Advertisement

Osteoporosis International

, Volume 27, Issue 1, pp 105–113 | Cite as

Serum 25-hydroxyvitamin D, parathyroid hormone, calcium intake, and bone mineral density in Spanish adults

  • J. M. Olmos
  • J. L. Hernández
  • P. García-Velasco
  • J. Martínez
  • J. Llorca
  • J. González-Macías
Original Article

Abstract

Summary

Vitamin D insufficiency is very common among Spanish community-dwelling adult subjects. A threshold of serum 25(OH)D around 30 ng/ml would be necessary for the prevention of secondary hyperparathyroidism and hip bone loss in our population, regardless of the dairy calcium ingestion.

Introduction

This study aims to assess 25-hydroxyvitamin D—25(OH)D—status in Spanish adult subjects and to analyze its relationships with serum PTH levels, calcium intake, and bone mineral density (BMD).

Methods

A total of 1811 individuals (1154 postmenopausal women and 657 men) aged 44–93 years participated in the study. Serum 25(OH)D, intact parathyroid hormone (PTH), aminoterminal propeptide of type I collagen (P1NP), and C-terminal telopeptide of type I collagen (β-CTX) levels were measured by electrochemiluminescence. BMD was determined by dual x-ray absorptiometry (DXA) at lumbar spine, femoral neck, and total hip.

Results

Serum 25(OH)D levels were below 10, 20, and 30 ng/ml in 5, 40, and 83 % of participants, respectively. There was a significant seasonal difference in mean serum 25(OH)D, with higher levels in summer–autumn. In multivariate analysis, 25(OH)D levels were negatively correlated with age, serum PTH and creatinine, body mass index, smoking, alcohol intake, and a number of chronic diseases, but positively with dairy calcium intake. The magnitude of the difference in serum PTH according to 25(OH)D quartiles was not influenced by calcium intake. A threshold of serum 25(OH)D around 30 ng/ml was observed for serum PTH and hip BMD.

Conclusions

Vitamin D insufficiency is very common among Spanish community-dwelling adult subjects. A threshold of serum 25(OH)D around 30 ng/ml would be necessary for the prevention of secondary hyperparathyroidism and hip bone loss in our population, regardless of the dairy calcium ingestion. Programs to improve vitamin D status may be required in our country.

Keywords

Bone mineral density Dairy calcium intake 25(OH)D Parathyroid hormone 

Notes

Acknowledgments

This work was supported by grants from the Instituto de Salud Carlos III—Fondo de Investigaciones Sanitarias (FIS, PI11/01092), Red Temática de Investigación Cooperativa en Envejecimiento y Fragilidad (RETICEF) (RD06/0013/1007), “Instituto de Salud Carlos III”, Ministerio de Economía y Competitividad, Spain, and Fondo Europeo de Desarrollo Regional (FEDER).

Conflicts of interest

None.

References

  1. 1.
    Holick MF (2007) Vitamin D, deficiency. N Engl J Med 357:266–281PubMedCrossRefGoogle Scholar
  2. 2.
    McKenna MJ (1992) Differences in vitamin D status between countries in young adults and the elderly. Am J Med 93:69–77PubMedCrossRefGoogle Scholar
  3. 3.
    Van der Wielen RP, Lowik MR, van der Berg H, de Groot LC, Haller J, Moreiras O, van Staveren WA (1995) Serum vitamin D concentrations among elderly people in Europe. Lancet 346:207–210PubMedCrossRefGoogle Scholar
  4. 4.
    Kuchuk NO, van Schoor NM, Pluijm SM, Chines A, Lips P (2009) Vitamin D status, parathyroid function, bone turnover, and BMD in postmenopausal women with osteoporosis: global perspective. J Bone Miner Res 24:693–701PubMedCrossRefGoogle Scholar
  5. 5.
    Bruyère O, Slomian J, Beaudart C, Buckinx F, Cavalier E, Gillain S, Petermans J, Reginster JY (2014) Prevalence of vitamin D inadequacy in European women aged over 80 years. Arch Gerontol Geriatr 59:78–82PubMedCrossRefGoogle Scholar
  6. 6.
    Spiro A, Buttriss JL, Vitamin D (2014) An overview of vitamin D status and intake in Europe. Nutr Bull 39:322–350PubMedPubMedCentralCrossRefGoogle Scholar
  7. 7.
    Lips P (2001) Vitamin D, deficiency and secondary hyperparathyroidism in the elderly: consequences for bone loss and fractures and therapeutic implications. Endocr Rev 22:447–501Google Scholar
  8. 8.
    Bates CJ, Carter GD, Mishra GD, O’Shea D, Jones J, Prentice A (2003) In a population study, can parathyroid hormone aid the definition of adequate vitamin D status? Osteoporos Int 14:152–159PubMedGoogle Scholar
  9. 9.
    Carter GD (2012) 25-Hydroxyvitamin D: a difficult analyte. Clin Chem 58:486–488PubMedCrossRefGoogle Scholar
  10. 10.
    Heaney RP (2005) Vitamin D, requirement in health and disease. Steroid Biochem Mol Biol 97:13–19CrossRefGoogle Scholar
  11. 11.
    Steingrimsdottir L, Gunnarson O, Indidason OS, Franzson L, Sigurdson G (2005) Relationship between serum parathyroid hormone levels, vitamin D sufficiency, and calcium intake. JAMA 294:2336–2341PubMedCrossRefGoogle Scholar
  12. 12.
    Adami S, Viapiana O, Gatti D, Idolazzi L, Rossini M (2008) Relationship between serum parathyroid hormone, vitamin D sufficiency, age, and calcium intake. Bone 42:267–270PubMedCrossRefGoogle Scholar
  13. 13.
    Kuchuck NO, Pluijm SM, van Schoor NM, Looman CWN, 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 94:1244–1250CrossRefGoogle Scholar
  14. 14.
    Hernández JL, Olmos JM, Pariente E, Martínez J, Valero C, García-Velasco P, Nan D, Llorca J, González-Macías J (2010) Metabolic syndrome and bone metabolism. Menopause 17:955–961PubMedCrossRefGoogle Scholar
  15. 15.
    Olmos JM, Hernández JL, Martínez J, Pariente E, Llorca J, González-Macías J (2010) Bone turnover markers in Spanish adult men. The Camargo Cohort Study. Clin Chim Acta 411:1511–1515PubMedCrossRefGoogle Scholar
  16. 16.
    Díez A, González-Macías J, Marín F, Abizanda M, Alvarez R, Gimeno A, for the ECOSAP study investigators et al (2007) Prediction of absolute risk of non-spinal fractures using clinical risk factors and heel quantitative ultrasound. Osteoporos Int 18:629–639CrossRefGoogle Scholar
  17. 17.
    Berry EM, Gupta MM, Turner SJ, Burns RR (1973) Variations in plasma calcium with induced changes in plasma specific gravity, total protein, and albumin. Br Med J 4:640–643PubMedPubMedCentralCrossRefGoogle Scholar
  18. 18.
    Looker AC, Orwoll ES, Johnston CC et al (1997) Prevalence of low femoral bone density in older U.S. adults from NHANES III. J Bone Miner Res 12:1761–1768PubMedCrossRefGoogle Scholar
  19. 19.
    Riancho JA, Valero C, Hernández JL, Olmos JM, Paule B, Zarrabeitia A, González-Macías J (2007) Biomechanical indices of the femoral neck estimated from the standard DXA output: age- and sex-related differences. J Clin Densitomet 10:39–45CrossRefGoogle Scholar
  20. 20.
    Ruston D, Hoare J, Henderson L, Bates CJ, Prentice A, Birch M (2004) National Diet and Nutrition Survey: adults aged 19–64 years. In Volume 4: nutritional status (anthropometry and blood analytes), blood pressure and physical activity. TSO. LondonGoogle Scholar
  21. 21.
    Rockell JEP, Skeaff CM, Williams SM, Green TJ (2006) Serum 25-hydroxyvitamin D concentrations of New Zealanders aged 15 years and older. Osteoporos Int 17:1382–1389PubMedCrossRefGoogle Scholar
  22. 22.
    Looker AC, Dawson-Hughes B, Calvo MS, Gunter EW, Sahynoun NR (2002) Serum 25-hydroxyvitamin D status of adolescents and adults in two seasonal subpopulations from NHANES III. Bone 30:771–777PubMedCrossRefGoogle Scholar
  23. 23.
    Dawson-Hughes B, Mithal A, Bonjour JP, Boonen S, Burckhardt P, Fuleihan GE et al (2010) IOF position statement vitamin D recommendations for older adults. Osteoporos Int 21:1151–1154PubMedCrossRefGoogle Scholar
  24. 24.
    Holick MF, Binkley NC, Bischoff-Ferrari HA, Gordon CM, Hanley DA, Heaney RP, Murad MH, Weaver CW (2011) Evaluation, treatment, and prevention of vitamin D deficiency: an Endocrine Society clinical practice guideline. J Clin Endocrinol Metab 96:1911–1930PubMedCrossRefGoogle Scholar
  25. 25.
    Gómez Alonso C, Naves ML, Fernández JL, Díaz-López JB, Fernández MT, Cannata J (2003) Vitamin D status and secondary hyperparathyroidism: the importance of 25-hydroxyvitamin D cut-off levels. Kidney Int 85:S44–S48CrossRefGoogle Scholar
  26. 26.
    González-Molero I, Morcillo S, Valdés S, Pérez-Valero V, Botas P, Delgado E, Hernández D, Olveira G, Rojo G, Gutiérrez-Repiso C, Rubio-Martín E, Menéndez E, Soriguer F (2011) Vitamin D deficiency in Spain: a population-based cohort study. Eur J Clin Nutr 65:321–328PubMedCrossRefGoogle Scholar
  27. 27.
    Quesada JM, Jans I, Benito P, Jimenez JA, Bouillon R (1989) Vitamin D status of elderly people in Spain. Age Ageing 18:392–397PubMedCrossRefGoogle Scholar
  28. 28.
    Pérez-Llamas F, López-Contreras MJ, Blanco MJ, López-Azorín F, Zamora S, Moreiras O (2008) Seemingly paradoxical seasonal influences on vitamin D status in nursing-home elderly people from Mediterranean area. Nutrition 24:414–420PubMedCrossRefGoogle Scholar
  29. 29.
    Calatayud M, Jódar E, Sánchez R, Guadalix S, Hawkins F (2009) Prevalence of deficient and insufficient vitamin D levels in a young healthy population. Endocrinol Nutr 56:164–169PubMedCrossRefGoogle Scholar
  30. 30.
    Gómez-de-Tejada MJ, Navarro MD, Saavedra P, Quesada JM, Jódar E, Sosa M (2014) Prevalence of osteoporosis, vertebral fractures and hypovitaminosis D in postmenopausal women living in a rural environment. Maturitas 77:282–286CrossRefGoogle Scholar
  31. 31.
    Quesada-Gómez JM, Diaz-Curiel M, Sosa-Henriquez M, Malouf-Sierra J, Nogues-Solan X, Gomez-Alonso C, Rodriguez-Mañas L, Neyro-Bilbao JL, Cortes X, Delgadillo J (2013) Low calcium intake and inadequate vitamin D status in postmenopausal osteoporotic women. J Steroid Biochem Mol Biol 136:175–177PubMedCrossRefGoogle Scholar
  32. 32.
    Docio S, Riancho JA, Pérez A, Olmos JM, Amado JA, González-Macías J (1998) Seasonal deficiency of vitamin D in children: a potential target for osteoporosis-preventing strategies. J Bone Miner Res 13:544–548PubMedCrossRefGoogle Scholar
  33. 33.
    Úbeda N, Basagoiti M, Alonso-Aperte E, Varela-Moreiras G (2007) Hábitos alimentarios, estado nutricional y estilos de vida en una población de mujeres menopáusicas españolas. Nutr Hosp 22:313–321PubMedGoogle Scholar
  34. 34.
    Bernal M, Cortés G, Giner A, Orden I, Horno M, Benedicto I (2010) Ha mejorado la dotación de vitamina D3 en España? Actuales niveles en una muestra de población. Rev Esp Geriatr Gerontol 45:15–18CrossRefGoogle Scholar
  35. 35.
    Mc Donald HM, Mavroeidi A, Barr RJ, Black AJ, Fraser WD, Reid DM (2008) Vitamin D status in postmenopausal women living at higher latitudes in the UK in relation to bone health, overweight, sunlight exposure and dietary vitamin D. Bone 42:996–1003CrossRefGoogle Scholar
  36. 36.
    Webb AR, Kline L, Holick MF (1988) Influence of season and latitude on the cutaneous synthesis of vitamin D3: exposure to winter sunlight in Boston and Edmonton will not promote vitamin D3 synthesis in human skin. J Clin Endocrinol Metab 67:373–378PubMedCrossRefGoogle Scholar
  37. 37.
    McLaughin J, Holick MF (1985) Aging decreases the capacity of human skin to produce vitamin D3. J Clin Invest 76:1536–1538CrossRefGoogle Scholar
  38. 38.
    Wacker M, Holick MF (2013) Sunlight and vitamin D: a global perspective for health. Dermatoendocrinol 5:51–108PubMedPubMedCentralCrossRefGoogle Scholar
  39. 39.
    Tovar-Sánchez A, Sánchez-Quiles D, Basterretxea G, Benedé JL, Chisvert A, Salvador A, Moreno-Garrido I, Blasco J (2013) Sunscreen products as emerging pollutants to coastal waters. PLoS One 8, e65451PubMedPubMedCentralCrossRefGoogle Scholar
  40. 40.
    Patel S, Hyer S, Barron J (2007) Glomerular filtration rate is a major determinant of the relationship between 25-hydroxyvitamin D and parathyroid hormone. Calcif Tissue Int 80:221–226PubMedCrossRefGoogle Scholar
  41. 41.
    Pasco JA, Henry MJ, Nicholson GC, Brennan SL, Kotowicz MA (2009) Behavioural and physical characteristics associated with vitamin D status in women. Bone 44:1085–1091PubMedCrossRefGoogle Scholar
  42. 42.
    Nimitphong H, Sritara C, Chailurkit LO, Chanprasertyothin S, Ratanachaiwong W, Sritara P, Ongphiphadhanakul B (2015) Relationship of vitamin D status and bone mass according to vitamin D-binding protein genotypes. Nutr J 14:29PubMedPubMedCentralCrossRefGoogle Scholar
  43. 43.
    Institute of Medicine (IOM) (2011) Dietary reference intakes for calcium and vitamin D. National Academies Press, Washington, DCGoogle Scholar
  44. 44.
    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 84:602–609PubMedPubMedCentralGoogle Scholar
  45. 45.
    Vieth R, Ladak Y, Walfish PG (2003) Age-related changes in the 25-hydroxyvitamin D versus parathyroid hormone relationship suggest a different reason why older adults require more vitamin D. J Clin Endocrinol Metab 88:185–191PubMedCrossRefGoogle Scholar

Copyright information

© International Osteoporosis Foundation and National Osteoporosis Foundation 2015

Authors and Affiliations

  • J. M. Olmos
    • 1
    • 2
  • J. L. Hernández
    • 1
    • 2
  • P. García-Velasco
    • 3
  • J. Martínez
    • 1
    • 2
  • J. Llorca
    • 1
    • 4
  • J. González-Macías
    • 1
    • 2
  1. 1.Bone Metabolic Unit, Department of Internal MedicineHospital Universitario Marqués de ValdecillaSantanderSpain
  2. 2.IDIVAL, Red Temática de Investigación Cooperativa en Envejecimiento y Fragilidad (RETICEF)University of CantabriaSantanderSpain
  3. 3.Centro de Salud CamargoSantanderSpain
  4. 4.Epidemiology Unit, Medical SchoolUniversity of Cantabria, Centro de Investigación Biomédica en Red Epidemiología y Salud Pública (CIBERESP)SantanderSpain

Personalised recommendations