrich T, Dawson-Hughes B (2006) Estimation of optimal serum concentrations of 25-hydroxyvitamin D for multiple health outcomes. Am J Clin Nutr 84:18–28

    CAS  PubMed  Google Scholar 

  41. Lips P (2001) Vitamin D deficiency and secondary hyperparathyroidism in the elderly: consequences for bone loss and fractures and therapeutic implications. Endocr Rev 22:477–501

    Article  CAS  PubMed  Google Scholar 

  42. Arabi A, Mahfoud Z, Zahed L, El-Onsi L, El-Hajj Fuleihan G (2010) Effect of age, gender and calciotropic hormones on the relationship between vitamin D receptor gene polymorphisms and bone mineral density. Eur J Clin Nutr 64:383–391

    Article  CAS  PubMed  Google Scholar 

  43. Wang TJ, Zhang F, Richards JB et al (2010) Common genetic determinants of vitamin D insufficiency: a genome-wide association study. Lancet 376:180–188

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  44. Cooper C (2005) Epidemiology of osteoporotic fracture: looking to the future. Rheumatology (Oxford) 44(4):iv36–iv40

    Google Scholar 

  45. Wendler C, von Cramon-Taubadel S, de Haen H, Padilla Bravo CA, Jrad S (2011) Food security in Syria: Preliminary results based on the 2006/07 expenditure survey. http://ageconsearch.umn.edu/bitstream/115537/2/Food%20security%20in%20Syria.pdf.

  46. Steingrimsdottir L, Gunnarsson O, Indridason OS, Franzson L, Sigurdsson G (2005) Relationship between serum parathyroid hormone levels, vitamin D sufficiency, and calcium intake. JAMA 294:2336–2341

    Article  CAS  PubMed  Google Scholar 

  47. Lips P, Duong T, Oleksik A, Black D, Cummings S, Cox D, Nickelsen T (2001) A global study of vitamin D status and parathyroid function in postmenopausal women with osteoporosis: baseline data from the multiple outcomes of raloxifene evaluation clinical trial. J Clin Endocrinol Metab 86:1212–1221

    Article  CAS  PubMed  Google Scholar 

  48. Valcour A, Blocki F, Hawkins DM, Rao SD (2012) Effects of age and serum 25-OH-vitamin D on serum parathyroid hormone levels. J Clin Endocrinol Metab 97:3989–3995

    Article  CAS  PubMed  Google Scholar 

  49. Garg MK, Tandon N, Marwaha RK, Menon AS, Mahalle N (2014) The relationship between serum 25-hydroxy vitamin D, parathormone and bone mineral density in Indian population. Clin Endocrinol 80:41–46

    Article  CAS  Google Scholar 

  50. Heaney RP (2003) Long-latency deficiency disease: insights from calcium and vitamin D. Am J Clin Nutr 78:912–919

    CAS  PubMed  Google Scholar 

Download references

Acknowledgments

The authors are grateful to Prof. Hyam Bashour for critically reading the manuscript. This work was funded by Damascus University.

Authors’ contributions

RSH and ZA contributed to the idea of research and participated in the study design. ZA supervised data collection. NA, RSH, and AK performed the statistical analysis. RSH and NA drafted the paper. All authors read and approved the manuscript.

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Nizar Abazid.

Ethics declarations

Conflicts of interest

None.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Sayed-Hassan, R., Abazid, N., Koudsi, A. et al. Vitamin D status and parathyroid hormone levels in relation to bone mineral density in apparently healthy Syrian adults. Arch Osteoporos 11, 18 (2016). https://doi.org/10.1007/s11657-015-0245-0

Download citation

  • Received:

  • Accepted:

  • Published:

  • DOI: https://doi.org/10.1007/s11657-015-0245-0

Keywords

Navigation