Evaluation Of Bone Mineral Density Measurement Results In Adolescents

Abstract

Abstract

Background/Aims:Vitamin D insufficiency commonly represents in pregnant women, reproductive females and adolescents as well as in younger children.  30-60 % of maximal body bone mass is composed during puberty so suffering from vitamin D insufficiency in this stage causes deterioration of bone health in adulthood. In our study we investigated to evaluate bone mineral density in adolescent school children. 

Methods:Study has been conducted on three different district schools in Erzurum which have different socioeconomic status. Subjects aged between 13 and 17 from different socioeconomic status were chosen randomly between April 2008 and October 2008. None of subjects had medical complaints. Students with chronic diseases or history of drug use which associated with vitamin D metabolism were excluded. 343 and 246 adolescents were admitted to study in spring and autumn respectively. 

Results:198 of subjects (57.7%) were male and 145(42.3) were female. Average age was 15.44±1.28. In spring, vitamin D deficiency was detected in 17.7 % and vitamin D insufficiency was detected in 72% of subjects. At the end of summer these rates were 1.6% and 41.1% respectively. According to the Z score, osteoporosis was detected in 39(11.4%) of the cases at the end of winter and 17(7%) at the end of the summer. In winter vitamin D insufficiency was 9 times more common in girls than boys. The most important factors associated with Vitamin D levels were physical exercise and sunlight exposure durations. There was no significant relevance detected between vitamin D levels and bone mineral density (BMD). At BMD, in winter, 11.4 % showed osteoporosis, 20.1 % showed osteopenia and 68.5 % were normal. Most common complaint was joint and muscle pain in subjects with osteoporozis. 

Conclusions: In adolescents who appear healthy and have no significant complaints, 30% decrease in BMD content and 72% vitamin D deficiency indicate the severity of this problem. The importance of nutrition, sunbathing and physical activity for families and adolescents should be explained to prevent diseases such as Osteoporosis and Vitamin D deficiency which is a serious public health problem.

Keywords

• Bone mineral density,Adolescent Ricketts,Vitamin D Insufficiency,Subclinic Vitamin D Deficiency,Osteoporosis

Adölesanlarda Kemik Mineral Dansite Ölçüm Sonuçlarının Değerlendirilmesi

Abstract

Keywords

• Kemik dansitometrisi,Adölesan riketsi,D vitamini yetersizliği,Subklinik vitamin D eksikliği,osteoporoz

References

1. 1. Mora S, Gilsanz V. Establishment of peak bone mass. Endocrinol Metabol Clin N Am 2003; 32: 39-63
2. 2. Hich JZ, Kerstetter JE. Nutrition in bone health revisited: A story beyond calcium. J Am Coll Nutr 2000; 19(6):715-737
3. 3. Heaney RP, Abrams S, Hughes DB, Looker A, Marcus R et al. Peak bone mass. Osteoporos Int 2000;11:985-1009.
4. 4. Van der Sluis IM, de Muinck Keizer-Schrama SM. Osteoporosis in Childhood: Bone density of children in health and disease. J Ped Endocrinol Metab 2001;14:817-32.
5. 5. Siddiqui A M., Hayat Z. Kamfar. Prevalence of vitamin D deficiency rickets in adolescent school girls in Western region, Saudi Arabia. Saudi Med J 2007; Vol. 28 (3): 441-444.
6. 6. Das G, Crocombe S, Mcgrath M, Berry JL, Mughal M Z. 2006. Hypovitaminosis D among healthy adolescent girls attending an iner city school. Arch Dis Child 91:569-572.
7. 7. Castells S. Metabolic bone disease. In: Lifshitz F, editor. Pediatric Endocrinology third ed. New York: Marcel Dekker Press ; 1996:521-534.
8. 8. Molgaard C, Thomsen BL, Michalsen KF. Whole body mineral accretion in healthy children and adolescents. Arch Dis Child 1999;81:10-15.

9. 9. Steelman J, Zeitler P. Osteoporosis in pediatrics. Pediatrics in Review 2001;22(2):56-64.
10. 10. Schönau E. Problems of bone analyses in childhood and adolescence. Pediatr Nephrol 1998;12:420-429.
11. 11. Compston JE, Cooper C, Kanis JA. Fortnightly Review: bone densitometry in clinical practice. BMJ 1995;310:1507-1510.
12. 12. Cummings SR, Black DM, Nevitt MC, Browner W, Cauley J et al. Bone density at various sites for prediction of hip fractures. Lancet 1993;341:72-75.
13. 13. Nicholson J.F., and Pesce M.A.: Laborattory Medicine and Reference Tables, In “Nelson Textbook of Pediatrics”, Berhman R. E. (eds.), 15. Edition, 2037, W. B. Saunders Company, Philadelphia, 1996.
14. 14. Cashman KD, Hill TR, Cotter AA, Boreham C. et all. Low vitamin D status adversely affects bone health parameters in adolescents. Am J Clin Nutr 2008;87:1039-44.
15. 15. Goksen D, Darcan S, Coker M, Kose T. Bone mineral density of healthy Turkish children and adolescents. J Clin Densitom 2006;9:84-90.
16. 16. Richardson JP: Vitamin D deficiency – the once and present epidemic. Am Fam Physician 2005;71:241–242.
17. 17. Guillemant J, Le H-T, Maria A, Allemandou A, Peres G et al. Wintertime vitamin D deficiency in male adolescents: effects on paratyroid function and responce to vitamin D3 supplements. Osteoporos Int 2001;12:875-879.
18. 18. Neville CE, Robson PJ, Murray LJ, Strain JJ, Twisk J et al. The effect of nutritient intake on bone minera status in young adults: The Northern Ireland Young Hearts Project. Calcif Tissue Int 2001; 70:89-98.
19. 19. Outila TA, Karkkainen M, Lamberg-Allardt CJE. Vitamin D status effects serum parathyroid hormone concentrations winter in female adolescnts: associations with forearm bone mineral density. AmJ Clin Nutr 2001;74:206-210.
20. 20. Kristinsson JÖ, Valdimarsson Ö, Sigursson G et al. Serum 25 hydroxyvitamin D levels and bone mineral density in 16-20 years old girls: lack of association. J Intern Med 1998;243(5);381-388.
21. 21. Sullivan SS, Rosen CJ, Halteman WA, Chen TC, Holick MF. Adolescent girls in Maine are at risk for citamin D insufficiency. J. Am Diet Assos 2005; 105: 971-974.
22. 22. Hatun S, Islam O., Cizmecioglu F., Kara B., Babaoglu K., Berk F. & Gökalp A.S. Subclinical vitamin D deficiency is increased in adolescant girls who wear concealing clothing. Am Soc Nutr Sci 2005;135, 218-222.
23. 23. Öztürk A., Hasanoğlu A. ve Vurgun N.: Kayseri ve çevresinde 0-3 yaş grubu çocuklarda raşitizm görülme sıklığı, Erciyes Tıp Dergisi 1989; 11:212-216.
24. 24. Semba RD, Garrett E, Johnson BA, Guralnik JM, Fried LP. Vitamin D deficiency among older women with and without disability. Am J Clin Nutr 2000;72:1529-1534.
25. 25. Uusi –Rasi K, Haapasalo H, Kannus P, Pasanen M, Sievanen H. Determinants of bone mineralization in 8 to 20 year old Finnish females.Eur J Clin Nutr 1997; 51:54-59.
26. 26. Lehtonen-Veromaa M., Mottonen T., Irjala K., Karkkainen M., Lamberg-Allardt C., Hakola P., and Viikari J.: Vitamin D intake is low and hypovitaminosis D common in healthy 9- to 15-year-old Finnish girls, Eur. J. Clin. Nutr. 1999; 53:746-751.
27. 27. Moussavi M., Heidarpour R, Aminorroaya A, Pournaghshband Z, Amini M. Prevalence of vitamin D deficiency in Isfahani high school students in 2004. Horm Res 2005;64:144-148.
28. 28. Leonard MB, Zemel BS. Current concepts in pediatric bone disease. Pediatr Clin North Am 2002; 49(1):143–73.
29. 29. Smotkin-Tangorra M, Purushothaman R, Gupta A, Nejati G, Anhalt H, Ten S. Prevalence of vitamin D ınsufficiency in obese children and adolescents. J Pediatr Endocrinol Metab 2007;20 (7):817-823.
30. 30. Budak N, Çiçek B, Şahin H, Tutuş A. Bone mineral density and serum 25-hydroxyvitamin D level: is there any difference according to the dressing style of female university students. Int Journal of Food Science and Nutritiın. 2004. 569-575.
31. 31. Bowden SA, Robinson RF, Carr R, Mahan JD. Prevalence of vitamin D deficiency and insufficiency in children with osteopenia or osteoporosis reffered to a pediatric metabolic bone clicic. Pediatrics Vol 121, Number 6, June 2008.
32. 32. Oliveri MB, Wittich A, Mautalen C, chaperon A, Kizlansky A. Peripheral bone mass is not effacted by winter vitamin D deficiency in children and young adults from Ushuai. Calcif Tissue Int 2000; 67:220-224
33. 33. Cheng S, Tylavsky F, Kröger H, et all. Association of low 25-hydroxyvitamin D concertrations with elevated parathyroid hormone concentrations and low cortical bone density in early pubertal and prepubertal Finnsh girls. Am J Clin Nutr 2003;78:485-92.
34. 34. Zeghoud F., Delaveyne R., Rehel P., Chalas J., Garabedian M., and Odievre M.: D vitamini and pubertal maturation .interest and tolerance of D vitamini supplementation: during the winter season, Arch. Pediatr. 1995; 2:221-226,
35. 35. Narchi H., El Jamil M., and Kulaylat N.: Symptoamatic rickets in adolescence, Arch Dis Child 2001; 84:501-503.
36. 36. Dahifar H, Faraji A, Yassobi S, Ghorbani A. Asymptomatic rickets in adolescent girls. Indian J of Pediatr, Vol 74-June, 2007.116:634 – 639.
37. 37. Abdullah MA, Salhi HS, Barky LA, Okamoto E, et all. Adolescent rickets in Saudi Arabia: A rich and sunny country. J of Ped Endoc&Met, 2002;15, 1017-1025.