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Osteoporosis International

, Volume 22, Issue 6, pp 1745–1753 | Cite as

Racial differences in the relationship between vitamin D, bone mineral density, and parathyroid hormone in the National Health and Nutrition Examination Survey

  • O. M. GutiérrezEmail author
  • W. R. Farwell
  • D. Kermah
  • E. N. Taylor
Original Article

Abstract

Summary

It is unclear whether optimal levels of 25-hydroxyvitamin D (25(OH)D) in whites are the same as in minorities. In adult participants of NHANES, the relationships between 25(OH)D, bone mineral density (BMD), and parathyroid hormone (PTH) differed in blacks as compared to whites and Mexican-Americans, suggesting that optimal 25(OH)D levels for bone and mineral metabolism may differ by race.

Introduction

Blacks and Hispanics have lower 25-hydroxyvitamin D concentrations than whites. However, it is unclear whether 25(OH)D levels considered “optimal” for bone and mineral metabolism in whites are the same as those in minority populations.

Methods

We examined the relationships between 25(OH)D and parathyroid hormone in 8,415 adult participants (25% black and 24% Mexican-American) in the National Health and Nutrition Examination Surveys 2003–2004 and 2005–2006; and between 25(OH)D and bone mineral density in 4,206 adult participants (24% black and 24% Mexican-American) in the 2003–2004 sample.

Results

Blacks and Mexican-Americans had significantly lower 25(OH)D and higher PTH concentrations than whites (P < 0.01 for both). BMD significantly decreased (P < 0.01) as serum 25(OH)D and calcium intake declined among whites and Mexican-Americans, but not among blacks (P = 0.2). The impact of vitamin D deficiency (25(OH)D ≤ 20 ng/ml) on PTH levels was modified by race/ethnicity (P for interaction, 0.001). Whereas inverse relationships between 25(OH)D and PTH were observed above and below a 25(OH)D level of 20 ng/ml in whites and Mexican-Americans, an inverse association between 25(OH)D and PTH was only observed below this threshold in blacks, with the slope of the relationship being essentially flat (P = 0.7) above this cut-point, suggesting that PTH may be maximally suppressed at lower 25(OH)D levels in blacks than in whites or Mexican-Americans.

Conclusions

The relationships between 25(OH)D, BMD, and PTH may differ by race among US adults. Whether race-specific ranges of optimal vitamin D are needed to appropriately evaluate the adequacy of vitamin D stores in minorities requires further study.

Keywords

Bone mineral density Ethnic differences Parathyroid hormone Vitamin D 

Notes

Acknowledgments

The authors thank UCLA Statistical Consulting for their assistance in these analyses.

Sources of funding

Research support was obtained from grants K23DK081673 (to OMG) and K08DK073381 (to ENT) from the National Institutes of Health. In addition, this study was supported with resources and facilities at the Veterans Affairs Medical Center, Boston, MA.

Conflicts of interest

Dr. Gutiérrez reports accepting honoraria from Abbott Laboratories.

References

  1. 1.
    Holick MF (2007) Vitamin D deficiency. N Engl J Med 357:266–281PubMedCrossRefGoogle Scholar
  2. 2.
    Chapuy MC, Preziosi P, Maamer M, Arnaud S, Galan P, Hercberg S, Meunier PJ (1997) Prevalence of vitamin D insufficiency in an adult normal population. Osteoporos Int 7:439–443PubMedCrossRefGoogle Scholar
  3. 3.
    Holick MF, Siris ES, Binkley N, Beard MK, Khan A, Katzer JT, Petruschke RA, Chen E, de Papp AE (2005) Prevalence of Vitamin D inadequacy among postmenopausal North American women receiving osteoporosis therapy. J Clin Endocrinol Metab 90:3215–3224PubMedCrossRefGoogle Scholar
  4. 4.
    Krall EA, Sahyoun N, Tannenbaum S, Dallal GE, Dawson-Hughes B (1989) Effect of vitamin D intake on seasonal variations in parathyroid hormone secretion in postmenopausal women. N Engl J Med 321:1777–1783PubMedCrossRefGoogle Scholar
  5. 5.
    Malabanan A, Veronikis IE, Holick MF (1998) Redefining vitamin D insufficiency. Lancet 351:805–806PubMedCrossRefGoogle Scholar
  6. 6.
    Steingrimsdottir L, Gunnarsson O, Indridason OS, Franzson L, Sigurdsson G (2005) Relationship between serum parathyroid hormone levels, vitamin D sufficiency, and calcium intake. JAMA 294:2336–2341PubMedCrossRefGoogle Scholar
  7. 7.
    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 84:18–28PubMedGoogle Scholar
  8. 8.
    Harris SS, Dawson-Hughes B (1998) Seasonal changes in plasma 25-hydroxyvitamin D concentrations of young American black and white women. Am J Clin Nutr 67:1232–1236PubMedGoogle Scholar
  9. 9.
    Harris SS, Soteriades E, Coolidge JA, Mudgal S, Dawson-Hughes B (2000) Vitamin D insufficiency and hyperparathyroidism in a low income, multiracial, elderly population. J Clin Endocrinol Metab 85:4125–4130PubMedCrossRefGoogle Scholar
  10. 10.
    Looker AC, Dawson-Hughes B, Calvo MS, Gunter EW, Sahyoun NR (2002) Serum 25-hydroxyvitamin D status of adolescents and adults in two seasonal subpopulations from NHANES III. Bone 30:771–777PubMedCrossRefGoogle Scholar
  11. 11.
    Nesby-O'Dell S, Scanlon KS, Cogswell ME, Gillespie C, Hollis BW, Looker AC, Allen C, Doughertly C, Gunter EW, Bowman BA (2002) Hypovitaminosis D prevalence and determinants among African American and white women of reproductive age: third National Health and Nutrition Examination Survey, 1988–1994. Am J Clin Nutr 76:187–192PubMedGoogle Scholar
  12. 12.
    Zadshir A, Tareen N, Pan D, Norris K, Martins D (2005) The prevalence of hypovitaminosis D among US adults: data from the NHANES III. Ethn Dis 15(S5):97–101Google Scholar
  13. 13.
    Clemens TL, Adams JS, Henderson SL, Holick MF (1982) Increased skin pigment reduces the capacity of skin to synthesise vitamin D3. Lancet 1:74–76PubMedCrossRefGoogle Scholar
  14. 14.
    Harris SS (2006) Vitamin D and African Americans. J Nutr 136:1126–1129PubMedGoogle Scholar
  15. 15.
    Giovannucci E, Liu Y, Willett WC (2006) Cancer incidence and mortality and vitamin D in black and white male health professionals. Cancer Epidemiol Biomark Prev 15:2467–2472CrossRefGoogle Scholar
  16. 16.
    Barrett-Connor E, Siris ES, Wehren LE, Miller PD, Abbott TA, Berger ML, Santora AC, Sherwood LM (2005) Osteoporosis and fracture risk in women of different ethnic groups. J Bone Miner Res 20:185–194PubMedCrossRefGoogle Scholar
  17. 17.
    Nelson DA, Jacobsen G, Barondess DA, Parfitt AM (1995) Ethnic differences in regional bone density, hip axis length, and lifestyle variables among healthy black and white men. J Bone Miner Res 10:782–787PubMedCrossRefGoogle Scholar
  18. 18.
    Aloia JF, Vaswani A, Ma R, Flaster E (1997) Comparison of body composition in black and white premenopausal women. J Lab Clin Med 129:294–299PubMedCrossRefGoogle Scholar
  19. 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 93:40–46PubMedCrossRefGoogle Scholar
  20. 20.
    Leder BZ, Araujo AB, Travison TG, McKinlay JB (2007) Racial and ethnic differences in bone turnover markers in men. J Clin Endocrinol Metab 92:3453–3457PubMedCrossRefGoogle Scholar
  21. 21.
    Bauer RL, Diehl AK, Barton SA, Brender J, Deyo RA (1986) Risk of postmenopausal hip fracture in Mexican American women. Am J Public Health 76:1020–1021PubMedCrossRefGoogle Scholar
  22. 22.
    Aloia JF (2008) African Americans, 25-hydroxyvitamin D, and osteoporosis: a paradox. Am J Clin Nutr 88:545S–550SPubMedGoogle Scholar
  23. 23.
    (2003–2004) National Health and Nutrition Examination Survey Data. In. National Center for Health Statistics. U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, Hyattsville, MD.Google Scholar
  24. 24.
    National Kidney Foundation (2002) K/DOQI clinical practice guidelines for chronic kidney disease: evaluation, classification, and stratification. Am J Kidney Dis 39:S1–266CrossRefGoogle Scholar
  25. 25.
    Coresh J, Astor BC, McQuillan G, Kusek J, Greene T, Van Lente F, Levey AS (2002) Calibration and random variation of the serum creatinine assay as critical elements of using equations to estimate glomerular filtration rate. Am J Kidney Dis 39:920–929PubMedCrossRefGoogle Scholar
  26. 26.
    Looker AC, Melton LJ 3rd, Harris T, Borrud L, Shepherd J, McGowan J (2009) Age, gender, and race/ethnic differences in total body and subregional bone density. Osteoporos Int 20:1141–1149PubMedCrossRefGoogle Scholar
  27. 27.
    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 116:634–639PubMedCrossRefGoogle Scholar
  28. 28.
    Cleveland W, Devlin S (1988) Locally-weighted regression: an approach to regression analysis by local fitting. J Am Stat Assoc 83:596–610CrossRefGoogle Scholar
  29. 29.
    Hurvich C, Simonoff J (1998) Smoothing parameter selection in nonparametric regression using an improved Akaike information criterion. J Roy Stat Soc 60:271–293CrossRefGoogle Scholar
  30. 30.
    Aloia JF, Talwar SA, Pollack S, Yeh J (2005) A randomized controlled trial of vitamin D3 supplementation in African American women. Arch Intern Med 165:1618–1623PubMedCrossRefGoogle Scholar
  31. 31.
    Chapuy MC, Arlot ME, Duboeuf F, Brun J, Crouzet B, Arnaud S, Delmas PD, Meunier PJ (1992) Vitamin D3 and calcium to prevent hip fractures in the elderly women. N Engl J Med 327:1637–1642PubMedCrossRefGoogle Scholar
  32. 32.
    Dawson-Hughes B, Dallal GE, Krall EA, Harris S, Sokoll LJ, Falconer G (1991) Effect of vitamin D supplementation on wintertime and overall bone loss in healthy postmenopausal women. Ann Intern Med 115:505–512PubMedGoogle Scholar
  33. 33.
    Bell NH, Yergey AL, Vieira NE, Oexmann MJ, Shary JR (1993) Demonstration of a difference in urinary calcium, not calcium absorption, in black and white adolescents. J Bone Miner Res 8:1111–1115PubMedCrossRefGoogle Scholar
  34. 34.
    Bryant RJ, Wastney ME, Martin BR, Wood O, McCabe GP, Morshidi M, Smith DL, Peacock M, Weaver CM (2003) Racial differences in bone turnover and calcium metabolism in adolescent females. J Clin Endocrinol Metab 88:1043–1047PubMedCrossRefGoogle Scholar
  35. 35.
    Cosman F, Morgan DC, Nieves JW, Shen V, Luckey MM, Dempster DW, Lindsay R, Parisien M (1997) Resistance to bone resorbing effects of PTH in black women. J Bone Miner Res 12:958–966PubMedCrossRefGoogle Scholar
  36. 36.
    Heaney RP (2002) The importance of calcium intake for lifelong skeletal health. Calcif Tissue Int 70:70–73PubMedCrossRefGoogle Scholar
  37. 37.
    Bell NH, Greene A, Epstein S, Oexmann MJ, Shaw S, Shary J (1985) Evidence for alteration of the vitamin D-endocrine system in blacks. J Clin Invest 76:470–473PubMedCrossRefGoogle Scholar
  38. 38.
    Engelman CD, Fingerlin TE, Langefeld CD, Hicks PJ, Rich SS, Wagenknecht LE, Bowden DW, Norris JM (2008) Genetic and environmental determinants of 25-hydroxyvitamin D and 1, 25-dihydroxyvitamin D levels in Hispanic and African Americans. J Clin Endocrinol Metab 93:3381–3388PubMedCrossRefGoogle Scholar
  39. 39.
    Dawson-Hughes B, Harris S, Kramich C, Dallal G, Rasmussen HM (1993) Calcium retention and hormone levels in black and white women on high- and low-calcium diets. J Bone Miner Res 8:779–787PubMedCrossRefGoogle Scholar
  40. 40.
    Bell NH, Epstein S, Greene A, Shary J, Oexmann MJ, Shaw S (1985) Evidence for alteration of the vitamin D-endocrine system in obese subjects. J Clin Invest 76:370–373PubMedCrossRefGoogle Scholar
  41. 41.
    Aloia JF, Talwar SA, Pollack S, Feuerman M, Yeh JK (2006) Optimal vitamin D status and serum parathyroid hormone concentrations in African American women. Am J Clin Nutr 84:602–609PubMedGoogle Scholar
  42. 42.
    Melamed ML, Michos ED, Post W, Astor B (2008) 25-hydroxyvitamin D levels and the risk of mortality in the general population. Arch Intern Med 168:1629–1637PubMedCrossRefGoogle Scholar
  43. 43.
    Liu PT, Stenger S, Li H, Wenzel L, Tan BH, Krutzik SR, Ochoa MT, Schauber J, Wu K, Meinken C, Kamen DL, Wagner M, Bals R, Steinmeyer A, Zugel U, Gallo RL, Eisenberg D, Hewison M, Hollis BW, Adams JS, Bloom BR, Modlin RL (2006) Toll-like receptor triggering of a vitamin D-mediated human antimicrobial response. Science 311:1770–1773PubMedCrossRefGoogle Scholar
  44. 44.
    Gutierrez OM, Mannstadt M, Isakova T, Rauh-Hain JA, Tamez H, Shah A, Smith K, Lee H, Thadhani R, Juppner H, Wolf M (2008) Fibroblast growth factor 23 and mortality among patients undergoing hemodialysis. N Engl J Med 359:584–592PubMedCrossRefGoogle Scholar
  45. 45.
    Ghandur-Mnaymneh L, Cassady J, Hajianpour MA, Paz J, Reiss E (1986) The parathyroid gland in health and disease. Am J Pathol 125:292–299PubMedGoogle Scholar

Copyright information

© International Osteoporosis Foundation and National Osteoporosis Foundation 2010

Authors and Affiliations

  • O. M. Gutiérrez
    • 1
    Email author
  • W. R. Farwell
    • 2
    • 3
  • D. Kermah
    • 4
  • E. N. Taylor
    • 5
    • 6
  1. 1.Division of Nephrology and Hypertension, Department of MedicineUniversity of Miami Miller School of MedicineMiamiUSA
  2. 2.Department of MedicineVeterans Affairs Medical CenterBostonUSA
  3. 3.Division of Aging, Department of Medicine, Brigham and Women’s HospitalHarvard Medical SchoolBostonUSA
  4. 4.Department of MedicineCharles Drew University of Medicine and ScienceLos AngelesUSA
  5. 5.Division of Nephrology and TransplantationPortlandUSA
  6. 6.Channing Laboratory, Brigham and Women’s HospitalHarvard Medical SchoolBostonUSA

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