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The Association Between Vitamin D Status and Parameters for Bone Density and Quality is Modified by Body Mass Index

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Abstract

The association of vitamin D status with bone mineral density (BMD) and Quantitative Ultrasound measurements (QUS) has been inconsistent in previous studies, probably caused by moderating effects. This study explored (1) the association of vitamin D status with QUS and BMD, and (2) whether these associations were modified by body mass index (BMI), age, gender, or physical activity. Two-independent cohorts of the Longitudinal Aging Study Amsterdam (LASA-I, 1995/1996, aged ≥65; LASA-II, 2008/2009, aged 61–71) and baseline measurement of the B-vitamins for the prevention of osteoporotic fractures (B-PROOF) study (2008–2011, aged 65+) were used. QUS measurements [broadband ultrasound attenuation (BUA) and speed of sound (SOS)] were performed at the calcaneus in all three cohorts (N = 1,235, N = 365, N = 1319); BMD was measured by Dual X-ray absorptiometry (DXA) in B-PROOF (N = 1,162 and 1,192 for specific sites) and LASA-I (N = 492 and 503). The associations of vitamin D status with BUA and BMD were modified by BMI. Only in persons with low-to-normal BMI (<25 kg/m2) and serum 25(OH)D <25 nmol/L was associated with lower BUA as compared to the reference group (≥50 nmol/L) in LASA-I and B-PROOF. Furthermore, in LASA-I, these individuals had lower BMD at the hip and lumbar spine. In LASA-II, no associations with BUA were observed. Vitamin D status was not associated with SOS, and these associations were not modified by the effect modifiers tested. The association between vitamin D status and BUA and BMD was modified by BMI in the older-aged cohorts: there was only an association in individuals with BMI <25 kg/m2.

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Acknowledgments

This study was partly funded by ZonMw. The Longitudinal Aging Study Amsterdam is largely supported by a grant from the Netherlands Ministry of Health, Welfare and Sports, Directorate of Long-Term Care. The serum 25(OH)D measurements were partly funded by Merck& Co. The B-PROOF study is funded by ZonMW, NZO (Dutch Diary Association), Orthica, NCHA (Netherlands Consortium of Healthy Aging), and Ministry of Economic Affairs, Agriculture, and Innovation. We would like to acknowledge our colleagues from the laboratories of the VU University Medical Center in Amsterdam, Isala Klinieken (Weezenland) in Zwolle, and Ziekenhuis Bernhoven in Oss and Veghel and team and participants of LASA and B-PROOF.

Conflict of interest

An unconditional grant was received from Merck & Co. for part of the serum 25(OH)D measurements. Evelien Sohl, Renate T de Jongh, Karin MA Swart, Anke W Enneman, Janneke P van Wijngaarden, Suzanne C van Dijk, Annelies C Ham, Nikita L van der Zwaluw, Elske M Brouwer-Brolsma, Nathalie van der Velde, Lisette CPGM de Groot, Saskia J te Velde, Paul Lips and Natasja M van Schoor declare that they have no conflict of interest.

Human and Animal Rights and Informed Consent

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

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Authors and Affiliations

  1. Department of Epidemiology and Biostatistics, EMGO Institute for Health and Care Research, VU University Medical Center, Van der Boechorststraat 7, Room A517, 1081 BT, Amsterdam, The Netherlands

    E. Sohl, K. M. A. Swart, S. J. te Velde & N. M. van Schoor

  2. Department of Internal Medicine and Endocrinology, VU University Medical Center, Amsterdam, The Netherlands

    R. T. de Jongh & P. Lips

  3. Department of Internal Medicine, Erasmus MC, University Medical Centre Rotterdam, Rotterdam, The Netherlands

    A. W. Enneman, S. C. van Dijk, A. C. Ham & N. van der Velde

  4. Division of Human Nutrition, Wageningen University, Wageningen, The Netherlands

    J. P. van Wijngaarden, N. L. van der Zwaluw, E. M. Brouwer-Brolsma & C. P. G. M. de Groot

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  1. E. Sohl
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  2. R. T. de Jongh
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  3. K. M. A. Swart
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Correspondence to N. M. van Schoor.

Additional information

Clinical trial register number for B-PROOF: Netherlands Trial: NTR 1333, ClinicalTrials.gov: NCT00696514.

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Sohl, E., de Jongh, R.T., Swart, K.M.A. et al. The Association Between Vitamin D Status and Parameters for Bone Density and Quality is Modified by Body Mass Index. Calcif Tissue Int 96, 113–122 (2015). https://doi.org/10.1007/s00223-014-9943-7

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