Osteoporosis International

, Volume 24, Issue 1, pp 179–186 | Cite as

Prevalence and seasonal variation of hypovitaminosis D and its relationship to bone metabolism in healthy Hungarian men over 50 years of age: the HunMen Study

  • H. P. Bhattoa
  • E. Nagy
  • C. More
  • J. Kappelmayer
  • A. Balogh
  • E. Kalina
  • P. Antal-Szalmas
Original Article



This study reports a high prevalence of hypovitaminosis D and low bone mineral density (BMD) in a healthy Hungarian male cohort over 50 years of age. Men with 25-hydroxyvitamin D levels of <75 nmol/L had a significantly higher 10-year hip and major osteoporotic fracture probability using the country-specific fracture risk assessment (FRAX) algorithm.


The aim of this study is to characterize the prevalence and seasonal variation of hypovitaminosis D and its relationship to bone metabolism in healthy Hungarian men over 50 years of age.


We determined levels of 25-hydroxyvitamin D (25-OH-D), PTH, osteocalcin (OC), C-terminal telopeptides of type-I collagen (CTX-I), procollagen type 1 amino-terminal propeptide (PINP), BMD at L1–L4 (LS) and femur neck (FN), daily dietary calcium intake, and the 10-year probability of hip fracture and a major osteoporotic fracture using the country-specific FRAX algorithm in 206 randomly selected ambulatory men.


The mean (range) age of the volunteers was 60 (51–81) years. The prevalence of hypovitaminosis D (25-OH-D, <75 nmol/L) was 52.9%. The prevalence of low (T-score < −1.0) BMD at the FN and LS was 45% and 35.4%, respectively. The mean (range) FRAX hip fracture and FRAX major osteoporotic fracture was 0.8% (0–9.4%) and 3.8% (1.7–16%), respectively. On comparing the vitamin D sufficient to the insufficient group, there was a statistically significant difference between the FRAX hip fracture and FRAX major osteoporotic fracture indexes. There was significant seasonal variation in the vitamin D levels; the lowest levels were measured in winter and the highest in summer.


A high prevalence of hypovitaminosis D and low BMD were observed in the studied Hungarian male population. This is the first study reporting higher 10-year hip and major osteoporotic fracture probability using the country-specific FRAX algorithm in individuals with hypovitaminosis D.


Bone health Bone markers FRAX Men Vitamin D 


  1. 1.
    Omdahl JL, Garry PJ, Hunsaker LA, Hunt WC, Goodwin JS (1982) Nutritional status in a healthy elderly population: vitamin D. Am J Clin Nutr 36:1225–1233PubMedGoogle Scholar
  2. 2.
    Khaw KT, Sneyd MJ, Compston J (1992) Bone density parathyroid hormone and 25-hydroxyvitamin D concentrations in middle aged women. BMJ 305:273–277PubMedCrossRefGoogle Scholar
  3. 3.
    Ooms ME, Lips P, Roos JC et al (1995) Vitamin D status and sex hormone binding globulin: determinants of bone turnover and bone mineral density in elderly women. J Bone Miner Res 10:1177–1784PubMedCrossRefGoogle Scholar
  4. 4.
    McAuley KA, Jones S, Lewis-Barned NJ, Manning P, Goulding A (1997) Low vitamin D status is common among elderly Dunedin women. N Z Med J 110:275–277PubMedGoogle Scholar
  5. 5.
    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 Int Med 115:505–512PubMedGoogle Scholar
  6. 6.
    Hollis BW (1996) Assessment of vitamin D nutritional and hormonal status: what to measure and how to do it. Calcif Tissue Int 58:4–5PubMedGoogle Scholar
  7. 7.
    Sherman SS, Hollis BW, Tobin JD (1990) Vitamin D status and related parameters in a healthy population: the effects of age, sex, and season. J Clin Endocrinol Metab 71:405–413PubMedCrossRefGoogle Scholar
  8. 8.
    van der Wielen RP, Lowik MR, van den Berg H et al (1995) Serum vitamin D concentrations among elderly people in Europe. Lancet 346:207–210PubMedCrossRefGoogle Scholar
  9. 9.
    Dawson-Hughes B, Harris SS, Dallal GE (1997) Plasma calcidiol, season, and serum parathyroid hormone concentrations in healthy elderly men and women. Am J Clin Nutr 65:67–71PubMedGoogle Scholar
  10. 10.
    Jacques PF, Felson DT, Tucker KL et al (1997) Plasma 25-hydroxyvitamin D and its determinants in an elderly population sample. Am J Clin Nutr 66:929–936PubMedGoogle Scholar
  11. 11.
    Chapuy MC, Preziosi P, Maamer M et al (1997) Prevalence of vitamin D insufficiency in an adult normal population. Osteoporos Int 7:439–443PubMedCrossRefGoogle Scholar
  12. 12.
    Woitge HW, Scheidt-Nave C, Kissling C et al (1998) Seasonal variation of biochemical indexes of bone turnover: results of a population-based study. J Clin Endocrinol Metab 83:68–75PubMedCrossRefGoogle Scholar
  13. 13.
    Lamberg-Allardt CJ, Outila TA, Karkkainen MU, Rita HJ, Valsta LM (2001) Vitamin D deficiency and bone health in healthy adults in Finland: could this be a concern in other parts of Europe? J Bone Miner Res 16:2066–2073PubMedCrossRefGoogle Scholar
  14. 14.
    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
  15. 15.
    Kudlacek S, Schneider B, Peterlik M et al (2003) Assessment of vitamin D and calcium status in healthy adult Austrians. Eur J Clin Invest 33:323–331PubMedCrossRefGoogle Scholar
  16. 16.
    Szulc P, Munoz F, Marchand F, Chapuy MC, Delmas PD (2003) Role of vitamin D and parathyroid hormone in the regulation of bone turnover and bone mass in men: the MINOS study. Calcif Tissue Int 73:520–530PubMedCrossRefGoogle Scholar
  17. 17.
    Maggio D, Cherubini A, Lauretani F et al (2005) 25(OH)D Serum levels decline with age earlier in women than in men and less efficiently prevent compensatory hyperparathyroidism in older adults. J Gerontol A Biol Sci Med Sci 60:1414–1419PubMedCrossRefGoogle Scholar
  18. 18.
    Bolland MJ, Grey AB, Ames RW, Mason BH, Horne AM, Gamble GD, Reid IR (2006) Determinants of vitamin D status in older men living in a subtropical climate. Osteoporos Int 17:1742–1748PubMedCrossRefGoogle Scholar
  19. 19.
    Saquib N, von Muhlen D, Garland CF, Barrett-Connor E (2006) Serum 25-hydroxyvitamin D, parathyroid hormone, and bone mineral density in men: the Rancho Bernardo study. Osteoporos Int 17:1734–1741PubMedCrossRefGoogle Scholar
  20. 20.
    Hannan MT, Litman HJ, Araujo AB et al (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
  21. 21.
    Araujo AB, Travison TG, Esche GR, Holick MF, Chen TC, McKinlay JB (2009) Serum 25-hydroxyvitamin D and bone mineral density among Hispanic men. Osteoporos Int 20:245–255PubMedCrossRefGoogle Scholar
  22. 22.
    McBeth J, Pye SR, O'Neill TW et al (2010) Musculoskeletal pain is associated with very low levels of vitamin D in men: results from the European Male Ageing Study. Ann Rheum Dis 69(8):1448–1452PubMedCrossRefGoogle Scholar
  23. 23.
    Looker AC, Orwoll ES, Johnston CC Jr 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
  24. 24.
    Zingmond DS, Melton LJ 3rd, Silverman SL (2004) Increasing hip fracture incidence in California Hispanics, 1983 to 2000. Osteoporos Int 15:603–610PubMedCrossRefGoogle Scholar
  25. 25.
  26. 26.
    Fardellone P, Sebert JL, Bouraya M, Bonidan O, Leclercq G, Doutrellot C, Bellony R, Dubreuil A (1991) Evaluation of the calcium content of diet by frequential self-questionnaire. Rev Rhum Mal Osteoartic 58(2):99–103PubMedGoogle Scholar
  27. 27.
  28. 28.
    Kanis JA, Melton LJ 3rd, Christiansen C, Johnston CC, Khaltaev N (1994) The diagnosis of osteoporosis. J Bone Miner Res 9:1137–1141PubMedCrossRefGoogle Scholar
  29. 29.
    Dawson-Hughes B, Heaney RP, Holick MF, Lips P, Meunier PJ, Vieth R (2005) Estimates of optimal vitamin D status. Osteoporos Int 16:713–716PubMedCrossRefGoogle Scholar
  30. 30.
  31. 31.
    Anonymous (1994) National Institute of Health Consensus Conference. Optimal calcium intake. JAMA 272:1942–1948CrossRefGoogle Scholar
  32. 32.
    Holick MF (1994) Vitamin D—new horizons for the 21st century. Am J Clin Nutr 60:619–630PubMedGoogle Scholar
  33. 33.
    Bhattoa HP, Bettembuk P, Ganacharya S, Balogh A (2004) Prevalence and seasonal variation of hypovitaminosis D and its relationship to bone metabolism in community dwelling postmenopausal Hungarian women. Osteoporos Int 15(6):447–451PubMedCrossRefGoogle Scholar
  34. 34.
    Holick MF (2007) Vitamin D deficiency. N Engl J Med 357:266–281PubMedCrossRefGoogle Scholar
  35. 35.
    Binkley N, Krueger D, Cowgill CS et al (2004) Assay variation confounds the diagnosis of hypovitaminosis D: a call for standardization. J Clin Endocrinol Metab 89:3152–3157PubMedCrossRefGoogle Scholar
  36. 36.
    Pye SR, Devakumar V, Boonen S et al (2010) Influence of lifestyle factors on quantitative heel ultrasound measurements in middle-aged and elderly men. Calcif Tissue Int 86(3):211–219PubMedCrossRefGoogle Scholar
  37. 37.
    Khosla S, Melton LJ 3rd, Atkinson EJ, O'Fallon WM, Klee GG, Riggs BL (1998) Relationship of serum sex steroid levels and bone turnover markers with bone mineral density in men and women: a key role for bioavailable estrogen. J Clin Endocrinol Metab 83(7):2266–2274PubMedCrossRefGoogle Scholar
  38. 38.
    Ross PD, Knowlton W (1998) Rapid bone loss is associated with increased levels of biochemical markers. J Bone Miner Res 3(2):297–302CrossRefGoogle Scholar
  39. 39.
    Nguyen TV, Meier C, Center JR, Eisman JA, Seibel MJ (2007) Bone turnover in elderly men: relationships to change in bone mineral density. BMC Musculoskelet Disord 8:13PubMedCrossRefGoogle Scholar
  40. 40.
    Bruyere O, De Cock C, Mottet C, Neuprez A, Malaise O, Reginster JY (2009) Low dietary calcium in European postmenopausal osteoporotic women. Public Health Nutr 12(1):111–114PubMedCrossRefGoogle Scholar
  41. 41.
    Adams JS, Hewison M (2010) Update in vitamin D. J Clin Endocrinol Metab 95(2):471–478PubMedCrossRefGoogle Scholar
  42. 42.

Copyright information

© International Osteoporosis Foundation and National Osteoporosis Foundation 2012

Authors and Affiliations

  • H. P. Bhattoa
    • 1
    • 2
  • E. Nagy
    • 1
  • C. More
    • 2
  • J. Kappelmayer
    • 1
  • A. Balogh
    • 2
  • E. Kalina
    • 1
  • P. Antal-Szalmas
    • 1
  1. 1.Department of Laboratory MedicineMedical and Health Science Center, University of DebrecenDebrecenHungary
  2. 2.Regional Osteoporosis Center, Department of Obstetrics and GynecologyMedical and Health Science Center, University of DebrecenDebrecenHungary

Personalised recommendations