Frequency of Vitamin D Deficiency in Postmenopausal Women Who Live in Ankara Region

Year 2019, Volume: 72 Issue: 2, 192 - 198, 02.10.2019

Zeynep Kendi Çelebi , Berna İmge Aydoğan Ali Uysal

Abstract

Objectives: The aim of this study is to define the frequency of vitamin D deficiency in postmenopausal women and to evaluate its implications on bone metabolism. Patients, who admitted to the Ankara University Faculty of Medicine Outpatient Clinics included to the study.

Materials and Methods: The study was conducted as a cross-sectional study. Postmenopausal women were scanned with DEXA and divided into three groups as osteoporosis, osteopenia, and the control group according to the T scores. During medical visit, patients’ clothing habits, and daily sunlight exposure rates have been scored from 1 to 4 with a questionnaire. Vitamin D, Parathyroid hormone (PTH), osteocalcin, Dependent personality disorder (DPD), calcium, phosphorus, Alkaline phosphotase (ALP) levels were compared.

Results: 29.8% of the women had osteoporosis, and 45.8% had osteopenia. Forty eight women (36.6%) were reported to have severe vitamin D deficiency (25-OH-D<10 ng/mL), 38 women (%29) moderate vitamin D deficiency (10≤25-OH-D<20 ng/mL), and 22 women (%16.8) mild vitamin D deficiency (20≤25-OH-D<30 ng/mL). Only 23 of the women (17.6%) had vitamin D levels higher than 30 ng/mL. It was observed that as the vitamin D levels dropped, PTH levels increased. The threshold for 25-OH-D level was estimated as 16.3 ng/mL. A negative relation was observed between vitamin D and osteocalcin and a positive relation was observed between ALP, osteocalcin and PTH.

Conclusion: Since the research to find out preventive effects of vitamin D on chronic diseases such as cancer, hypertension, diabetes mellitus and it is already known that vitamin D reduces the risk of falls and fracture, closer follow-up of patients with vitamin D levels below 16.3 ng/mL with appropriate vitamin replacement may be important in reducing bone loss.

Keywords

Postmenopausal Osteoporosis , Secondary Hyperparathyroidism , Vitamin D Deficiency

Ankara Bölgesinde Yaşayan Postmenapozal Kadınlarda D Vitamini Eksikliği Görülme Oranı

Abstract

Amaç: Ankara Üniversitesi Tıp Fakültesi Dahiliye Polikliniklerine başvuran postmenapozal kadınlarda D vitamini eksikliği sıklığının ve kemik metabolizması üzerine olan etkilerinin belirlenmesi.

Gereç ve Yöntem: Çalışma kesitsel bir çalışma olarak düzenlendi. Postmenapozal 131 kadın Dexa ile taranarak osteoporoz, osteopeni ve kontrol grubu olarak üçe ayrıldı. Hasta viziti sırasında hastaların giyimleri ve günlük aldıkları güneş ışığı miktarı 1’den 4’e kadar skorlandı. Bu kadınlarda D vitamini, Paratiroid hormon (PTH), osteokalsin, Bağımlı kişilik bozukluğu (DPD), kalsiyum, fosfor, Alkalin fosfataz (ALP) seviyeleri karşılaştırıldı.

Bulgular: Kadınların %29,8’inde osteoporoz, %45,8’inde osteopeni saptandı. Kırk sekiz kadında (%36,6) ağır D vitamini eksikliği (25-OH-D<10ng/ mL), 38 kadında (%29) orta dereceli D vitamini eksikliği (10≤25-OH-D<20 ng/mL arası), 22 kadında (%16,8) hafif D vitamini eksikliği (20≤25- OH-D<30 ng/mL arası) saptandı. Kadınların sadece 23’ünde (%17,6) D vitamini 30 ng/mL’nin üzerinde bulundu. D vitamini seviyesi azaldıkça PTH seviyesinde artış olduğu gösterildi. D vitamini eksikliği için eşik değer 16,3 ng/mL saptandı. Kemik belirteçleri değerlendirildiğinde D vitamini ilişkisi
incelendiğinde D vitamini ile osteokalsin arasında negatif ilişki, ALP ve osteokalsin ile PTH arasında pozitif ilişki gösterildi.

Sonuç: Dünya genelinde D vitamini eksikliğine sık rastlanmaktadır ve D vitaminin kanser, hipertansiyon, diabetes mellitus gibi kronik hastalıklardan koruyuculuğu, düşme ve kırık riskini azalttığı bilinmektedir. D vitamini seviyesi 16,3 ng/mL’nin altında olan vakaların uygun vitamin replasmanı ile daha yakın takibi kemik kaybını azaltmada önem arz etmektedir.

Keywords

D Vitamini Eksikliği , Postmenapozal Osteoporoz , Sekonder Hiperparatiroidizm

References

• 1. Lips P, Hosking D, Lippuner K, et al. The prevalence of vitamin D inadequacy amongst women with osteoporosis: an international epidemiological investigation. J Intern Med. 2006;260:245-254.
• 2. Neuprez A, Bruyère O, Collette J, et al.Vitamin D inadequacy in Belgian postmenopausal osteoporotic women. BMC Public Health. 2007;7:64.
• 3. Sahota O, Mundey MK, San P, et al. The relationship between vitamin D and parathyroid hormone: calcium homeostasis, bone turnover, and bone mineral density in postmenopausal women with established osteoporosis. Bone. 2004;35:312-319.
• 4. González G, Alvarado JN, Rojas A, et al. High prevalence of vitamin D deficiency in Chilean healthy postmenopausal women with normal sun exposure: additional evidence for a worldwide concern. Menopause. 2007;14:455-461.
• 5. Bruyère O, Malaise O, Neuprez A, et al. Prevalence of vitamin D inadequacy in European postmenopausal women. Curr Med Res Opin. 2007;23:1939- 1934.
• 6. Bandeira F, Griz L, Dreyer P, et al. Vitamin D deficiency: A global perspective. Arq Bras Endocrinol Metabol. 2006;50:640-646.
• 7. Hill TR, O’Brien MM, Lamberg-Allardt C, et al. Vitamin D status of 51-75-year-old Irish women: its determinants and impact on biochemical indices of bone turnover. Public Health Nutr. 2006;9:225-233.
• 8. Ono Y, Suzuki A, Kotake M, et al. Seasonal changes of serum 25-hydroxyvitamin D and intact parathyroid hormone levels in a normal Japanese population.J Bone Miner Metab. 2005;23:147-151.
• 9. Levis S, Gomez A, Jimenez C, et al. Vitamin d deficiency and seasonal variation in an adult South Florida population. J Clin Endocrinol Metab. 2005;90:1557-1562.
• 10. Need AG, O’Loughlin PD, Morris HA, et al. The effects of age and other variables on serum parathyroid hormone in postmenopausal women attending an osteoporosis center. J Clin Endocrinol Metab. 2004;89:1646- 1649.
• 11. Garnero P, Munoz F, Sornay-Rendu E, et al. Associations of vitamin D status with bone mineral density, bone turnover, bone loss and fracture risk in healthy postmenopausal women. The OFELY study. Bone. 2007;40:716-722.
• 12. Raisz LG. Pathogenesis of osteoporosis: concepts, conflicts, and prospects. J Clin Invest. 2005;115:3318-3325.
• 13. Bhattoa HP, Bettembuk P, Ganacharya S, et al. Prevalence and seasonal variation of hypovitaminosis D and its relationship to bone metabolism in community dwelling postmenopausal Hungarian women. Osteoporos Int. 2004;15:447-451.
• 14. Melin A, Wilske J, Ringertz H, et al. Seasonal variations in serum levels of 25-hydroxyvitamin D and parathyroid hormone but no detectable change in femoral neck bone density in an older population with regular outdoor exposure. J Am Geriatr Soc. 2001;49:1190-1196.
• 15. Tuzun S, Eskiyurt N, Akarirmak U, et al. Turkish Osteoporosis Society. Incidence of hip fracture and prevalence of osteoporosis in Turkey: the FRACTURK study. Osteoporos Int. 2012;23:949-955.
• 16. Öğüş E , Sürer H, Kılınç ŞA, et al. D Vitamini Düzeylerinin Aylara, Cinsiyete ve Yaşa Göre Değerlendirilmesi. Ankara Med J. 2015;15:1-5.
• 17. Atli T, Gullu S, Uysal AR, et al. The prevalence of Vitamin D deficiency and effects of ultraviolet light on Vitamin D levels in elderly Turkish population. Arch Gerontol Geriatr. 2005;40:53-60.
• 18. Thomas MK, Lloyd-Jones DM, Thadhani RI, et al. Hypovitaminosis D in medical inpatients . N Engl J Med. 1998;338:777-783.
• 19. Michaelsson K, Wolk A, Byberg L, et al.The seasonal importance of serum 25-hydroxyvitamin D for bone mineral density in older women. J Intern Med. 2017;281:167-178.
• 20. Saraiva GL, Cendoroglo MS, Ramos LR, et al. Influence of ultraviolet radiation on the production of 25 hydroxyvitamin D in the elderly population in the city of São Paulo (23 degrees 34’S), Brazil Osteoporos Int. 2005;16:1649-1654.
• 21. Adami S, Isaia G, Luisetto G, et al. ICARO Study Group Fracture incidence and characterization in patients on osteoporosis treatment: the ICARO study. J Bone Miner Res. 2006;21:1565-1570.
• 22. Jackson C, Gaugris S, Sen SS, et al. The effect of cholecalciferol (vitamin D3) on the risk of fall and fracture: a meta-analysis. QJM. 2007;100:185-192.
• 23. Rizzoli R, Eisman JA, Norquist J, et al. Risk factors for vitamin D inadequacy among women with osteoporosis: an international epidemiological study. Int J Clin Pract. 2006;60:1013-1019.
• 24. Arantes HP, Kulak CA, Fernandes CE, et al. Correlation between 25-hydroxyvitamin D levels and latitude in Brazilian postmenopausal women: from the Arzoxifene Generations Trial. Osteoporos Int. 2013;24:2707-2712.
• 25. Cummings SR , Melton LJ 3rd. Epidemiology and outcomes of osteoporotic fractures. Lancet. 2002;359:1761-1767.
• 26. Melton LJ 3rd . How many women have osteoporosis now?. J Bone Miner Res. 1995;10:175-177.
• 27. WHO Technical Report Series. Research on the Menopause in 1990s . Report of a wWHO Scientific Group 1994.
• 28. Lips P, Duong T, Oleksik A, et al. A global study of vitamin D status and parathyroid function in postmenopausal women with osteoporosis: baseline data from the multiple outcomes of raloxifene evaluation clinical trial. J Clin Endocrinol Metab. 2001;86:1212-1221.
• 29. Holick MF, Siris ES, Binkley N, et al. Prevalence of Vitamin D inadequacy among postmenopausal North American women receiving osteoporosis therapy. J Clin Endocrinol Metab. 2005;90:3215-3224.
• 30. Van Schoor NM, Visser M, Pluijm SM, et al. Vitamin D deficiency as a risk factor for osteoporotic fractures. Bone. 2008;42:260-266.
• 31. Xie Z, Xia W, Zhang Z, et al. Prevalence of Vitamin D Inadequacy Among Chinese Postmenopausal Women: A Nationwide, Multicenter, Cross- Sectional Study. Front Endocrinol (Lausanne). 2019;9:782.
• 32. Lips P. Vitamin D deficiency and secondary hyperparathyroidism in the elderly: consequences for bone loss and fractures and therapeutic implications. Endocr Rev. 2001;22:477-501.
• 33. Budak N, Çiçek B,Şahin H, et al. Bone mineral density and serum 25- hydroxyvitamin D level: is there any difference according to the dressing style of the female university students ? International Journal of Food Sciences and Nutrition, 2004;55:569-575.
• 34. Güler T, Sivas F, Başkan BM, ve ark. The effect of outfitting style on bone mineral density.Rheumatol Int. 2007;27:723-727.
• 35. Hayirlioglu DA, Gokaslan H, Cimsit C, ve ark. The impact of clothing style on bone mineral density among women in Turkey. Rheumatol Int. 2008;28:521–525.
• 36. Guzel R, Kozanoglu, ED, Guler-Uysal F, et al. Vitamin D Status And Bone Mineral Density Of Veiled And Unveiled Turkish Women. Journal Of Women’s Health & Gender-Based Medicine 2001;10
• 37. Napoli N, Strollo R, Sprini D, et al. Serum 25-OH Vitamin D in relation to Bone Mineral Density and Bone Turnover. Int J Endocrinol. 2014;2014:487463.
• 38. Need AG, Horowitz M, Morris HA, et al. Vitamin D status: effects on parathyroid hormone and 1, 25-dihydroxyvitamin D in postmenopausal women. Am J Clin Nutr. 2000;71:1577-1581.