Effect of vitamin D-fortified foods on bone health and osteoporosis: a scoping review and future policies focusing on the United Arab Emirates.

BackgroundAlthough broad-scale data might suggest low prevalence, millions of children in India still suffer from Vitamin A and Vitamin D deficiencies despite India’s existing guidelines for Vitamin A deficiency. To address the issue, the Government of India has recommended fortification of oil and milk to improve Vitamin A and Vitamin D consumption. However, there is limited information on the health benefits and cost-effectiveness of fortifying oil and milk at scale.ObjectiveTo estimate the health benefits and cost-effectiveness of supplementation programme and fortification of milk and oil among children under 5 years, pregnant women, women in the reproductive age group, and the elderly.Data and methodsTo measure the health benefits associated with supplementation and fortification of oil and milk, the number of DALYs that are currently lost due to Vitamin A and Vitamin D deficiencies were estimated. For Vitamin A related mortality, a reduction of 4%, 12% and 23% were assumed while the assumptions for estimating morbidity benefits were derived from Global Burden of Disease. For the costing exercise, we considered the following two scenarios: (1) high-dose vitamin A supplementation for children and pregnant women; (2) industrial fortification of oil for children, pregnant women, women in the reproductive age group, and the elderly.ResultsOverall, intervention related to Vitamin A could avert 1,119,044 Years of Life Lost (YLLs) at a 23% reduction, 194,616 YLLs at 4%, and 583,849 YLLs at 12% and 28,534 YLDs. Intervention related to Vitamin D could avert 99,219 YLDs. The total cost for supplying supplements to approximately 109,965 thousand children and 26,920 thousand pregnant women is around 26 million USD. The cost to fortify is 7.6 million USD for oil and 9.8 million USD for milk fortification for children and women. The overall cost effectiveness ratio of the fortification programme is 150.ConclusionFortification could emerge as a potentially superior long-term solution, considering the widespread consumption of oil and milk, offering a broader reach to the population.

Response to Levin Letter

Diagnosis and treatment of osteoporotic fractures

Exercise and calcium-vitamin D are independently recognized as important strategies to prevent osteoporosis, but their combined effects on bone strength and its determinants remain uncertain. To assess whether calcium-vitamin D(3) fortified milk could enhance the effects of exercise on bone strength, structure, and mineral density in middle-aged and older men. An 18-month factorial design randomized controlled trial in which 180 men aged 50-79 years were randomized to the following: exercise + fortified milk; exercise; fortified milk; or controls. Exercise consisted of progressive resistance training with weight-bearing impact activities performed 3 d/week. Men assigned to fortified milk consumed 400 ml/d of 1% fat milk containing 1000 mg/d calcium and 800 IU/d vitamin D(3). Changes in bone mineral density (BMD), bone structure, and strength at the lumbar spine (LS), proximal femur, mid-femur, and mid-tibia measured by dual energy x-ray absorptiometry and/or quantitative computed tomography. There were no exercise-by-fortified milk interactions at any skeletal site. Main effect analysis showed that exercise led to a 2.1% (95% confidence interval, 0.5-3.6) net gain in femoral neck section modulus, which was associated with an approximately 1.9% gain in areal BMD and cross-sectional area. Exercise also improved LS trabecular BMD [net gain 2.2% (95% confidence interval, 0.2-4.1)], but had no effect on mid-femur or mid-tibia BMD, structure, or strength. There were no main effects of the fortified milk at any skeletal site. A community-based multi-component exercise program successfully improved LS and femoral neck BMD and strength in healthy older men, but providing additional calcium-vitamin D(3) to these replete men did not enhance the osteogenic response.

12105 Background: Aromatase Inhibitor (AI) therapy and androgen deprivation therapy (ADT) significantly accelerate bone loss and increase fracture risk. Vitamin D (VITD) protects against bone loss, but it is unclear whether the recommended daily allowance (RDA; 600 IU/day for ages 51-70) of VITD is sufficient for cancer patients. Data from two RCTs were pooled to examine the safety and efficacy of high-dose VITD versus the RDA of VITD on bone mineral density (BMD). Methods: 164 breast and prostate cancer patients on AIs and ADT, respectively, with low VITD (<32 ng/ml) were randomized to either high-dose VITD (50,000 IU/week; n=99) or placebo (n=65) for 24 weeks. All subjects received 600 IU/day of VITD. Of the 99 subjects assigned to high-dose VITD, 38 breast subjects also received the Exercise for Cancer Patients (EXCAP) program combining walking and resistance training. Serum VITD and calcium were assessed at weeks 0, 6, 12, 18, and 24. BMD was assessed at the hip and spine via DXA at weeks 0 and 24. The effect of high-dose VITD was tested via ANCOVA model adjusted for cancer type, baseline BMD and VITD. Results: High-dose VITD significantly reduced the amount of hip BMD loss versus the RDA of VITD (high-dose VITD: −0.8% vs placebo: −2.6%; p<0.01) over 24 weeks. Hip BMD loss was greater for subjects on ADT (high-dose VITD: −1.5% vs placebo: −4.1%; p=0.03) than subjects on AI therapy (high-dose VITD: −0.2% vs placebo: −1.7%; p=0.02). Among the high-dose VITD group, there was no BMD difference at the total hip between those who received EXCAP exercise vs no EXCAP (p=0.96). The largest differences in BMD were for those with lower baseline VITD levels (<27 ng/ml) for both total hip (high-dose VITD: −0.6% vs placebo: −3.2%; p<0.001) and femoral neck (high-dose VITD: +0.2% vs placebo: −2.4%; p=0.03). No between-group pooled differences were noted for total spine BMD (high-dose VITD: −0.2% vs placebo: −0.1%; p=0.82). High-dose VITD increased serum VITD without negatively affecting serum calcium (Table). Conclusions: High-dose VITD was safe and effective in significantly reducing hip BMD loss, with the largest benefit in those with lower baseline VITD levels. A phase III RCT is needed to confirm these findings. NCI Funding: K07 CA168911/R21 CA175793/UG1 CA189961/T32 CA102618 Clinical trial information: NCT02064946, NCT01419730 . [Table: see text]

Vitamin concentrates with vitamins A and D are used for fortification of fluid milk. Although many of the degradation components of vitamins A and D have an important role in flavor/fragrance applications, they may also be source(s) of off-flavor(s) in vitamin fortified milk due to their heat, oxygen, and the light sensitivity. It is very important for the dairy industry to understand how vitamin concentrates can impact flavor and flavor stability of fluid milk. Currently, little research on vitamin degradation products can be found with respect to flavor contributions. In this review, the history, regulations, processing, and storage stability of vitamins in fluid milk are addressed along with some hypotheses for the role of vitamin A and D fortification on flavor and stability of fluid milk.

Contraception

Biomechanics of fracture: is bone mineral density sufficient to assess risk?

Effects of cholecalciferol supplementation and optimized calcium intakes on vitamin D status, muscle strength and bone health: A one-year pilot randomized controlled trial in adults with severe burns

There is still controversy over the effect of vitamin D3 supplementation on bone health. The effects of vitamin D3 supplementation on bone mineral density (BMD) and markers of bone turnover, as well as the dose-response relationship between vitamin D3 and bone health in adults, were evaluated. The PubMed, Scopus, Cochrane, Web of Science, and AGRIS databases were searched for articles published through April 30, 2022. Thirty-nine of the 6409 records identified met the inclusion criteria. Data were extracted from articles by 2 authors, and data extraction was cross-checked independently. A random-effects model was used to estimate the pooled effect size and the associated 95%CI for the effect of vitamin D3 for each outcome. A one-stage random-effects dose-response model was used to estimate the dose-response relationship between vitamin D3 supplementation and BMD. Results of meta-analysis showed a beneficial effect of vitamin D3 at the lumbar spine (standardized mean difference [SMD] = 0.06; 95%CI, 0.01-0.12) and femoral neck (SMD = 0.25; 95%CI, 0.09-0.41). Dose-response analysis revealed a linear relationship between vitamin D3 supplementation doses and BMD at the femoral neck, lumbar spine, and total hip sites. No significant effect of vitamin D3 supplementation on whole-body or total hip BMD was observed (P > 0.05). Vitamin D3 supplementation significantly decreased BMD at both proximal and distal forearm (SMD = -0.16; 95%CI, -0.26 to -0.06). The variables of ethnicity, age, baseline 25-hydroxyvitamin D (25[OH]D), menopause status, vitamin D3 dosing frequency, and bone health status (P interaction = 0.02) altered the effect of vitamin D3 supplementation on BMD. Additionally, a nonlinear relationship between vitamin D3 supplement doses and markers of bone turnover was found. A protective effect of vitamin D3 supplementation on BMD of the lumbar spine, femoral neck, and total hip is implicated. PROSPERO registration number CRD42017054132.

Vitamin D plays an important role in maintaining bone and calcium metabolism. Vitamin D deficiency causes not only low bone mineral density via secondary hyperparathyroidism, but also impairment of bone mineralization. Vitamin D deficiency also increases the risk of fall. Thus, vitamin D deficiency results in increased fracture risk. Serum 25 (OH) D level reflects Vitamin D store and more than 30 ng/mL is recommended for bone health, but the measurement of serum 25 (OH) D is not reimbursed by Japanese health insurance system. Vitamin D supplementation to vitamin D deficient osteoporotics reduces the fracture incidence by both increasing bone mineral density and reducing falls. Evaluation of vitamin D status and its adequate supplementation are prerequisite for proper osteoporosis management.

Research on the relationship between bone and muscle health in low- and middle-income countries, particularly Central Asia, remains limited. To explore the correlation between muscle and bone health and to estimate the FRAX risk for major osteoporotic fractures (MOF) and hip fractures in the Mongolian population, stratified by age and sex. A cross-sectional study was conducted in Ulaanbaatar and regional Mongolia from May to August 2024. Handgrip strength, sarcopenia risk (SARC-F) and bone mineral density using peripheral DXA (BMD T-score) were assessed. Fracture risks were estimated using the FRAX model. Participants (n = 857; median age, 52 years; 53.0% women) had a median grip strength of 28 kg and a median BMD T-score of - 1.9. Most (69.5%) were at low sarcopenia risk (SARC-F < 4). SARC-F was moderately correlated with FRAX scores for MOF and hip fractures (r ≈ 0.27, p < 0.001) while grip strength was negatively correlated with FRAX scores(r = - 0.24, p < 0.001). Grip strength positively correlated with BMD T-scores (r = 0.22, p < 0.001). Fracture risks increased with age, with women showing higher rates than men. Higher sarcopenia risk (SARC-F ≥ 4) was associated with lower BMD and increased fracture risk. Lower grip strength (< 18 kg for women, < 28 kg for men) was linked to higher fracture risk and lower BMD. This study highlights the interconnected nature of muscle and bone health in the Mongolian population, demonstrating that lower grip strength and higher sarcopenia risk are significantly associated with increased fracture risk and reduced bone density. These findings underscore the importance of integrated strategies for musculoskeletal health assessment and fracture prevention, particularly in aging populations.

Objective To evaluate vitamin D status of the middle and old aged women in the urban area of Guiyang,and to explore the impact of vitamin D status on the bone mineral density.Methods A total of 511 healthy women,aged 40 to 79 years old,living in one of the urban communities in Guiyang,were selected by means of stratified cluster sampling.The levels of serum 25-hydroxyvitamin D [25 (OH) D] and intact parathyroid hormone (iPTH) were detected by radioimmunoassay.In addition,the bone mineral density (BMD) of hip,lumbar vertebrae 1-4 (L1-4),and neck of left femur were detected by Dual energy X ray absorptiometry.Results The average serum level of 25(OH)D in all subjects was (21.3 ± 7.9) ng/ml and that of iPFH was (29.3 ± 16.5) pg/ml.Severe deficiency [25 (OH) D＜ 10 ng/ml],deficiency [10 ≤ 25 (OH) D＜20 ng/ml],insufficiency [20 ≤ 25 (OH) D ≤ 30ng/ml],and sufficiency [25 (OH) D＞ 30 ng/ml] of vitamin D were ascertained in 5.3％,42.3％,37.9％,and 14.5％ of the total cases respectively.The morbidity of secondary hyperparathyroidism was 4.7％.The level of 25 (OH) D was positively correlated with the BMD of L1-4 and neck of left femur (both P＜0.01).The level of iPTH was negatively correlated with BMD of neck of left femur and L1-4 (both P＜0.05).Conclusion The majority of middle and old aged women in the urban area of Guiyang city were found to be of vitamin D deficiency and insufficiency.Vitamin D status is positively correlated with BMD at lumbar spine and proximal femur.Serum 25 (OH) level below 20 ng/ml is associated with raised parathyroid hormone,which increases the risk of osteoporosis. Key words: Vitamin D; Parathyroid hormone; Bone health; Middle and old aged women

Objective To investigate the effects of secondary hypoparathyroidism on bone metabolism and health management in patients with differentiated thyroid carcinoma(DTC). Methods Sixty patients with DTC who underwent total or subtotal thyroidectomy from January 2017 to May 2018 were enrolled. Among them, 30 patients had secondary hypoparathyroidism and hypocalcemia(hypothyroidism), while the other 30 patients had normal parathyroid function(control group). These two groups of patients were routinely examined for their parathyroid hormone(PTH), vitamin D, serum calcium, serum phosphorus, alkaline phosphatase(ALP), free triiodothyronine(FT3), free thyroxine(FT4), and thyroid stimulating hormone(TSH) at 1, 6, and 12 months after surgery and to determine dual-energy X-ray bone mineral density(BMD) and health-management-related indicators. PTH, vitamin D, serum calcium, serum phosphorus, and ALP in the parathyroid group were tested by conducting a paired t-test, and the indicators for the parathyroid and control groups(FT3, FT4, TSH, and L2 to L4, neck of femoral, femur trochanter, Ward’ s triangle BMD value) were compared by conducting an independent sample t-test. Results 1. A statistically significant difference in PTH, serum calcium, and serum phosphorus was observed among patients with hypothyroidism at 1 and 6 months after surgery, 6 months after surgery, and 12 months after surgery(PTH: t= –2.467, –2.753, P=0.021, 0.033; serum calcium: t=–2.941, –3.652, P=0.007, 0.002; serum phosphorus: t=4.550, 4.167, P=0.000, 0.004), but no significant difference was observed in terms of vitamin D and ALP(vitamin D: t=2.153, 1.965, P=0.062, 0.074; ALP: t=1.970, 1.672, P=0.061, 0.066); 2. At 12 months after surgery, the BMD of the neck of femoral decreased in the parathyroid group, showing a statistically significant difference from the control group(t=1.08, P=0.002). At 1, 6, and 12 months after surgery, the patients with hypothyroidism showed no significant differences from the control group in terms of thyroid function level(FT3, FT4, and TSH), lumbar vertebrae(L2 to L4), Ward’s triangle, and femur trochanter BMD(t=0.606 to 1.82, all P>0.05). 3. After taking calcium and vitamin D, the clinical symptoms of hypocalcemia in patients with hypothyroidism were significantly improved. Twelve months after surgery, hand and foot numbness and muscle spasms accounted for 6.67% of the symptoms, and after taking calcium and vitamin D, the medication compliance of the patients decreased to 80%. Conclusions 1.The BMD of neck of femoral in patients with hypothyroidism decreased at 12 months after surgery, and the BMD of lumbar vertebrae(L2~L4), Ward’s triangle and femur trochanter was not significant; 2.Most patients with parathyroid hypofunction showed clinical manifestations of hypocalcemia after DTC, and their symptoms were significantly relieved after the calcium and active vitamin D treatment. However, the medication compliance of these patients gradually declined. Therefore, health education and management should be further strengthened. Key words: Differentiated thyroid carcinoma; Hypoparathyroidism; Bone density; Health management

BackgroundAnorexia Nervosa (AN) is an eating disorder characterised by extremely low body weight and body image distortion. It is more common in females and is expected to become increasingly more...