Lower 25OHD Levels Research Articles

Vitamin D deficiency influences histomorphometric features of bone in primary hyperparathyroidism

Introduction Vitamin D deficiency is common in patients with primary hyperparathyroidism (PHPT). The presence of low levels of vitamin D may affect the skeletal consequences of PHPT. Methods In this cross-sectional study, transiliac crest bone biopsies were performed after double tetracycline labeling in patients with mild PHPT and analyzed according to serum levels of 25 hydroxyvitamin D (25OHD). Results We studied 30 patients with mild PHPT (age 53 ± 11 years; 67% women; calcium 11.1 ± 1.0 mg/dl; PTH 149 ± 129 pg/ml). Serum 25OHD levels were low in the majority of subjects (mean 21 ± 11 ng/ml) and inversely associated with PTH (r = −0.69; p < 0.01). 25OHD levels were directly associated with cortical width (Ct.Wi; r = 0.46, p < 0.03) and trabecular separation (Tb.Sp; r = 0.41; p < 0.04), but inversely associated with cancellous bone volume (BV/TV; r = −0.39, p < 0.04). Subjects with 25OHD levels < 20 ng/ml (n = 14) and ≥ 20 ng/ml (n = 16) were compared. Groups did not differ by age, sex, menopausal status, serum calcium, creatinine, or 1,25(OH) 2D. PTH was 1.8-fold higher in subjects with 25OHD < 20 (265 ± 166 pg/ml vs. 95 ± 50 pg/ml; p < 0.01). On histomorphometric analysis, those with low 25OHD had lower Ct.Wi (541 ± 167 μm vs. 712 ± 200 μm; p < 0.03). Conversely, measures of trabecular microarchitecture were better in those with lower 25OHD, with higher BV/TV (26.1 ± 6.1% vs. 20.4 ± 6.4%; p < 0.03), greater trabecular number (Tb.N: 2.0 ± 0.4 mm −1 vs. 1.8 ± 0.4 mm −1; p < 0.04) and lower Tb.Sp (371 ± 90 μm vs. 472 ± 137 μm; p < 0.04). There were no differences between the groups in bone remodeling indices. Conclusions Low levels of 25OHD in patients with PHPT are associated with higher concentrations of PTH, greater catabolic effects in cortical bone and greater anabolic effects in trabecular bone.

Prevalence and significance of vitamin D deficiency and insufficiency among apparently healthy adults

Objective This study aims to determine the prevalence and significance of vitamin D deficiency and insufficiency among apparently healthy adults. Design and methods A total of 123 subjects, 56.9% males and 43.1% females, were recruited from a tertiary care hospital in Karachi, Pakistan. Questionnaires were administered to gather demographics; height, weight, and blood samples were also taken. For staging serum 25OHD, the cutoff values ≤ 50 nmol/L and 50.1–74.9 nmol/L were defined as deficiency and insufficiency, respectively. Results The mean vitamin D level in the study subjects was 41.1 ± 9.6 nmol/L. Of them, 90% had low serum 25OHD levels: 69.9% were deficient and 21.1% had insufficient levels of 25OHD. There was a significant negative correlation between serum 25OHD and iPTH levels. Conclusion The high prevalence of vitamin D deficiency and insufficiency showed that a high proportion of apparently healthy adults are at risk of developing musculoskeletal and other chronic diseases. Serum iPTH and serum 25OHD levels are better markers of this deficiency as compared to other markers.

Serum levels of vitamin D, PTH and calcium and breast cancer risk—a prospective nested case–control study

Previous studies indicate that calcium and its regulating hormones, i.e., parathyroid hormone (PTH) and vitamin D, might affect breast cancer risk. Evidence also suggests that this relationship could be influenced by menopausal status and BMI. We examined breast cancer risk related to prediagnostic serum levels of vitamin D (25OHD(2) and 25OHD(3)), PTH and calcium using a nested case-control design within the Malmö Diet and Cancer Study. There were 764 incident breast cancer cases, and 764 controls were selected by incidence density matching, using age as the underlying time scale, matching on calendar time at inclusion, menopausal status and age at inclusion. Using logistic regression analysis, odds ratios (OR) with 95% confidence intervals were calculated for breast cancer risk in different quartiles of the analyzed factors. All analyses were adjusted for risk factors for breast cancer, and for levels of albumin, creatinine and phosphate. Analyses were repeated stratified for BMI and menopausal status, and for low vs. high levels of 25OHD(3), PTH and calcium. There was a weak, nonsignificant inverse association between breast cancer risk and 25OHD(3), and the OR for the 2nd, 3rd and 4th quartiles, as compared to the first, were 0.84 (0.60-1.15), 0.84 (0.60-1.17) and 0.93 (0.66-1.33). Serum calcium was positively associated with breast cancer in premenopausal women (OR for the 4th quartile = 3.10:1.33-7.22 and p for quartile trend = 0.04), and in women with BMI > 25 (OR for the 4th quartile = 1.94:1.12-3.37 and p for trend < 0.01). There was no association between baseline serum PTH and breast cancer risk.

25-Hydroxyvitamin D Status Does Not Affect Intraoperative Parathyroid Hormone Dynamics in Patients with Primary Hyperparathyroidism

Deficiency of 25-hydroxyvitamin D (25OHD) is a stimulus for the secretion of parathyroid hormone (PTH). During surgery for primary hyperparathyroidism, 25OHD deficiency may artificially elevate PTH, decreasing the sensitivity of intraoperative PTH (ioPTH) measurements. Of 351 patients with known 25OHD status who underwent curative surgical treatment of primary hyperparathyroidism, 198 (56%) patients were 25OHD deficient (<25ng/mL). A curative decrease in ioPTH was defined as a greater than 50% PTH decrease 5, 10, or 15min after resection. There was no statistical difference between 25OHD deficient and sufficient patients in PTH, phosphorous, and alkaline phosphatase preoperatively. There was a positive correlation between PTH and calcium, alkaline phosphatase, and gland weight, while there was an inverse correlation between preoperative PTH and 25OHD. The average ioPTH decrease was not significantly different after 5, 10, or 15min, and 25OHD status did not affect when ioPTH indicated surgical cure. Lower 25OHD levels are correlated with higher PTH and alkaline phosphatase levels in patients with primary hyperparathyroidism. 25OHD status did not affect the average percent ioPTH decrease or the rate of cure. 25OHD deficiency does not affect ioPTH dynamics.

Low serum levels of 25-hydroxyvitamin D (25-OHD) among psychiatric out-patients in Sweden: Relations with season, age, ethnic origin and psychiatric diagnosis

In a chart review at a psychiatric out-patient department, latitude 59.3°N, a sample of patients with tests of serum 25-hydroxy-vitamin D (25-OHD) and plasma intact parathyroid hormone (iPTH) was collected, together with demographic data and psychiatric diagnoses. During 19 months, 117 patients were included. Their median 25-OHD was 45 nmol/l; considerably lower than published reports on Swedish healthy populations. Only 14.5% had recommended levels (over 75). In 56.4%, 25-OHD was under 50 nmol/l, which is related to several unfavourable health outcomes. Seasonal variation of 25-OHD was blunted. Patients with ADHD had unexpectedly low iPTH levels. Middle East, South-East Asian or African ethnic origin, being a young male and having a diagnosis of autism spectrum disorder or schizophrenia predicted low 25-OHD levels. Hence, the diagnoses that have been hypothetically linked to developmental (prenatal) vitamin D deficiency, schizophrenia and autism, had the lowest 25-OHD levels in this adult sample, supporting the notion that vitamin D deficiency may not only be a predisposing developmental factor but also relate to the adult patients’ psychiatric state. This is further supported by the considerable psychiatric improvement that coincided with vitamin D treatment in some of the patients whose deficiency was treated.

Search for hidden secondary causes in postmenopausal women with osteoporosis

The prevalence of secondary processes in women with postmenopausal osteoporosis (OP) is not well known. The aim of this study was to analyze the prevalence of conditions contributing to bone loss in postmenopausal women with OP and to evaluate the clinical characteristics and the impact of these disorders on the severity of the disease. A total of 204 postmenopausal women (mean +/- SD age, 64.9 +/- 10 y) with OP were prospectively included. None had an evident secondary cause of OP. Bone mineral density assessment, spine x-ray, and laboratory tests including parathormone (PTH), 25-hydroxyvitamin D (25OHD), thyroid hormones, urinary N-terminal cross-linked telopeptide of type I collagen (NTx), and 24-hour urinary calcium and cortisol were performed in all participants before treatment. As a group, 82% had low 25OHD levels (<30 ng/mL), 35% had increased PTH levels (>65 pg/mL), and 20% had hypercalciuria (>250 mg/24 h). In addition, 41% had increased NTx urinary levels (>65 nmol/mmol). PTH levels were related to age and were higher in women with femoral Z score less than -2.0 (80.3 pg/mL vs 57.7 pg/mL; P = 0.03). Participants with increased urinary NTx showed lower lumbar T and Z scores, whereas women with low 25OHD levels had lower femoral neck bone mineral density and T score values. In addition, participants with vertebral fractures had higher prevalence of 25OHD levels less than 20 ng/mL (69.2% vs 53.4%; P < 0.05). Secondary processes that contribute to low bone mass in postmenopausal women with OP are frequent, especially vitamin D insufficiency, increased PTH values, and hypercalciuria. In addition, increased bone resorption is frequently observed in this group of women. Most of these processes contributed to the severity of the disease.

A Pilot Study of Vitamin D and Balance Characteristics in Middle-Aged, Healthy Individuals

To examine what relationship exists between 25-hydroxyvitamin D (25-OHD) levels and postural competency in the middle-aged, healthy individual. A community convenience sample. Major medical center employees. Thirty-five healthy individuals older than 40 years of age who demonstrated appropriate cognition and physical stability. Specific exclusion criteria included any prior history of hip, knee, or ankle fracture or surgery. Questionnaire regarding exercise and sun exposure, vitamin D blood level, followed by computerized dynamic posturography (CDP) assessment of balance. CDP scores of individuals with normal and subnormal vitamin D levels. Thirteen male and 22 female subjects had a mean age of 56.0 years (standard deviation, 7.6; range, 42-77). Self-reported, retrospective mean weekly sun exposure was 7.36 hours (standard deviation, 6.4 hours). Twenty-six subjects (76.5%) described themselves as regular exercisers. Mean 25-OHD level for the sample was 21.5 ng/mL (standard deviation, 12.1 ng/mL). When subjects were divided into those with low and high 25-OHD levels, there was no significant difference in composite limits of stability reaction time scores (mean, 0.98 seconds and 0.84 seconds; P = .23), composite maximal velocity scores (4.2 degrees /second and 5.5 degrees /second; P = .08), composite end point excursion (70.3% and 70.1%; P = .95), and directional control composite scores (71.0% and 71.4%; P = .93). The two groups also showed no significant differences in rhythmic weight shifting left and right as well as forward and backward. Unlike studies involving elderly subjects, this study of younger, healthy subjects did not demonstrate a relationship between vitamin D and balance.

Energy Restriction Is Associated with Lower Bone Mineral Density of the Tibia and Femur in Lean but Not Obese Female Rats1–3

Energy restriction decreases bone mineral density (BMD), and epidemiological studies suggest that the risk of weight loss-induced bone loss is greater in lean than in heavier individuals. Our goal in this study was to determine how bone density and geometry respond to energy restriction in mature obese rats compared with lean rats. At 6 mo of age, 36 diet-induced obese and lean female Sprague-Dawley rats were allocated to control (CTL; ad libitum; n = 18) and energy-restricted (EnR; 40% restriction; n = 18) diets. After 10 wk of dietary intervention, obese EnR rats lost more weight (−61 ± 14 g) than lean EnR rats (−91 ± 34 g) (P < 0.02), whereas body weight did not change significantly in the 2 CTL groups (14 ± 23 g). Only the lean EnR (and not obese EnR) rats showed lower BMD compared with CTL rats at the tibia, distal, and proximal femur and femoral neck, and trabecular bone volume (P < 0.05). Serum estradiol declined in lean EnR rats compared with baseline (P < 0.05) but not in the obese EnR rats. In addition, the final serum 25-hydroxyvitamin D (25OHD) concentration was higher (P < 0.05) in obese than in lean EnR rats. Serum parathyroid hormone decreased (P < 0.05) from baseline to final in lean and obese CTL, but not EnR rats. These data support the hypothesis that energy restriction in lean rats compared with obese rats is more detrimental to bone, and it is possible that the greater decline in estrogen and lower levels of 25OHD contribute to this effect.

Serum concentrations of 17β‐E2 and 25‐hydroxycholecalciferol (25OHD) in relation to all‐cause mortality in older men – the MINOS study

To examine the association of serum hormone levels with all-cause mortality in older community-dwelling men. Single centre cohort study. Men aged 50 and older, insured by Société de Secours Minière de Bourgogne (Montceau les Mines, France). Among 3400 men invited to participate, 782 volunteers had serum hormone measurements and were followed up for 10 years. No exclusion criteria were used. Nonsurvivors (n = 182) were older, had more comorbidities and lower physical performance. The lowest quartile of 25-hydroxycholecalciferol (25OHD) level predicted mortality [HR = 1.44, 95% confidence interval (CI): 1.03-2.03, P < 0.05] regardless of age, BMI, smoking, physical activity, vitamin D supplementation, and health status; mainly for the first 3 years. The 17beta-E(2) level predicted mortality independent of confounders after the third year (HR = 1.21 per 1 SD increase, 95% CI: 1.09-1.35, P < 0.001). In the fully adjusted models, risk of death increased per quartiles of 17beta-E(2) (trend -P < 0.001) and was higher in the third and the fourth quartiles compared with the lowest quartile (HR = 1.80, 95% CI: 1.09-2.98, P < 0.05 and HR = 2.83, 95% CI: 1.71-4.67, P < 0.001). Concentrations of testosterone and PTH did not predict mortality independent of the model. In older men, increased 17beta-E(2) level predicted mortality after 3 years of follow-up. Thus, high 17beta-E(2) level may reflect presence of risk factors precipitating development of diseases. Low 25OHD level predicted mortality more weakly, mainly for the first 3 years of the follow-up, and was strongly influenced by the confounding variables. Thus, low 25OHD level may reflect poor current health status and unhealthy lifestyle.

Low Parathyroid Hormone Levels in Bedridden Geriatric Patients with Vitamin D Deficiency

To identify the clinical conditions associated with low parathyroid hormone (PTH) in patients with vitamin D deficiency and to evaluate the stability of the blunted PTH response to vitamin D deficiency over 6 months. Secondary analysis of a randomized double-blind controlled vitamin D supplementation trial. Four long-term care hospitals in Helsinki, Finland. Two hundred eighteen chronically bedridden patients. Plasma 25-hydroxyvitamin D (25-OHD), intact PTH, amino-terminal propeptide of type I procollagen (PINP), carboxy-terminal telopeptide of type I collagen (ICTP), activities of daily living (ADLs), and body mass index (BMI) were measured at baseline and at 6 months. Patient records were reviewed for demographic data. PTH was within reference values (8-73 ng/L) despite low 25-OHD level (<50 nmol/L) in 74.8% (n=163) of patients (mean age 84.5+/-7.5). Patients in the lowest PTH quartile (<38 ng/L) were characterized by a history of hip fractures (OR=2.9, P=0.01), low BMI (OR=0.9, P=.02), and high ICTP (OR=1.1, P=.03). PTH remained within reference values even after 6 months in 76.2% of the patients with persistent vitamin D deficiency in the placebo group. The absence of secondary hyperparathyroidism seems to be common and persistent in frail chronically bedridden patients with vitamin D deficiency. Attenuated parathyroid function appears to be associated with immobilization that causes accelerated bone resorption. Further studies addressing the possible adverse effects of low PTH are warranted.

Low bone density in premenopausal women at high risk for breast cancer

1532 Background: Tamoxifen when used in the high estrogen milieu of premenopausal women may reduce bone density. However, the proportion of premenopausal women at increased risk for breast cancer who have low bone density and are likely to take tamoxifen is unknown. Methods: Premenopausal women attending a high-risk clinic were invited to take part in an ongoing prospective study assessing bone mineral density (BMD) loss. Women on bisphosphonates or those previously treated with selective estrogen receptor modulators were excluded. BMD was measured by DEXA, serum 25-hydroxyvitamin D (25OHD) by chemiluminescence, and information on risk factors for osteoporosis and breast cancer was obtained by questionnaire. Results: 106 premenopausal women were entered between April and October 2008. Median age was 42 (range 23–57), median body mass index (BMI) was 25 kg/m2 (range 15–44). All but two were Caucasian. 13% had a prior biopsy with atypical hyperplasia (AH) or in situ carcinoma, 36% had a family history of osteoporosis, 56% took calcium supplements, and 47% took vitamin D supplements. Median sun exposure was 480 minutes per month, the majority with sunscreen. Median serum 25OHD was 34 ng/ml. Five had deficiency (&lt; 20 ng/mL), and 45 women deficiency or insufficiency (&lt; 32 ng/mL). Seven subjects ages 31 to 48 had evidence of low BMD (T-score of less than -1.0 in the spine or hip.) One woman with low BMD by DEXA had a 25OHD level &lt; 32 ng/ml. Women with low BMD had lower BMIs (median of 22 vs. 25 kg/m2, p = 0.020) than women with normal bone density. There was no difference in history of vitamin D and calcium supplement use, and low 25OHD levels did not explain the low T-scores. Information on vitamin D receptor polymorphisms associated with BMD loss is pending. Importantly, 21% of women with a prior biopsy demonstrating AH or in situ carcinoma had evidence of bone density loss compared to 4% of women without such a biopsy (p = 0.048). Conclusions: Premenopausal women with a history of AH or in situ carcinoma are most likely to take tamoxifen for primary prevention and in our ongoing study have a high enough incidence of low bone density to make baseline assessment by DEXA a consideration, particularly for those with predisposing factors such as low BMI and lack of sun exposure. No significant financial relationships to disclose.

Vitamin D status and falls, frailty, and fractures among postmenopausal Japanese women living in Hawaii

Vitamin D status and its relationship to physical performance, falls, and fractures in 495 postmenopausal women of Japanese ancestry in Hawaii were investigated. The mean 25-hydroxyvitamin D (25-OHD) was 31.94 ng/mL. No significant association of 25-OHD was demonstrated with most outcomes, possibly due to higher 25-OHD levels in this population. In this study, we investigated vitamin D status and its relationship to physical performance, muscle strength, falls, and fractures in postmenopausal Japanese females living in Hawaii. Of 510 community-dwelling women who participated in the eighth examination of the Hawaii Osteoporosis Study, 495 were included in these analyses. Multivariate regression models were used to evaluate the relationship of 25-OHD (D(3) and total) to eight performance-based measurements, 12 activities of daily living (ADLs), and muscle strength (grip, triceps, and quadriceps). Logistic regression analyses were performed to evaluate the relationship of 25-OHD to falls, vertebral fractures, and non-vertebral fractures. The mean total 25-OHD was 31.94 +/- 9.46 ng/mL; 44% of subjects had values <30 ng/mL, while none had values <10-12 ng/mL. There was little evidence of seasonal variation. Among performance-based measures, ADLs, and strength tests, only quadriceps strength was significantly associated with total 25-OHD (p = 0.0063) and 25-OHD(3) (p = 0.0001). No significant association of 25-OHD was found with vertebral or non-vertebral fractures, or incidence of one or more falls. Lack of serum 25-OHD relationship with falls and fractures or most physical performance measures in this study may be related to the low prevalence of very low 25-OHD levels in this population.

The impact of age, vitamin D 3 level, and incidental parathyroidectomy on postoperative hypocalcemia after total or near total thyroidectomy

Background Hypocalcemia caused by transient or definitive hypoparathyroidism is the most frequent complication after thyroidectomy. We aimed to compare the impact of incidental parathyroidectomy and serum vitamin D 3 level on postoperative hypocalcemia after total thyroidectomy (TT) or near total thyroidectomy (NTT). Patients Two hundred consecutive patients with nontoxic multinodular goiter treated by TT and NTT were included prospectively in the present study. Group 1 (n = 49) consisted of patients with a postoperative serum calcium level ≤8 mg/dL, and group 2 (n = 151) had a postoperative serum calcium level greater than 8 mg/dL. Patients were evaluated according to age, preoperative serum 25-hydroxy vitamin D (25-OHD) levels, postoperative serum calcium levels, incidental parathyroidectomy, and the type of thyroidectomy. Results Patients in group 1 (n = 49) were hypocalcemic, whereas patients in group 2 (n = 151) were normocalcemic. Preoperative serum 25-OHD levels in group 1 were significantly lower than in group 2 ( P < .001). The incidence of hypoparathyroidism was significantly higher following TT (13.5%) than following NTT (2.5%) ( P < .05). The risk for postoperative hypocalcemia was increased 25-fold for patients older than 50 years, 28-fold for patients with a preoperative serum 25-OHD level less than 15 ng/mL, and 71-fold for patients who underwent TT. Incidental parathyroidectomy did not have an impact on postoperative hypocalcemia. The highest risk of postoperative hypocalcemia was found in the patients with all of the above variables. Conclusions Age, preoperative low serum 25-OHD, and TT are significantly associated with postoperative hypocalcemia. Patients with advanced age and low preoperative serum 25-OHD levels should be placed on calcium or vitamin D supplementation after TT to avoid postoperative hypocalcemia and decrease hospital stay.

Influence of obesity on vitamin D–binding protein and 25-hydroxy vitamin D levels in African American and white women

25-Hydroxy vitamin D (25OHD) is lipophilic and highly bound to vitamin D–binding protein (VDBP) in plasma. In the present study, we examined VDBP and 25OHD levels by race and body mass index (BMI) in young adult women to determine whether circulating VDBP plays a role in the low levels of 25OHD with obesity and among African Americans. In agreement with previous studies, mean 25OHD levels were lower in African American women than in whites ( P < .01). In a hierarchical multiple regression model, BMI was associated with 25OHD after adjustment for age in white women ( P = .02, R 2 = .10) but not in African American women. The VDBP levels, by contrast, were similar in African Americans and whites, and were unrelated to BMI in either racial group. Furthermore, VDBP was unrelated to the plasma level of 25OHD. These data confirm an interaction between race and obesity in vitamin D metabolism, and imply that the carrier protein is not an important determinant of circulating 25OHD in women, nor is it affected by race or adiposity.

Effects of vitamin D insufficiency on bone mineral density in African American men

In African American men serum, 25-hydroxyvitamin D (25-OHD) was below 30 ng/ml in 89% of subjects. In overall group, there was no correlation between 25-OHD and bone mineral density (BMD). A subgroup analysis of subjects with 25-OHD <or=15 ng/ml showed that serum 25-OHD was positively associated with BMD. This study examined the effects of low serum 25-hydroxyvitamin D (25-OHD) on bone mineral density (BMD) in African American (AA) men from the general medicine clinic at an inner city Veteran Administration medical center. The data for 112 AA males who had both 25-OHD levels and BMD of spine and hip were extracted and analyzed using SAS software. AA men were aged 38 to 85 years, with mean age of 62 years. Levels of 25-OHD ranged from 4 to 45 ng/ml, with mean 17.5 ng/ml, 24% and 89% of the subjects had 25-OHD below 10 and 30 ng/ml, respectively. In the overall group, there was no correlation between 25-OHD and BMD at any site. In a subgroup analysis of subjects with 25-OHD <or=15 ng/ml, in multiple adjusted models, 25-OHD was positively associated with BMD of spine (r = 0.26, p = 0.05), total hip (r = 0.27, p < 0.05), ward's triangle (r = 0.25, p = 0.05), and trochanter (r = 0.30, p < 0.05). The negative effect of vitamin D insufficiency on bone was observed only at very low levels of 25-OHD, suggesting that AA male skeleton is relatively resistant to the effects of secondary hyperparathyroidism.

Vitamin D supplementation has no major effect on pain or pain behavior in bedridden geriatric patients with advanced dementia

In a few, earlier, uncontrolled trials, alleviation of chronic pain has been documented by vitamin D supplementation. This randomized double-blind placebo controlled trial addressed the association between pain and vitamin D deficiency and the effects of vitamin D supplementation on pain in institutionalized aged patients. 216 long-term care patients were enrolled in Helsinki, Finland. Pain was assessed by three tools: Resident Assessment Instrument (RAI), Discomfort Behavior Scale, and Pain Assessment in Advanced Dementia Scale. Scores for Cognitive Performance Scale (CPS) and other clinical assessments were also collected from the RAI-database. Levels of 25-hydroxyvitamin D (25- OHD) and parathyroid hormone were also determined. Patients in pain (n=202) were randomized into three treatment groups, each receiving 0, 400, or 1200 IU cholecalciferol per day, respectively. Assessments were repeated after six-month vitamin D supplementation. Patients were aged (84.5+/-7.5 yrs), demented (CPS= 4.9+/-1.4, range 1-6), and chronically bedridden. Pain was present in 38.4% to 83.8% of patients depending on assessment tool. Low 25-OHD levels (<50 nmol/L) were very common (98.1%). However, vitamin D deficiency was not associated with pain or pain behavior. The supplementation resulted in a marked increase in 25-OHD levels. However, neither prevalence of painlessness nor pain scores changed significantly after vitamin D supplementation. We were not able either to show an association between vitamin D deficiency and pain or to observe alleviation of pain by vitamin D supplementation. The independent role of vitamin D in the etiology of pain remains controversial.

Níveis baixos de 25-hidroxivitamina D (25OHD) em pacientes com doença inflamatória intestinal e sua correlação com a densidade mineral óssea

Patients with inflammatory bowel disease (IBD) are at risk of having vitamin D deficiency (25-OHD) and low bone mineral density (BMD). To measure 25OHD in a young group of IBD patients submitted to a clinical evaluation, routine biochemistry and BMD measurement (lumbar spine and proximal femur). 39 Crohn disease (CD) and 37 ulcerative colitis (UC) patients had lower serum levels of 25OHD compared to the control group (CD p = 0.003; UC p < 0.001), and 48.5% of the UC patients were 25OHD deficient. Lumbar spine BMD was lower in patients than controls (CD p = 0.001; UC p = 0.008). In CD patients, serum levels of 25OHD were significantly correlated with total femur (r = 0.391; p = 0.027) and femoral neck (r = 0.384; p = 0.03) BMD. It was found lower levels of 25OHD and BMD in young IBD patients compared to normal controls, suggesting an important role of 25OHD deficiency in the pathogenesis of the IBD bone disease.

Plasma 1,25(OH)2D levels decrease in postmenopausal women with hypovitaminosis D.

Although calcitriol (1,25(OH)2D) is considered the biologically active vitamin D metabolite, several studies have shown that calcidiol (25OHD) is the vitamin D metabolite that is most closely linked to parathyroid function and indices of calcium homeostasis. Moreover, low levels of 25OHD have been associated with increased risk of different diseases including cancer, diabetes, and myopathy. Cross-sectional study. We studied relations between plasma concentrations of 25OHD, 1,25(OH)2D, and parathyroid hormone (PTH) in fasting plasma samples from 315 healthy postmenopausal women randomly selected from the local background population. P-1,25(OH)2D levels varied in a concentration-dependent manner with P-25OHD levels (P<0.001). Thus, P-1,25(OH)2D levels were the lowest in women with vitamin D insufficiency, i.e., P-1,25(OH)2D levels were reduced by approximately one-third in subjects with P-25OHD levels below 25 nmol/l compared with levels above 80 nmol/l (P<0.01). The association was most pronounced at P-25OHD concentrations below 80 nmol/l, whereas no major increase in P-1,25(OH)2D was observed at P-25OHD concentrations above 80 nmol/l. In multiple regression analysis, PTH was a minor although significant predictor of P-1,25(OH)2D levels. In normal postmenopausal women, the conversion of 25OHD to active vitamin D depends on the substrate concentration. Our data support that vitamin D insufficiency should be considered at P-25OHD levels below 80 nmol/l.

Prevalence of vitamin D deficiency among healthy infants in Sacramento, CA

Concern about vitamin D deficiency in infants and children has recently increased. We conducted a one year study to determine the prevalence of vitamin D deficiency in infants 6â18 mos of age in Sacramento, CA and to identify dietary and lifestyle risk factors for deficiency. 178 healthy infants seen at the pediatric clinic at UC Davis Medical Center were recruited 8/06-8/07. Demographic, lifestyle, and dietary data were collected and plasma 25(OH) vitamin D (25OHD) concentrations were measured by radioimmunoassay. The mean ± SD concentration for all infants was 94 ± 40 nmol/L. 9% (16/178) were found to be deficient (<50 nmol/L), 69% (11) of whom were currently breastfed. 28% (11/40) of all infants receiving breast milk were deficient. Exclusively breastfed infants (no other milk source) had significantly lower 25OHD levels (64 ± 41 nmol/L) than infants not currently breastfed and receiving milk, formula, or both (103 ± 37 nmol/L; p < 0.05). 12.5% (5/40) of breastfed infants reported taking vitamin D supplements. Significant differences were not seen based on sun exposure or race/ethnicity. These results suggest 25OHD values in infants 6â19 mos of age are most strongly determined by infant feeding practices and usual predictors for vitamin D status in adults such as seasonality, ethnicity, and sun exposure are less important. Vitamin D supplements are recommended for exclusively breastfed infants by two months of age. These data suggest that increased attention to this recommendation may decrease the prevalence of vitamin D deficiency in this population of infants.

The association between vitamin D and inflammation with the 6-minute walk and frailty in patients with heart failure.

To identify relationships between anabolic hormones, inflammatory markers, and physical function. Cross-sectional. Outpatient university heart failure program in Connecticut. Sixty patients with an ejection fraction of 40% or less. The 6-minute walk distance and frailty phenotype were measured. The relationship between physical measures of hormones and inflammatory mediators were examined. Linear and ordinal logistic regression analyses were performed for the physical measures. Forty-three men (mean age 77 +/- 9) and 17 women (mean age 78 +/- 12) participated. Longer 6-minute walk distance was correlated with higher 25-hydroxyvitamin D (25OHD) level, and a shorter walk was correlated with higher cortisol: dehydroepiandrosterone sulphate (DHEAS) ratio, high-sensitivity C-reactive protein (hsCRP), interleukin-6 (IL6), and intact parathyroid hormone (PTH) (all P<.05). Percentage of free testosterone, DHEAS alone, and N-terminal pro-brain natriuretic peptide (NTpro-BNP) did not correlate with 6-minute walk distance. Higher frailty phenotype score (more frail) was correlated with higher high-sensitivity CRP, higher IL6, and lower 25OHD levels (all P<.05). Linear regression with the 6-minute walk distance as the dependent variable and independent variables of age, sex, percentage of free testosterone, DHEAS, 25OHD, intact PTH, hsCRP, IL6, cortisol/DHEAS ratio, and NTpro-BNP, revealed age, sex, 25OHD and hsCRP to be significant (coefficient of determination=53.5%). Ordinal logistic regression with the frailty phenotype and hormonal levels revealed that age, 25OHD, and hsCRP also predicted frailty status. Twenty-five-hydroxyvitamin D and hsCRP levels may contribute to lower aerobic capacity and frailty in patients with heart failure. A longitudinal study will further define the role of 25OHD and hsCRP on muscle strength and functional decline.