Prevalence of vitamin D insufficiency among adolescents and its correlation with bone parameters using high-resolution peripheral quantitative computed tomography
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Vitamin D deficiency and insufficiency are highly prevalent among adolescents in Hong Kong, which is a sub-tropical city with ample sunshine. Vitamin D level is significantly correlated with key bone density and bone quality parameters. Further interventional studies are warranted to define the role of vitamin D supplementation for improvement of bone health among adolescents.
The relationship between bone quality parameters and vitamin D (Vit-D) status remains undefined among adolescents. The aims of this study were to evaluate Vit-D status and its association with both bone density and bone quality parameters among adolescents.
Three hundred thirty-three girls and 230 boys (12–16 years old) with normal health were recruited in summer and winter separately from local schools. Serum 25(OH) Vit-D level, bone density and quality parameters by Dual Energy X-ray Absorptiometry (DXA) and High-Resolution peripheral Quantitative Computed Tomography (HR-pQCT), dietary calcium intake, and physical activity level were assessed.
Sixty-four point seven percent and 11.4 % of subjects were insufficient [25 ≤ 25(OH)Vit-D ≤ 50 nmol/L] and deficient [25(OH)Vit-D < 25 nmol/L] in Vit-D, respectively. The mean level of serum 25(OH)Vit-D in summer was significantly higher than that in winter (44.7 ± 13.6 and 35.9 ± 12.6 nmol/L, respectively) without obvious gender difference. In girls, areal bone mineral density (aBMD) and bone mineral content (BMC) of bilateral femoral necks, cortical area, cortical thickness, total volumetric bone mineral density (vBMD), and trabecular thickness were significantly correlated with 25(OH)Vit-D levels. In boys, aBMD of bilateral femoral necks, BMC of the dominant femoral neck, cortical area, cortical thickness, total vBMD, trabecular vBMD, BV/TV, and trabecular separation were significantly correlated with 25(OH)Vit-D levels.
Vit-D insufficiency was highly prevalent among adolescents in Hong Kong with significant correlation between Vit-D levels and key bone density and bone quality parameters being detected in this study. Given that this is a cross-sectional study and causality relationship cannot be inferred, further interventional studies investigating the role of Vit-D supplementation on improving bone health among adolescents are warranted.
KeywordsAdolescent Bone quality DXA HR-pQCT Vitamin D insufficiency
Areal bone mineral density
Bone mineral content
Bone mineral density
Bone volume-to-tissue volume ratio
Coefficient of variation
Cortical volumetric bone mineral density
Trabecular volumetric bone mineral density
Total volumetric bone mineral density
Food Frequency Questionnaire
High-Resolution peripheral Quantitative Computed Tomography
Peripheral Quantitative Computed Tomography
Region of interest
Volumetric bone mineral density
The project was supported by General Research Fund, Research Grants Council of Hong Kong Special Administrative Region (Project number: 468411, 468809). The funding body has no role in design of study, data collection and analysis, manuscript preparation, or decision to publish.
Compliance with ethical standards
Ethical approval was obtained from the University and Hospital Clinical Research Ethics Committee. The study complied with the Declaration of Helsinki strictly. Detailed explanation of the study protocol was given in the presence of legal guardians. Written informed consents were obtained from all subjects and their legal guardians before examinations and measurements were conducted.
Conflicts of interest
Tsz Ping Lam received research funding from Pfizer. Jack Chun Yiu Cheng, Gary Wing Kin Wong, Suzanne Suet Ying Ho, Ling Qin, Kwong Man Lee, Bobby Kin Wah Ng, Tracy Yaner Zhu, Chung Shun Ho, Vivian Wing Yin Hung, Fiona Wai Ping Yu, Ka Yee Cheuk, and Tsz Fung Cheung declare that they have no conflict of interest.
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