Bone mineral density of the spine and femur in healthy Saudi females: relation to vitamin D status, pregnancy, and lactation

Knowledge and Awareness of Osteoporosis: A Survey of Physical Therapy Providers in Saudi Arabia

Background

Osteoporosis "OP" is classified as one of the most serious health conditions worldwide. OP increases the skeletal fracture risk by 35%, particularly at hip, spine, and wrist joints. Healthcare professionals should be aware of OP clinical signs and have good knowledge while managing all patients.

Objectives

This study aims to investigate the current level of osteoporosis knowledge and awareness among physical therapy providers in Saudi Arabia.

Methods

One hundred and sixty-eight physical therapy providers participated in this cross-sectional electronic survey from February to July of 2021. The participants completed the Osteoporosis Knowledge Assessment Tool questionnaire (OKAT). Descriptive analysis was utilized to assess the current level of osteoporosis knowledge among physical therapy providers.

Results

Among the 168 participants, 55% (n = 92) were over 31 years old and 45% (n = 76) were 30 years old or under. The majority of participants 37% (n = 62) had more than 10 years of experience, 45% (n = 76) mainly treat orthopedic conditions, and 70% (n = 117) live in the western region. The results showed that 67.9% (n = 114) of participants had good knowledge about osteoporosis, while 19.6% (n = 33) had poor knowledge, and only 12.5% (n = 21) had excellent knowledge.

Conclusion

Physical therapy providers in Saudi Arabia have a good knowledge of osteoporosis. The overall OP preventive measure knowledge questions were poor. It is crucial for physical therapy providers to act appropriately to prevent falls and mitigate any potential risks.

Association Between Vitamin D Level and Z-Score Changes of Bone Density in College-Age Saudi Girls: A Cross-Sectional Study

Objective

Vitamin D (VD) deficiency is a worldwide health problem. VD plays a crucial role in calcium homeostasis, phosphorus metabolism and bone health. Still much remain to understand the effect of VD deficiency on bone mass. This study aimed to evaluate the relationship between VD levels and bone mass density (BMD) among college-age Saudi females.

Methods

In a cross-sectional study, 460 females with a median age of 21 years, were enrolled, completed a comprehensive, structured questionnaire which was validated by experienced endocrinologist, a dietician, and a statistician. Body mass indexes (BMI) were calculated, and BMD was estimated through quantitative ultrasound to ankle. Serum VD, calcium, phosphate, parathyroid hormone, and alkaline phosphatase were measured using chemiluminescent immunoassay technique.

Results

VD deficiency reached up to 83.3% (66.9% insufficiency and 16.4% deficiency). Lower than normal BMD was detected in 18.3% of subjects, with only 1.1% having a non-age-matched high risk for osteoporosis. The significant independent predictors of Z-score were age of menarche, menstrual irregularities, dairy products consumption, physical activity, BMI, alkaline phosphatase, and history of previous VD supplementation.

Conclusion

VD deficiency and low BMD are highly prevalent among college-age Saudi females. Low BMD is not linked to serum level of VD but to its previous use as a supplementation. Early lifestyle changes, attention to gynecological problems, and prevention of VD deficiency are all needed to support BMD among these girls.

Relationship of caffeine regimen with osteopenia of prematurity in preterm neonates: a cohort retrospective study

BACKGROUND

Caffeine is a routinely prescribed pharmacological active compound in neonatal intensive care units (NICU) for treating apnea of prematurity (AOP), which also decreases the risk of bronchopulmonary dysplasia and cerebral palsy in neonates. Caffeine-induced excessive calcium loss can promote the development of metabolic bone disease (MBD) in preterm neonates. This study aimed to evaluate the effect of the caffeine regimen on the development of osteopenia of prematurity (OOP), using serum alkaline phosphatase (serum-ALP) concentrations as a surrogate marker at the 4^th week of life.

METHODS

This retrospective cohort study was conducted including neonates of < 32 weeks gestational age (GA) and birth weight < 1500 g, admitted to NICU from April-2017 to December-2018 and received caffeine therapy till 28 days of life for AOP. Based on serum-ALP levels, formed the high and low-ALP groups. Neonatal characteristics, caffeine regimen, risk factors for OOP, including duration of parenteral nutrition (PN), exposure to medicines associated with MBD, and intake of essential vitamins and minerals, were compared in both groups. Predictors of OOP were analyzed through logistic regression.

RESULTS

From the total of 268 participants, 52 (19%) developed OOP, mostly female (61.5%). In the high ALP group, the serum-ALP levels were significantly higher than in the low-ALP group (725.0 ± 143.8 vs 273.6 ± 55.0 units/L, p < 0.001). The high-ALP group received significantly (p < 0.001) higher daily and cumulative caffeine doses and were associated with a higher likelihood of developing OOP in this study cohort [cumulative dose (mg) (AOR = 1.082 95% CI 1.011 to 1.157) and daily dose (mg/kg/day) (AOR = 2.892 95% CI 1.392 to 6.007)]. Smaller GA was found directly related to OOP. Among the other medical risk factors, phosphorus intake was significantly low in the high-ALP group. No, significant relationship between duration of PN and use of steroids and diuretics, and intake of vitamins and minerals were identified.

CONCLUSION

The daily and cumulative doses of caffeine and smaller GA are associated with the development of OOP in this study cohort. Clinical randomized control studies are needed to validate the outcomes and determine the range of safest and most effective caffeine doses for treating AOP in preterm neonates.

The influence of lactation and its duration on bone mineral density in pregnancy and postpartum: A systematic review with meta-analysis

BACKGROUND

There is a plethora of research on the association of parity and duration of lactation with bone mineral density (BMD) during and after pregnancy. However, there are no consensus conclusions on the impact of the duration of lactation on BMD.

AIMS

The aim of this study was to examine the effect of pregnancy, and the duration of lactation on BMD during pregnancy, postpartum phase and 12 months post-delivery.

METHODS

The search terms 'parity' 'lactation' 'BMD' were searched for using PubMed, CINAHL, SCOPUS and EMBASE databases in English language. Two independent reviewers assessed the quality of the included studies using Critical Appraisal Skills Program (CASP) appraisal tool and extracted data on BMD (g/cm²) in Excel. A meta-analysis was conducted with a random effect model using Cochrane Review Manager (Rev 5.4) to analyse the outcome. Heterogeneity was assessed with Chi Squared and I² test. The duration of lactation was grouped into short lactation duration (SLD), ≤4 months and longer lactation duration (LLD) > 6 months.

RESULTS

Twenty-one studies were included in this review with four studies included in the meta-analysis. BMD reduced during pregnancy and lactation. Recovery and net gains in BMD followed weaning. However, at 12 months postpartum, women in the LLD group had significant losses at the lumbar spine while those in the SLD recovered BMD. Between the SLD and LLD groups, the change in BMD was not significant 0.48 g/cm² (95% CI -0.14, 1.10, p = 0.13). BMD losses were greater in primiparous women than multiparous women.

CONCLUSION

Women who breastfed for >6 months had significantly reduced BMD. However, compared to women that breastfed for a ≤4 months there was no significant change in BMD. Further investigation is needed to clarify the association between lactation and BMD in a postpartum population in those women extending breastfeeding beyond one year.

National guidelines on nutrient reference values for the healthy adult population and for pregnant or lactating women are based on heterogeneous sources of evidence: review of guidelines

Many countries provide dietary guidelines for health practitioners and/or the general population. However, there is no general, international guideline serving as a template for national dietary guidelines, and there is little to no consensus regarding reference values for different nutrients. The present review compared 27 national dietary guidelines for healthy adults as well as for pregnant and/or breastfeeding women, and analysed their quality and the evidence behind their recommendations. The guidelines were evaluated for their quality using the instrument Agree II, and found to be heterogeneous (overall quality score 14%-100%) and often insufficient (quality score < 50%) due to missing information about their methodology and sources of evidence. We analysed the evidence (number of studies, study types and publication years) of reference values of a number of nutrients using the five guidelines that provided the highest scores in the Agree II assessment. The reference values varied among guidelines, were rarely based on up-to-date meta-analyses, and were often based on insufficiently reported evidence (22/27 guidelines with quality score < 50%). We recommend systematic reviews of high quality studies to formulate future guidelines, and to use guidelines on how to write guidelines.

Prevalence and Predictors of Vitamin D Inadequacy: A Sample of 2,547 Patients in a Mediterranean Country

Background The aim of this retrospective study was to identify prevalence and risk factors for vitamin D inadequacy in a sunny Mediterranean country. Methods Results of 2,547 patients aged 19 to >60 years were included in this study. Data were derived from the laboratory database at Rafik Hariri University Hospital, Beirut, Lebanon, over a period of two years (2016-2017). Data included patient's age, gender, date of test, and vitamin D level. Females were questioned through phone call for marital status, parity, and veiling. Results The prevalence of vitamin D inadequacy was 83.5% overall, 86.4% in males, and 82.3% in females. At a cut-off of 20 ng/mL, vitamin D deficiency affected 63% of the studied population. A significant association was observed between vitamin D and age. The highest prevalence (71.2%) was found in females in the age group of 19-39 years, while no significant correlation with age was observed in males. Vitamin D levels were lower in veiled women (mean 25(OH)D = 17.9 ng/mL) compared to non-veiled women, although this difference was not significant. In addition, vitamin D inadequacy does not show a significant association with gender, parity, marital status, and season of the year. Conclusion The high prevalence of vitamin D inadequacy in our study in both males and females of all age groups calls for urgent actions at the national level to increase awareness in the population and to prevent the serious complications of vitamin D deficiency in all patients, especially those who are at a high risk.

Juvenile lupus and serum vitamin D levels: A cross-sectional study

BACKGROUND

Juvenile systemic lupus erythematosus (JSLE) is usually associated with vitamin D deficiency and low bone mineral density.

OBJECTIVES

To evaluate serum levels of 25-OH vitamin D in JSLE patients and to correlate these findings with disease activity and bone density.

METHODS

This study was conducted on 100 patients with JSLE and 100 healthy children as controls. Disease duration and SLEDAI for disease activity were evaluated. CBC, anti-dsDNA, C3,C4,24hr urinary proteins, creatinine, estimated glomerular filtration rate(e-GFR),Ca,P,PTH, 25 (OH) D levels, and bone mineral density(BMD)Z score were measured.

RESULTS

There were significant differences in mean 25(OH)D concentration between patients group (19.37 ± 9.72 ng/ml) and controls 35.90 ± 9.66 ng/ml(p < 0.05), with significant difference between active and inactive patients (p < 0.05).There were significant negative correlations between serum 25(OH)D and SLEDAI (r-0.545, p 0.001), steroid dose (r-0.561, p 0.001), anti-dsDNA (r-0.685, p 0.006), 24 hr-proteinuria (r-0.738, p 0.001) and PTH (r-0.335, p 0.001), significant positive correlations between 25(OH)D and C3 (r0.617, p 0.001),C4 (r0.544, p 0.001) serum Ca (r0.424, p 0.001) and Z score (r0.561, p 0.001),with non-significant correlations between 25(OH)D and serum P and both disease & steroid duration, (p > 0.05).

CONCLUSION

Vitamin D deficiency is common in JSLE, it's correlated significantly with disease activity and bone mineral density.

Trabecular bone score and bone mineral density reference data for women aged 20-70 years and the effect of local reference data on the prevalence of postmenopausal osteoporosis: a cross-sectional study from Sri Lanka

This paper describes age-specific BMD and TBS data of Sri Lankan women aged 20-70 years. No significant change of TBS and BMDs were seen between 20 and 50 years but a rapid decline was seen between 50 and 70 years. Prevalence of osteoporosis showed a marked difference when local reference data were used instead of manufacture provided data.

INTRODUCTION

It is recommended that country-specific reference data are used when estimating diagnostic and therapeutic thresholds in osteoporosis. This study estimated normative BMD and TBS reference data for women aged 20-70 in Sri Lanka and the effect of local reference data on the diagnosis of osteoporosis among postmenopausal women.

METHODOLOGY

A group of healthy community-dwelling women (n = 355) aged 20-70 was recruited from Galle district in the Southern province in Sri Lanka using stratified random sampling method. They underwent DXA adhering to the manufacturer's protocol and regional BMDs and TBS of the lumbar spine were measured.

RESULTS

The highest mean BMD in the spine (0.928 g/cm²) was seen in 20-29 age group while there was a delay in achieving the peak BMD in the femoral neck (0.818 g/cm²) and total hip (0.962 g/cm²) regions(40-49 years). BMDs showed only a mild change between 20 and 49 years but a rapid decline was seen after 50 years (spine 0.013, femoral neck 0.012, and total hip 0.011 g/cm² per year). The highest TBS was seen in 20-29 age group (1.371) and TBS trend with age was parallel to spine BMD. When the reference data provided by the manufacturer was used, 37% of postmenopausal women were found to have osteoporosis but this value changed to 17.6% when the local reference data were used.

CONCLUSION

We found a significant difference in the prevalence of osteoporosis when the local reference values were used instead of data provided by the manufacturer. However, representative data from more centers and fracture data are required before a recommendation to use local instead of international reference data can be stated.

Status of bone health and association of socio-demographic characteristics with Bone Mineral Density in Pakistani Females

Background & Objective:

The “silent thief” of bone osteoporosis is associated with various modifiable factors, identifying these factors is important in decreasing the prevalence of this highly prevalent disease. Therefore, this study was planned to identify these risk factors for osteoporosis in premenopausal and postmenopausal Pakistani women.

Methods:

A total of 1205 pre and postmenopausal females between the ages of 20 to 80 years were selected. Detailed history about the socio-demographic characteristics including age, education, profession, marital and resident status was recorded. Medical and gynecological history was also taken after informed consent Bone health of females was assessed using calcaneal ultrasound bone densitometer. SPSS 22.0 was used to analyze data.

Results:

Univariate analysis showed that age (30-39 yrs, and 60-69 yrs), occupation (housewives) and education (secondary and primary education, illiterate) were significantly associated with low bone mass density (LBMD). Multivariate analysis showed that age 30-39 years (OR=0.25 95%CI 0.13 – 0.49), age 40-49 years (OR=0.30 95%CI 0.15 – 0.59), age 50-59 years (OR=0.42 95%CI 0.22 – 0.79), primary education (OR=3.83, 95%CI 2.30 - 6.38) and illiteracy (OR=3.83 95%CI 2.52 – 5.82), were significantly associated with LBMD. The prevalence of osteopenia and osteoporosis was 29.8%, 27.2%, respectively, while 43% subjects had normal BMD.

Conclusion:

It is concluded that, within Pakistani population, the prevalence of osteopenia is high even at an early age group and the odds of having LBMD are more in less educated or illiterate women.

Vitamin D status in relation to age, bone mineral density of the spine and femur in obese Saudi females - A hospital-based study

The aim of the present study was to evaluate the association between Bone mineral density in lumber spine and femoral neck with serum total levels of vitamin D, sun exposure and Consumption of vitamin D Supplement in obese Saudi females aged between 30 and 54 years old. Recent attention to the high prevalence of osteoporosis and its association with low vitamin D levels in adults has raised the importance of vitamin D evaluation. A low level of vitamin D is considered to be one of the most important risk factors for osteoporosis. In this study; 120 obese Saudi females with no diagnosed chronic diseases attending the Outpatient clinic at king Khalid University hospital in Riyadh. Saudi Arabia, recruited randomly in period of 12 months. In this study, Serum levels of total Vitamin D were considered to be severe deficient if it was lower than 25 ng/mL, mild to moderate deficient if it was between 25 and 60 ng/mL and optimum level if it was 61–200 ng/mL. The results showed that; sun exposure was significantly affect and Correlate with serum level of Vitamin D in the subjects. In addition, daily consumption of Vitamin D supplement was significantly affect and Correlate with serum level of Vitamin D in the subjects of this study. Moreover, the results showed that; 50% of the age group (40–49 years old) having severe deficiency of Vitamin D. While, 50% of the age group (50–59 years old) having optimal level of Vitamin D. And these results mean that age is not Correlated with vitamin D deficiency in subjects of this study.

Bone health in adult women with ED: A longitudinal community-based study

Although Eating Disorders (ED) are known to affect bone health and development, little is known about the longitudinal effect of ED and ED behaviours on bone health in community dwelling adult women. Women (n = 3507) enrolled in the Avon Longitudinal Study of Parents and Children (ALSPAC) participated in a two-phase prevalence study to assess lifetime ED and ED behaviours (fasting, restrictive eating, vomiting and misuse of medication). Crude and adjusted linear regression methods investigated the association between ED diagnoses and behaviours, and total body, hip, leg and arm bone mineral density (BMD) DXA scans at mean ages of 48 and 52 years. Lifetime occurrence of Anorexia Nervosa (AN) was associated with lower BMD Z-scores for the whole body (mean difference (MD) = -0.28; 95% CI: -0.49, -0.05), hip (MD = -0.45; 95% CI -0.74, -0.16), leg (MD = -0.28; 95% CI -0.52, -0.03) and arm (MD = -0.44; 95% CI -0.68, -0.19) compared to no ED. This effect was mostly accounted for by lowest ever BMI. In post-hoc analyses, Restrictive AN, but not Binge-Purge AN was associated with a lower total body BMD Z-scores (MD = -0.37; 95% CI -0.62, -0.12). Lifetime Fasting and Restrictive Eating were associated with low BMD of the total body, hip, arm and leg in adjusted analyses, all p < 0.05. Both lifetime ED diagnoses and ED behaviours in a large community sample were predictive of low BMD in mid-life. This study confirms that the effects of AN, fasting and restrictive eating, and low BMI on bone health seen in clinical samples also occur in community samples.

Caffeine is a risk factor for osteopenia of prematurity in preterm infants: a cohort study

Background

Caffeine, the most commonly used medication in Neonatal Intensive Care Units, has calciuric and osteoclastogenic effects.

Methods

To examine the association between the cumulative dose and duration of therapy of caffeine and osteopenia of prematurity, a retrospective cohort study was conducted including premature infants less than 31 weeks and birth weight less than 1500 g. Osteopenia of prematurity was evaluated using chest X-rays on a biweekly basis over 12 weeks of hospitalization.

Results

The cohort included 109 infants. 51% had osteopenia of prematurity and 8% had spontaneous rib fractures. Using the generalized linear mixed model, caffeine dose and duration of caffeine therapy showed a strong association with osteopenia of prematurity. Steroids and vitamin D were also significantly correlated with osteopenia of prematurity while diuretic use did not show a statistically significant effect.

Conclusion

The cumulative dose and duration of therapy of caffeine, as well as steroid are associated with osteopenia of prematurity in this cohort. Future studies are needed to confirm these findings and determine the lowest dose of caffeine needed to treat effectively apnea of prematurity.

Implications of the nutrition transition for vitamin D intake and status in Aboriginal groups in the Canadian Arctic

Aboriginal Canadians have low intakes of vitamin D and are shifting away from consumption of traditional foods. Higher body mass index, skin pigmentation, and geographic latitude of residence further predispose Canadian Aboriginal populations to low vitamin D status. Low vitamin D status could compromise bone health and other health outcomes. Studies assessing vitamin D status of different Aboriginal groups are limited. The aim of this review is to examine the literature on vitamin D status and intakes of Canadian Aboriginal populations living in the Arctic. PubMed was searched for relevant articles published from 1983 to 2013. The prevalence of 25-hydroxy vitamin D deficiency ranged from 13.9% to 76.0% among children and adults in the summer. Furthermore, mean vitamin D intakes among all age groups were below the estimated average requirement. As vitamin D deficiency has been recently associated with chronic diseases, and Aboriginal populations living in the Arctic are at high risk for low vitamin D status, their vitamin D status should be assessed regularly across seasons.

Knowledge and attitudes about vitamin D, and behaviors related to vitamin D in adults with and without coronary heart disease in Saudi Arabia

Background

Vitamin D deficiency is prevailing in Saudi Arabia. Recent national data indicated an inverse association between vitamin D status and coronary heart disease (CHD), which increases concerns about vitamin D deficiency as a serious public health problem. Therefore, the current study aimed to investigate whether knowledge, attitudes and behaviors related to vitamin D contribute to the prevalence of vitamin D deficiency among adults with and without CHD in Saudi Arabia.

Methods

This case-control study consisted of 130 CHD cases and 195 matched controls. The study subjects were recruited from three hospitals in Saudi Arabia. Structured interviews were completed to collect data on participants’ socio-demographics, knowledge about vitamin D, attitudes toward sun exposure, and behaviors related to vitamin D. Also, serum vitamin D levels were measured.

Results

Severe vitamin D deficiency [serum 25(OH)D < 10 ng/mL] was more prevalent in the CHD cases than in the controls (46% and 3%, respectively). The total knowledge score was higher in the controls than in the cases [2.5 (±1.8) and 1.6 (±2.2), respectively]. The cases had better attitudes toward sun exposure compared to the controls (p = 0.001); however, the controls had better attitudes toward vitamin D compared to the cases (p = 0.001). The controls had a higher consumption of multivitamin supplements than the cases (6.7% and 0.8%, respectively; p = 0.010). Similarly, the controls had a higher consumption of butter (p = 0.001), oily fish (p = 0.004), and liver (p = 0.003) than the cases; however, the cases had a significantly higher intake of milk (p = 0.001). A multivariate logistic regression showed that vitamin D deficiency [25(OH)D < 20 ng/mL] was associated with low levels of knowledge about vitamin D, with an odds ratio of 1.82 (95% CI: 1.08–3.06, P = 0.024). Vitamin D deficiency was also associated with low intake of vitamin supplements, with an odds ratio of 4.35 (95% CI: 2.12–8.92, P < 0.001).

Conclusion

The present study revealed that low levels of knowledge about vitamin D and low consumption of vitamin supplementation, including vitamin D, calcium, multivitamin, and calcium supplements with vitamin D, may have contributed to the higher prevalence of vitamin D deficiency among the CHD cases than among the controls. Further studies using a qualitative approach are crucial to explore the underlying reasons for low knowledge about vitamin D and behaviors related to vitamin D including the intake of vitamin supplementation  that may contribute to the high burden of vitamin D deficiency in the country.

Electronic supplementary material

The online version of this article (doi:10.1186/s12889-017-4183-1) contains supplementary material, which is available to authorized users.

Pregnancy-related osteoporosis and spinal fractures

Pregnancy-related osteoporosis is a very rare condition characterized by the occurrence of fracture during pregnancy or the puerperium. Despite its relative rarity, it can be a dangerous condition that causes severe back pain, height loss and disability. Normal physiologic changes during pregnancy, genetic or racial difference, obstetrical history and obstetrical disease, such as preterm labor or pregnancy-induced hypertension, are presumed risk factors of pregnancy-related osteooporosis. However, exact etiology and pathogenesis are uncertain. The management and natural history are still poorly defined. Traditional medications for osteoporosis are calcium/vitamin D and bisphosphonate. Concerns with bisphosphonate include accumulation in bone and fetal exposure in subsequent pregnancies. The newly developed medication, teriparatide, has shown good results. We report six cases of pregnancy-related osteoporosis and spinal fracture with literature review.

Relationship between newborn craniotabes and vitamin D status

OBJECTIVE

In recent studies, vitamin D deficiency during pregnancy and early infancy has been reported to predispose children to many chronic diseases, except those of the skeletal system. The aim of this study was to investigate whether craniotabes in otherwise healthy newborns is physiological, its relationship to vitamin D deficiency and whether or not it requires treatment.

METHODS

A total of 150 healthy newborns with a weight of over 2000 g were included. Newborns were divided into two groups during postnatal discharge (1-3.'s day): those with and without craniotabes. The 25-hydroxy (OH) vitamin D levels of the newborns' mothers were measured, and all infants were re-evaluated for craniotabes, as well as tested to determine levels of serum calcium (Ca), phosphorus (P), alkaline phosphatase (ALP), parathyroid hormone (PTH) and 25(OH) vitamin D, urine calcium and creatinine.

RESULTS

Craniotabes was present in 45 (30%) of newborns enrolled in the study. Craniotabes of the newborns born during the winter months was significantly higher. PTH level was significantly higher in 1-month-old newborns with craniotabes than those without craniotabes. No relationship was observed between diet and craniotabes, but in exclusively breastfed infants, vitamin D level was statistically significantly lower. No statistically significant difference was found in the occurrence of craniotabes in newborns with or without vitamin D support.

CONCLUSION

The relationship between newborn craniotabes and maternal vitamin D deficiency is not clear. However, the present study illustrates that maternal vitamin D deficiency is still a major problem. Therefore, measures to prevent maternal vitamin D deficiency should be strengthened.

The Relationship between 25 (OH) D Levels (Vitamin D) and Bone Mineral Density (BMD) in a Saudi Population in a Community-Based Setting

BACKGROUND

Vitamin D deficiency has been linked to an increased risk of osteoporosis. Vitamin D deficiency has reached high levels in the Saudi population, but there is conflicting evidence both in the Saudi population, and worldwide, regarding the existence of a correlation between these low vitamin D levels and reduced BMD (bone mineral density), or osteoporosis.

OBJECTIVE

The objective of this study was primarily to determine whether there was a correlation between vitamin D deficiency and osteoporosis in the Saudi population. We aimed to investigate whether the high levels of vitamin D deficiency and insufficiency would translate to higher prevalence of osteoporosis, and whether there is a correlation between vitamin D levels and bone mineral density.

MATERIALS AND METHODS

This was a community based cross sectional study conducted in the Family Medicine Clinics at King Faisal Specialist Hospital and Research Centre in Riyadh, Saudi Arabia. Electronic records of 1723 patients were reviewed. Laboratory and radiology results were collected, including vitamin D levels, calcium levels, and bone mineral density scan results.

RESULTS

Among the whole population, 61.5% had moderate to severe vitamin D deficiency with levels less than 50nmol/L. 9.1% of the population had osteoporosis, and 38.6% had osteopenia. Among the whole population, there was no significant correlation between spine or total femoral BMD and serum 25(OH) D.

CONCLUSION

Vitamin D deficiency is prevalent in the Saudi population. However, no correlation has been found between vitamin D deficiency and reduced bone mineral density in any age group, in males or females, Saudis or Non-Saudis, in our population in Riyadh, Saudi Arabia.

Extremely High Prevalence of Maternal and Neonatal Vitamin D Deficiency in the Arab Population

BACKGROUND

Vitamin D deficiency is a global public health problem. The published literature on vitamin D deficiency is limited among Arab pregnant women and its association with different metabolic markers.

OBJECTIVE

To determine the prevalence of vitamin D deficiency in Arab pregnant women and neonates and its association with various biomarker profiles.

METHODS

This is a multicenter study taken from a large prospective project in Riyadh, the capital city of Saudi Arabia. Maternal biochemical levels were measured routinely. Maternal and neonatal 25(OH)D levels were assessed using a chemiluminescence immunoassay. A total of 1,097 pregnant women >16 years old with gestational ages <24 weeks were recruited from different tertiary hospitals in Riyadh between February 2011 and June 2012.

RESULTS

Almost 85% of pregnant subjects had 25(OH)D level <50 nmol/L. Vitamin D deficiency among neonates was 88%. Maternal 25(OH)D was significantly associated with neonatal 25(OH)D (r = 0.54, p < 0.01), as well as serum calcium (r = 0.16, p = 0.02) and phosphate levels (r = 0.17, p = 0.02), and had an inverse correlation with parathyroid hormone (r = -0.22, p = 0.001).

CONCLUSION

Maternal and neonatal vitamin D deficiency is alarmingly high in Arabs and significantly associated with each another. Universal screening for serum 25(OH)D may be appropriate for Arab mothers and vitamin D supplementation mandatory until term. The study puts a spotlight on vitamin D deficiency with the hope that health professionals will address it adequately to prevent the known long-term consequences for metabolism and bone health of both mothers and their children.

Low bone mineral density among young healthy adult Saudi women. Prevalence and associated factors in the age group of 20 to 36 years

Objectives:

To screen for low bone mineral density among young adult Saudi women using quantitative ultrasound (QUS) and exploring the high risk groups.

Methods:

A cross-sectional study was performed on 279, 20-36 years old female students and employees of Taibah University, Al Madinah Al Munawwarah, Kingdom of Saudi Arabia between January and May 2014. The study included bone status assessed using QUS, a structured self-reported questionnaire, anthropometric measurements, and evaluation of bone markers of bone metabolism.

Results:

The prevalence of low bone mineral density was 9%. Serum osteocalcin was found significantly higher in candidates with low bone mineral density, 20.67 ng/ml versus 10.7 ng/ml, and it was negatively correlated with T-scores. At any given point in time the exposed subjects to low calcium intake and inadequate sun exposure in the population were 11 times and 3 times more likely to have low bone mineral density, (adjusted odds ratio [OR], 11.0; 95%confidence interval [CI]=3.16, 38.34; p=0.001) and (adjusted OR, 3.32, 95%CI=1.27, 8.66, p<0.01).

Conclusion:

Early detection screening programs for low bone mineral density are needed in Saudi Arabia as it affects young Saudi women specially the high-risk group that includes young women with insufficient calcium intake and insufficient sun exposure. Serum osteocalcin as a biomarker for screening for low bone mineral density could be introduced.

Association between Vitamin D Status and Coronary Heart Disease among Adults in Saudi Arabia: A Case-Control Study

Recent evidence has pointed out an association between vitamin D deficiency and coronary heart disease (CHD). Due to the growing epidemic of CHD and vitamin D deficiency in Saudi Arabia, exploring the role of vitamin D in the prevention of CHD is crucial. The aim of this study was to examine the association between vitamin D status and CHD in Saudi Arabian adults. This case-control study included 130 CHD cases and 195 age-sex matched controls. Study subjects were recruited from three hospitals in the western region of Saudi Arabia. Study participants were interviewed face-to-face to collect data on their socio-demographic characteristics and family history of CHD. Fasting blood samples were collected, and serum levels of vitamin D, glucose, and total cholesterol were measured. Body weight, height, and blood pressure measurements were also recorded. Severe vitamin D deficiency (25(OH)D < 10 ng/mL) was much more prevalent in CHD cases than in controls (46% and 3%, respectively). The results of multivariate logistic regression showed that vitamin D deficiency (25(OH)D < 20 ng/mL) was associated with CHD, with an odds ratio of 6.5 (95% CI: 2.7-15, p < 0.001). The current study revealed that vitamin D deficiency is independently associated with CHD, suggesting an important predictor of CHD among Saudi adults.

Macronutrients Imbalance and Micronutrient Deficiencies among Healthy Saudi Physicians in Al Madina, Saudi Arabia

Context:

Diet and nutrition are important factors in the promotion and maintenance of good health. Physicians are involved in medical nutrition therapy of their patients; however, little is known on how physicians are personally adherent to good nutrition. The aim of the study was to assess the nutritional practices of Saudi physicians.

Subjects and Methods:

This is a pilot study that included 48 healthy Saudi physicians, of both genders, randomly selected from King Fahad Hospital, Madina, Saudi Arabia from June 2013 to December 2013. Self-reported dietary intake over 24 h was assessed. The adequacy of nutrient intake was evaluated by comparing the physicians’ intake to the dietary reference intakes (DRI).

Results:

The mean age of physicians was 41.6 ± 10 years, weight was 78 ± 20.2 kg, and body mass index was 27.76 ± 5.37 kg/m². They reported adequate daily consumption of food energy with high intake of carbohydrate (178.5 ± 46.4%) of DRI and high fat and protein intake from animal sources with low fiber intake (34.9 ± 25.1%) of DRI. Daily intakes for most of the micronutrients were lower than recommended with the exception of phosphorus, Vitamin E, and Vitamin B12 with no significant difference between males and females, except for lower intake of iron and Vitamin D by females. Vitamin D was the most severe deficient vitamin; 46.1 ± 53.9% of DRI.

Conclusions:

Nutritional practices of the sampled group of Saudi Physicians were not optimal. They have a high prevalence of micronutrients deficiencies. In addition, they tend to consume less fiber, more carbohydrate, and food from animal sources. Actions are needed to control nutrition status in Saudi Arabia, including the adoption of healthy eating pattern early in life, extensive nutrition and health education, and intervention strategies.

Vitamin D status and parathyroid hormone levels in relation to bone mineral density in apparently healthy Syrian adults

Vitamin D deficiency was highly prevalent in this study. More than half of the participants with vitamin D level less than 5 ng/mL had secondary hyperparathyroidism, which implicated a major bone health concern. After adjustment for potential predictors, parathyroid hormone (PTH) explained about 3 % of the variance in total hip bone mineral density (BMD).

PURPOSE

Bone mineral density (BMD) is known to be influenced by serum 25-hydroxyvitamin D (25OHD) and intact parathyroid hormone (PTH) levels. The relationship between 25OHD and PTH with BMD has not been well documented in Syrian adults. We aimed to determine how differences in serum 25OHD and PTH levels impacted hip and lumbar spine BMD among apparently healthy Syrian adults.

METHODS

25OHD and PTH were measured in 156 participants aged 18-53 years from Damascus and its surroundings. Lumbar spine and hip BMD measurements were measured by dual-energy X-ray absorptiometry using Hologic Discovery Wi densitometer. Multivariate regression models were used to investigate the relationships between 25OHD, PTH, and BMD.

RESULTS

All participants, except one male, had 25OHD <30 ng/mL (<75 nmol/L), and 89.1 % of them had 25OHD levels less than 20 ng/mL (50 nmol/L). Secondary hyperparathyroidism was significantly more prevalent in the lowest 25OHD quartile compared to that in the highest quartile (59 vs. 10.3 %, p < 0.0001). Mean bone mineral density at all sites in our participants was lower when compared to that of their Caucasian counterparts in Europe and North America. No significant correlation was found between 25OHD and BMD either at hip or at lumbar spine. In the multivariate analyses, after adjustment for potential predictors, PTH explained about 3 % of the variation in total hip BMD.

CONCLUSIONS

Low BMD was relatively frequent at all measured sites. PTH, but not 25OHD, was a predictor for total hip BMD in a young population.

A Cross-Sectional Study of Postpartum Changes in Bone Status in Indian Mothers

BACKGROUND

Bone turnover is high during lactation. However, studies on bone status of Indian urban mothers are scarce. Hence, the objective was to conduct a cross-sectional study on the lactation-related changes in bone health status of Indian mothers postpartum using Dual X-ray Absorptiometry (DXA) at 3 time points: within a week of delivery, at 1- and 3-years postpartum. We also explored the association of dietary calcium intake, physical activity, serum vitamin D status, and dietary traditional food supplements (Dietary Food supplements) with bone health.

METHODS

A cross-sectional study was conducted; 300 full-term, healthy primiparous women (28.6 ± 3.4 year) were randomly selected and categorized into 3 groups: 128 mothers within 7 days of delivery (Group A), 88 with 1-year-old children (B), and 84 with 3-year-old children (C). Anthropometry, lactation history, physical activity, diet, biochemical tests (vitamin D, parathyroid hormone), body composition, areal bone mineral density (a-BMD) at total body (TB), AP spine (APS), and dual neck femur (DF) were assessed by DXA (GE-Lunar DPX).

RESULTS

Significantly higher APS-BMD (mean ± SD) was observed in Group C (1.107 ± 0.098 g/cm(2)) than that in A (1.045 ± 0.131 g/cm(2)) (p < 0.05). When adjusted for breastfeeding practices, mean (±standard error) APS-BMD was lowest in women in Group A (1.024 ± 0.013 g/cm(2)), but was higher at 1-year (1.079 ± 0.02 g/cm(2)) and at 3-years postpartum (1.111 ± 0.019 g/cm(2)), though differences were significant only between groups A and C (p < 0.05). Most mothers from all 3 groups consumed inadequate amount of nutrients except dietary fat and showed low physical activity. Multiple regression analysis indicated that dietary calcium, moderate physical activity, serum vitamin D, and consumption of dietary food supplements were not significant predictors of APS-BMD (p > 0.1).

CONCLUSION

Prevalence of nutrient and vitamin D deficiencies, low physical activity, and poor sunlight exposure were major concerns in Indian lactating mothers; improvement in bone mass at APS was observed at 3-years which was most likely due to physiologic changes.

Low mineral density of a weight-bearing bone among adult women in a high fertility population

Evolutionary theories of aging posit that greater reproductive effort causes somatic decline given a fundamental trade-off between investing energy in reproduction and repair. Few studies in high fertility human populations support this hypothesis, and problems of phenotypic correlation can obscure the expected trade-off between reproduction and somatic condition. This cross-sectional study investigates whether greater reproductive effort is associated with reduced calcaneal bone mineral density (BMD) among female Tsimane forager-farmers of lowland Bolivia. We also investigate whether female Tsimane BMD values are lower than sex- and age-matched US reference values, despite the fact that Tsimane engage in higher physical activity levels that can increase mechanical loading. To measure calcaneal BMD, quantitative ultrasonography was performed on 130 women (mean ± SD age = 36.6 ± 15.7, range = 15-75) that were recruited regardless of past or current reproductive status. Anthropometric and demographic data were collected during routine medical exams. As predicted, higher parity, short inter-birth interval, and earlier age at first birth are associated with reduced BMD among Tsimane women after adjusting for potential confounders. Population-level differences are apparent prior to the onset of reproduction, and age-related decline in BMD is greater among Tsimane compared with American women. Greater cumulative reproductive burden may lower calcaneal BMD individually and jointly with other lifestyle and heritable factors. Fitness impacts of kin transfers in adulthood may determine the value of investments in bone remodeling, and thus affect selection on age-profiles of bone mineral loss.

Vitamin D deficiency among Jordanian university students and employees

Purpose

– This paper aims to assess the prevalence of vitamin D deficiency among female university students and employees at the Hashemite University (HU) and, then, to identify risk factors for developing vitamin D deficiency among this population. Vitamin D deficiency remains widespread in many countries, including Jordan, and has been linked to many diseases.

Design/methodology/approach

– In this cross-sectional study, blood samples were taken from 320 healthy females – 160 students and 160 employees – aged between 18 and 65 years old who presented for routine checkup at the medical center of HU. Level of direct sun exposure and barriers to getting enough sunlight (dress style, skin color and sunscreen use) were questioned. Serum levels of 25-hydroxyvitamin D were measured, and the daily intakes of vitamin D, calcium and phosphorous were estimated through completing an adopted food frequency questionnaire. All required data were collected using a face-to-face interview by trained dietitians. The software package ESHA was used to determine the daily intake from the nutrients.

Findings

– The prevalence of vitamin D deficiency (25-OHD < 25 nmol/L) was 31.2 per cent in female students compared to 20.5 per cent in female employees. Prolonged exposure to sun was independently related to vitamin D deficiency (odds ratio = 4.55); participants exposed for 30 minutes daily were at a higher risk for vitamin D deficiency. However, estimated vitamin D intake was not affected by age and working status.

Research limitations/implications

– The present study has some important limitations. First, this study based on serum 25-OHD results, which alone, without biochemical parameters such as parathyroid hormone (either primary or secondary), might be linked to accelerated degradation of 25-OHD and shorter half-life. Second, the half-life of 25-OHD was not consistently available. Third, the smaller sample size of participants. Finally, the present study did not distinguish between intake of vitamin D2 and D3. This limitation caused the inability to precisely evaluate the prevalence of vitamin D deficiency in the studied population.

Practical implications

– This study indicates that it is crucial to create awareness concerning the daily intake of vitamin D in the community to avoid long-term complications related to vitamin D deficiency, by using urgent measures including vitamin D supplementation and fortification of some highly consumed food, milk and other dairy products. Educational endeavors about sensible sun exposure should be implemented to improve vitamin D status among this population. The findings of the present study call for action at the national level to build strategies for health promotion about vitamin D supplementation in groups at risk for low supplementation (e.g. younger female students, with previous chronic diseases and poor sun exposure), and engage these populations in strategizing for successful and demographically relevant outreach and education in their own communities along with effort to prevent obesity and diabetes as well as raising awareness through simple programs to prevent and treat vitamin D deficiency among women living in Jordan.

Originality/value

– The high prevalence of vitamin D deficiency among female university students in this study emphasizes the necessity of vitamin D supplementation and calls for action to build strategies for health promotion concerning vitamin D supplementation.

2015 Guidelines for Osteoporosis in Saudi Arabia: Recommendations from the Saudi Osteoporosis Society

BACKGROUND AND OBJECTIVES

To provide guidelines for medical professionals in Saudi Arabia regarding osteoporosis.

DESIGN AND SETTINGS

A panel of 14 local experts in osteoporosis assembled to provide consensus based on the strength of evidence and expert opinions on osteoporosis treatment.

PATIENTS AND METHODS

The Saudi Osteoporosis Society (SOS) formed a panel of experts who performed an extensive published studies search to formulate recommendations regarding prevention, diagnosis, and treatment of osteoporosis in Saudi Arabia. Both local and international published studies were utilized whenever available.

RESULTS

Dual x-ray absorptiometry (DXA) scanning is still the golden standard for assessing bone mineral density (BMD). In the absence of local, country-specific fracture risk assessment tool (FRAX), the SOS recommends using the USA (White) version of the FRAX tool. All women above 60 years of age should be evaluated for BMD. This is because the panel recognized that osteoporosis and osteoporotic fractures occur at a younger age in Saudi Arabia. Hormone replacement therapy (HRT) is not recommended for treating postmenopausal women with osteoporosis. BMD evaluation should be performed 1-2 years after initiating intervention, and the assessment of bone turnover biomarkers should be performed whenever available to determine the efficacy of intervention.

CONCLUSION

All Saudi women above the age of 60 years must undergo a BMD assessment using DXA. Therapy decisions should be formulated with the use of the USA (White) version of the FRAX tool.

Risk factors and prevalence of vitamin d deficiency among Iranian women attending two university hospitals

BACKGROUND

Several studies indicated that there is a high prevalence of vitamin D deficiency in Middle East countries.

OBJECTIVES

The aim of this study was to determine the prevalence and assess some risk factors of vitamin D deficiency among women attending our clinics in Tehran, the capital of Iran.

PATIENTS AND METHODS

Five hundred and thirty-eight women aged 20-80 years were entered in this cross-sectional study from 2011 to 2012. Serum 25-hydroxy vitamin D levels were measured in all participants after recruiting their demographic and anthropometric data and past medical histories. Deficiency was defined as levels less than 35 nmol/L and classified as mild (≥ 25 nmol/L), moderate (12.5-25 nmol/L) and severe (≤ 12.5 nmol/L).

RESULTS

The prevalence of vitamin D deficiency was 69%; mild, moderate and severe degrees were seen in %10.4, %38.3, and %20.3 respectively. Analysis of logistic regression shows that age (OR:0.96, CI: 0.93-0.97), menopause (OR: 0.44, CI: 0.21-0.99) and consumption of multivitamin supplements (OR: 2.67, CI: 1.4-5) were independent predictive factors for Vitamin D deficiency.

CONCLUSIONS

This study showed a high prevalence of vitamin D deficiency among Iranian women especially in reproductive ages.

Prevalence and factors associated with low bone mineral density in Saudi women: a community based survey

Background

Low bone mineral density (BMD) is a public health issue in Saudi Arabia. This study measured the prevalence and factors associated with low BMD in Saudi women in Riyadh, Saudi Arabia.

Methods

A cross sectional study using two stage cluster sampling technique was conducted in Riyadh, 2009. Thirty clusters, each comprising of 300 houses were randomly chosen and from each cluster 38–40 households were selected to identify 1150 women of >40 years. Women were invited to primary health care center for filling of self-administered questionnaire (n = 1069) comprising of sociodemographic, health, diet and physical activity variables. 1008 women underwent screening for low BMD using the quantitative ultrasound technique. 535 (53%) women with positive screening test were referred to King Khalid Hospital for Dual X-ray Energy absorptiometry (DXA).

Results

362 women underwent DXA and 212 (39.6%) were screened low BMD either at lumbar spine or femur neck. Mean age of women was 55.26(±8.84) years. Multivariate logistic analysis found; being aged 61 to 70 years (OR 2.75, 95% CI: 1.32-1.48), no literacy (OR 2.97, 95% CI:1.44 - 6.12) or primary education (OR 4.12, 95% CI:2.05-8.29), history of fractures (OR 2.20, 95% CI:1.03- 4.69) and not drinking laban(diluted yogurt) (OR 2.81, 95% CI:1.47- 5.37) significantly associated with low BMD.

Conclusions

Women with low level of education, who do not drink laban and had history of fractures were at high risk of low BMD.

A case of teriparatide on pregnancy-induced osteoporosis

Pregnancy-induced osteoporosis is a rare disorder characterized by fragility fracture and low bone mineral density (BMD) during or shortly after pregnancy, and its etiology is still unclear. We experienced a case of a 39-year-old woman who suffered from lumbago 3 months after delivery. Biochemical evidence of increased bone resorption is observed without secondary causes of osteoporosis. Radiologic examination showed multiple compression fractures on her lumbar vertebrae. We report a case of patient with pregnancy-induced osteoporosis improved her clinical symptom, BMD and bone turnover marker after teriparatide therapy.

Compression fracture in postpartum osteoporosis

Osteoporosis is mainly a problem in postmenopausal women. However, we had a case of postpartum compression fracture associated with osteoporosis. A 42-year-old multiparous woman had undergone tertiary cesarean section without complications 1 month before. She was breast-feeding her baby and had no other bone-related complication history. She did not exercise on a regular basis. She experienced back pain abruptly and was diagnosed with a recent compression fracture of T12, L1, and L3. We evaluated this rare case of postpartum osteoporosis and compression fracture.

Vitamin D and its Relation to Bone Mineral Density in Postmenopause Women

Objective

Compare the level of vitamin D with the bone mineral density (BMD) in postmenopausal women, with or without fractures.

Methods

250 women with mean age of 71.1 were evaluated. The serum levels of vitamin D considered sufficient were ≥ 30 ng/mL, insufficient between 20 and 30 ng/mL and deficient < 20 ng/mL. The bone mineral density was measured and considered osteopenia when T value total of lumbar spine or hip was between -1 and -2.5 and osteoporosis < 2.5. The patients with fractures accounted for 25.2%.

Results

There was no significant difference in the vitamin D (ng/mL) levels among the age groups (p = 0.25), the levels of fractures (p = 0.79) and the levels of BMD (p = 0.76).

Conclusion

82% of the patients presented deficient and insufficient blood levels of vitamin D. Ours results showed any significant correlation between vitamin D levels and bone mineral density after adjusting for age.

Vitamin d deficiency among postmenopausal women with osteoporosis

BACKGROUND

Hypovitaminosis D is widely prevalent in India and is a formidable issue especially in postmenopausal women. The study intends to estimate the prevalence of vitamin D deficiency among postmenopausal women with osteoporosis.

METHODS

The study was performed at a referral teaching institute in north India between 2007 and 2009. One hundred and ninety postmenopausal osteoporotic women were enrolled and the clinical information was collected along with the assessment of biochemical parameters.

RESULTS & CONCLUSION

Serum vitamin D was found to be de- ficient in two third of patients. A significant correlation was observed between body mass index and bone mineral density at lumbar spine. Prevention and early detection of hypovitaminosis D is the key to reduce the incidence of osteoporosis among postmenopausal women.

Prevalence of low bone mass in postmenopausal Kuwaiti women residents in the largest province of Kuwait

We measured bone mineral density (BMD) in Kuwaiti women residents in the largest province of Kuwait state to highlight the BMD changes with each age, in particular when they reach the postmenopausal stage. Healthy Kuwaiti females between the ages of 10 and 89 years, who were residents in the largest province of Kuwait, were included in the study. After measurements of their height and weight, their bone mineral density of L2-L4 lumbar spine and femur (neck and total) was measured using dual-energy X-ray absorptiometry. Out of the studied 903 female subjects, 811 fulfilled the inclusion criteria. Their mean ± SEM age and body mass index (BMI) were respectively 47 ± 1 years and 30.8 ± 0.2 kg/m(2). Out of these 811 subjects, 454 were postmenopausal, and their age and BMI were 55.0 ± 0.3 years and 32.0 ± 0.3 kg/m(2), respectively. We have demonstrated that osteoporotic BMD of the spine and femur neck occurred in 20.2 and 12.5 % of postmenopausal Kuwaiti females, whereas osteopenic BMD of the spine and femur neck was observed at a frequency of 35.4 and 42.8 % of women, respectively. When the subjects were subdivided as per BMI, it was notable that overweight and obese had significantly higher BMD than normal weight postmenopausal women. BMD of the spine, femur neck, and femur total demonstrated significant positive correlations with body weight and BMI, whereas they demonstrated significant negative correlations with age. Low BMD of the femur neck and spine, reflected by the combination of osteopenia and osteoporosis, seemed to occur in more than half (55.3-55.6 %) of postmenopausal Kuwaiti women.

OBJECTIVES

Most of the studies on assessment of prevalence of low bone mass were focused in Caucasian population. Data on subjects of the Mediterranean area are limited. We measured bone mineral density (BMD) in Kuwaiti women residents in the largest province of Kuwait state to highlight the BMD changes with each age, in particular when they reach the postmenopausal stage.

SUBJECTS AND METHODS

Kuwaiti female subjects of different age groups between 10 and 89 years, who were residents in the largest province of Kuwait (Hawalli), were included in the study. They were included if they had been healthy over the last 12 months, had no past history of bone disease, and are not taking any prescription medication that may affect bone density. Their bone mineral density of L2-L4 lumbar spine and femur (neck and total) was measured using dual-energy X-ray absorptiometry.

RESULTS

Out of the studied 903 female subjects, 811 fulfilled the inclusion criteria and were included in the study. Their mean ± SEM age and body mass index (BMI) were respectively 47 ± 1 years and 30.8 ± 0.2 kg/m(2). Out of these 811 subjects, 454 were postmenopausal, and their age and BMI were 55.0 ± 0.3 years and 32.0 ± 0.3 kg/m(2), respectively. We have demonstrated that osteoporotic BMD of the spine and femur neck occurred in 20.2 and 12.5 % of postmenopausal Kuwaiti females, respectively, whereas osteopenic BMD of the spine and femur neck was observed at a frequency of 35.4 and 42.8 % of women. When subjects were subdivided as per BMI, it was notable that overweight and obese postmenopausal women had significantly higher BMD of lumbar spine, femur neck, and femur total than normal weight postmenopausal women. Bone mineral densities of the spine, femur neck, and femur total demonstrated significant positive correlations with body weight and BMI, whereas they demonstrated significant negative correlations with age.

CONCLUSION

Low BMD of the femur neck and spine, reflected by the combination of osteopenia and osteoporosis, seemed to occur in more than half (55.3-55.6 %) of postmenopausal Kuwaiti women residents at the largest province of Kuwait.

Low vitamin d and cardiovascular risk factors in males and females from a sunny, rich country

BACKGROUND

Low serum vitamin (vit) D levels are common even in sunny countries. We assessed the prevalence and relationship of low vit D with cardiovascular risk factors in Qatar.

METHODS

Data were collected retrospectively from January 2008 and November 2009. In patients who had low vi t D (< 30 ng/ml ) , demographic and clinical profiles were analyzed and compared in males and females.

RESULTS

The overall mean level of vit D among 547 patients was 14.4±11 ng/mL. Among the low vitamin D group, 56% were females (mean age 48±12) and 44% males (mean age 49.6±13). Severely low vit D levels (<10 ng/mL) were found in 231 (46%) patients with mean age of 46±12 years. Compared with females, males with low vitamin D were more likely to have diabetes mellitus (38 vs 22%, p=0.001), dyslipidemia (41 vs 29%, p=0.007), myocardial infarction (5.5 vs 1.5%, p=0.001) and angiographically documented coronary artery disease (CAD) (53 vs 17%, p=0.001). Multivariate logistic regression analysis showed that in the presence of low vit D, age and hypertension were independent predictors of CAD (OR 1.07;95% CI: 1.02-1.11) and OR 8.0; 95% CI: 1.67-39.82), respectively.

CONCLUSIONS

Our study supports the widespread prevalence of low vit D in sunny regions. Low vit D is associated with 3 times increase in the rate of MI among males. Hypertension increases the risk of CAD 8 times in the presence of low vit D regardless of gender.

Hypovitaminosis D and prevalent asymptomatic vertebral fractures in Moroccan postmenopausal women

BACKGROUND

Hypovitaminosis D is associated to accentuated bone loss. However, association between osteoporotic vertebral fractures (VFs) and vitamin D status has not been clearly established.

OBJECTIVE

To determine serum vitamin D status and to assess the association of vitamin D status with bone mineral density (BMD) and asymptomatic VFs prevalence using vertebral fracture assessment (VFA) in a cohort of Moroccan menopausal women.

METHODS

from June to September 2010, 178 menopausal women 50 years old and over were enrolled in this cross-sectional study. The mean ± SD (range) age, weight, height and BMI were 58.8 ± 8.2 (50 to 79) years, 73.2 ± 13.8 (35 to 119) Kgs, 1.56 ± 0.06 (1.43 - 1.79) m and 29.8 ± 5.9 (17.5 - 49.8) kg/m2, respectively. VFA images and scans of the lumbar spine and proximal femur were obtained using a GE Healthcare Lunar Prodigy densitometer. VFs were defined using a combination of Genant semiquantitative approach and morphometry. Serum levels of 25-hydroxyvitamin D (25(OH)D) were measured.

RESULTS

Among the 178 women, 45 (25.2%) had densitometric osteoporosis, and on VFA, VFs (grade 2 or 3) were detected in 20.2% while grade 1 were identified in 33.1%. The mean values of serum levels of 25(OH)D were 15.8 ± 11.6 ng/ml (range: 3.0 - 49.1) with 152 patients (85.3%) having levels <30 ng/ml (insufficiency) and 92 (51.6%) <10 ng/ml (deficiency). Stepwise regression analysis showed that presence of VFs was independently related to age, 25(OH)D and densitometric osteoporosis.

CONCLUSION

our study shows that advanced age, hypovitaminosis D and osteoporosis are independent risk factors for asymptomatic VFs in Moroccan postmenopausal women.

Peak bone mineral density and its determinants in an Asian Indian population

Data on peak bone mineral density (BMD) and its determinants in Asian Indians are limited. We studied the peak BMD and its determinants in Asian Indians. A total of 1137 young (age: 25--35yr) healthy volunteers of either sex (558 men and 579 women) were recruited for dietary evaluation, analyses of serum calcium, inorganic phosphorus, alkaline phosphatase, 25-hydroxyvitamin D [25(OH)D], and intact parathyroid hormone (iPTH) levels, and measurement of BMD with dual-energy X-ray absorptiometry. In men and women, peak bone mass (PBM) at the femoral neck, femoral trochanter, total femur, and lumbar spine was achieved between 25 and 30yr of age, whereas PBM at the femoral intertrochanter occurred between 30 and 35yr of age. Peak BMD was lower than that of Caucasians by 15.2--21.1% in men and 14.4--20.6% in women. On stepwise multiple regression, height and weight were the most consistent predictors of BMD at all sites in both groups. In men, 25(OH)D positively predicted BMD at the hip, whereas in women, serum iPTH negatively predicted BMD at the femoral trochanter and total femur. The study concluded that Asian Indians have significantly lower peak BMD than Caucasians and that weight and height are the most consistent predictors of BMD at all sites in both men and women.

Establishment of age-specified bone mineral density reference range for Indian females using dual-energy X-ray absorptiometry

We undertook this study to establish age-specified bone mineral density (BMD) reference range for Indian females using dual-energy X-ray absorptiometry. BMD at multiple skeletal sites was measured in 2034 healthy women aged 18--85yr. The effect of anthropometry and biochemical parameters on BMD was determined. Peak BMD was observed between 30 and 35yr at the hip, lumbar spine, and radius. Significant positive correlation of height and weight with BMD was observed at 33% radius, femur neck, and lumbar spine, whereas significant negative correlation was seen between serum alkaline phosphatase (ALP) and serum parathyroid hormone levels with BMD at aforementioned sites. On multivariate regression analysis, age, weight, and serum ALP were the most consistent contributors to variance in the BMD. Compared with age-matched US females, BMD of lumbar spine was significantly lower for our subjects in all age groups. Prevalence of osteoporosis among women aged older than 50yr was significantly higher based on Caucasian T-scores as opposed to using peak BMD/standard deviation values from the population under review at lumbar spine but not at femoral neck.

Fibromyalgia syndrome: is it related to vitamin D deficiency in premenopausal female patients?

There are a number of studies that have evaluated the relationship between fibromyalgia (FM) and vitamin D deficiency with conflicting results. The aim of this study was to assess vitamin D deficiency in patients with FM and to evaluate the relationship with the common symptoms of FM and levels of serum vitamin D. Forty premenopausal female fibromyalgia patients and 40 age- and sex-matched control subjects were included in the study. The demographic characteristics of all subjects, including age, sex, and body mass index, were recorded. The number of tender points was recorded, and the intensity of the widespread pain of the subjects was measured by the visual analog scale. The activities of daily living component of the Fibromyalgia Impact Questionnaire (FIQ-ADL), was used to assess physical functional capacity. Serum vitamin D was measured in both groups, and vitamin D levels <37.5 nmol/L were accepted as vitamin D deficiency. The vitamin D levels and clinical and laboratory characteristics of the patient and control groups were comparatively analyzed. The relationship between vitamin D levels and clinical findings of the FM patients were also determined. The mean age was 41.23 ± 4.8 and 39.48 ± 4.08 years for the patient and control groups, respectively. The pain intensity, number of tender points, and FIQ-ADL scores were higher in FM patients than in control subjects. The mean levels of vitamin D in the patient and control groups were determined to be 31.97 ± 15.50 and 28.97 ± 13.31 nmol/L, respectively (p > .05). The incidence of vitamin D deficiency was similar between the patient and control groups (67.5% vs. 70%). Vitamin D levels significantly correlated with pain intensity (r = -0.653; p = .001) and FIQ-ADL scores in the FM group (r = -0.344; p = .030). In conclusion, the results of this study indicate that deficiency of vitamin D is not more common in premenopausal female patients with FM than in control subjects without FM. However, the association between pain and vitamin D levels in FM patients emphasizes that hypovitaminosis of vitamin D in the FM syndrome may have an augmenting impact on pain intensity and functional status. Future studies are needed to show the effect of vitamin D supplementation in the reduction of pain intensity and disability in patients suffering from this chronic condition.

Vitamin D in the Persian Gulf: integrative physiology and socioeconomic factors

Countries of the Persian Gulf region--Bahrain, Iran, Iraq, Kuwait, Oman, Qatar, Saudi Arabia, and United Arab Emirates--have become increasingly modernized, resulting in a transformation of lifestyle based on technology, sedentary activity, lack of sunlight, and unhealthy dietary patterns. These factors have led to a higher prevalence not only of vitamin D undernutrition, but also chronic obesity, insulin resistance, prediabetes, and type 2 diabetes. This review explores the integrative physiologic effects of vitamin D with socioeconomic factors and propose a hypothesis-driven model for their contributions to obesity and diabetes in the Persian Gulf. Further research into these interactions may ultimately lead to novel preventive strategies and therapies for metabolic disorders in this geographic region.

Effect of diet and lifestyle factors on bone health in postmenopausal women

Our objective was to examine the effect of nutritional intake and lifestyle factors on bone mass in postmenopausal Saudi women. A total of 122 apparently healthy postmenopausal Saudi women were recruited from the Center of Excellence for Osteoporosis Research in Jeddah. A questionnaire on lifestyle habits and dietary intake was administered to all participants. Anthropometric and bone mineral density (BMD) values were measured. Fasting blood samples were taken to measure concentrations of bone-related parameters and hormones. Most of the sample population was found to be vitamin D deficient with a serum vitamin D level below 50 nmol/l. Those participants with normal BMD values had significantly lower serum vitamin D levels than osteopenic individuals (P < 0.05). Overall, mean total caloric, total fat, and saturated fat intakes were above recommended levels. Almost 60% of the total study population had lower calcium intake than the estimated average requirements whereas the whole population had vitamin D intake level below the estimated average requirements. Only BMD of the femoral neck showed significant correlations with serum vitamin D level and dietary cholesterol intake. After adjustment for confounding variables; serum vitamin D levels were significantly correlated with cholesterol intake. Dietary calcium intake was significantly correlated with intake of protein and fiber whereas dietary vitamin D intake was significantly correlated with intake level of total fat, all fatty acids, cholesterol, and fiber. Our findings reveal the important role of dietary vitamin D and calcium in osteopenic patients and the likely requirement for supplementation of these nutrients in the Saudi population.

Influence of vitamin D levels on bone mineral density and osteoporosis

BACKGROUND AND OBJECTIVES

The effects of vitamin D on bone mass remain to be understood. This study was conducted with the objective of evaluating the influence of 25-hydroxyvitamin D (25OHD) levels on bone mineral density (BMD) among Saudi nationals.

DESIGN AND SETTING

Cross-sectional study carried out at university hospital from 1 February 2008 to 31 May 2008.

SUBJECTS AND METHODS

Healthy Saudi men and women in the peak bone mass (PBM) age group and those aged ≥ 50 years were recruited from the outpatient department of King Fahd University Hospital, Al Khobar, Saudi Arabia, between February 1, 2008, and May 31, 2008. Patient age and sex were documented, and body mass index was calculated. Hematological, biochemical, and serum 25OHD tests were performed. BMD was determined by dual-energy x-ray absorptiometry of the upper femur and lumbar spine. Patients were divided into three groups, based on their 25OHD level.

RESULTS

Data from 400 patients were analyzed. Among individuals with a normal 25OHD level, 50% of women and 7% of men in the PBM age group and 26.4% of women and 49.2% of men aged ≥ 50 years had low bone mass. In patients with 25OHD insufficiency, 84.2% of women and 88.9% of men in the PBM age group and 83.3% of women and 80% of men aged ≥ 50 years had low bone mass. Results for patients with 25OHD deficiency revealed that none of the men and women in the PBM age group or ≥ 50 years old had normal BMD. Significant positive correlations between 25OHD level and BMD and significant negative correlations with parathyroid hormone were shown in most of the groups.

CONCLUSIONS

This study showed that the vitamin D level significantly influences BMD reading among Saudi individuals. Evaluation and treatment of hypovitaminosis D should be considered during management of low bone mass.

Age, race, weight, and gender impact normative values of bone mineral density

BACKGROUND

Osteoporosis and fractures represent a major public health issue. Accurate normative reference bone mineral density (BMD) values are vital for diagnosing osteoporosis. The generalizability of the T-score method across gender, race, and age in clinic decision-making has been debated. Our aim was to identify the best statistical model to derive normative BMD values in both men and women in the multiethnic United States population.

METHODS

The Third National Health and Nutrition Examination Survey was used as a data source. Gender- and race/ethnicity-stratified data analyses and modeling were conducted on 9779 persons (ages 20 to 65 years) who reported no conditions or medications likely to affect bone metabolism. Sampling and design effects were addressed using STATA 10. Model comparisons were conducted by partial F tests and residual plots.

RESULTS

Polynomial regression provided a statistically significant better fit than linear regression in predicting normative BMD in both men and women. Age-centered polynomial models provided the best model for predicting normative BMD values.

CONCLUSION

The gender- and race-specific lower limit of normal values obtained created a new classification method of low BMD, which might mitigate some of the T-score limitations in men and minority populations.