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Prevalence of vitamin D insufficiency among adolescents and its correlation with bone parameters using high-resolution peripheral quantitative computed tomography

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Abstract

Summary

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.

Introduction

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.

Methods

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.

Results

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.

Conclusion

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.

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Abbreviations

25(OH)Vit-D:

25-Hydroxy-vitamin D

aBMD:

Areal bone mineral density

BMC:

Bone mineral content

BMD:

Bone mineral density

BV/TV:

Bone volume-to-tissue volume ratio

Ca:

Calcium

CV:

Coefficient of variation

CtAr:

Cortical area

CtPm:

Cortical perimeter

CtTh:

Cortical thickness

Dcort:

Cortical volumetric bone mineral density

Dtrab:

Trabecular volumetric bone mineral density

Dtot:

Total volumetric bone mineral density

FFQ:

Food Frequency Questionnaire

HR-pQCT:

High-Resolution peripheral Quantitative Computed Tomography

pQCT:

Peripheral Quantitative Computed Tomography

PTH:

Parathyroid hormone

ROI:

Region of interest

SD:

Standard deviation

TbAr:

Trabecular area

TbN:

Trabeculae number

TbSp:

Trabecular separation

TbTh:

Trabecular thickness

vBMD:

Volumetric bone mineral density

Vit-D:

Vitamin D

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Acknowledgments

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.

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Authors and Affiliations

  1. Bone Quality and Health Centre, Department of Orthopaedics and Traumatology, Faculty of Medicine, The Chinese University of Hong Kong, Prince of Wales Hospital, General Office, 5/F LCW Clinical Sciences Building, Sha Tin, NT, Hong Kong, China

    T. F. Cheung, K. Y. Cheuk, F. W. P. Yu, V. W. Y. Hung, T. Y. Zhu, B. K. W. Ng, L. Qin, J. C. Y. Cheng & T. P. Lam

  2. Department of Chemical Pathology, Faculty of Medicine, The Chinese University of Hong Kong, Sha Tin, Hong Kong, China

    C. S. Ho

  3. Lee Hysan Clinical Research Laboratory, Faculty of Medicine, The Chinese University of Hong Kong, Sha Tin, Hong Kong, China

    K. M. Lee

  4. The Jockey Club School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, Sha Tin, Hong Kong, China

    S. S. Y. Ho

  5. Department of Paediatrics, Faculty of Medicine, The Chinese University of Hong Kong, Sha Tin, Hong Kong, China

    G. W. K. Wong

  6. SH Ho Scoliosis Research Laboratory, Sha Tin, Hong Kong, China

    J. C. Y. Cheng & T. P. Lam

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  1. T. F. Cheung
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Ethics declarations

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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Cheung, T.F., Cheuk, K.Y., Yu, F.W.P. et al. Prevalence of vitamin D insufficiency among adolescents and its correlation with bone parameters using high-resolution peripheral quantitative computed tomography. Osteoporos Int 27, 2477–2488 (2016). https://doi.org/10.1007/s00198-016-3552-4

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