Skip to main content

Advertisement

SpringerLink
Log in

Correlation of vitamin D, bone mineral density and parathyroid hormone levels in adults with low bone density

  • Original Article
  • Published:
Indian Journal of Orthopaedics Aims and scope Submit manuscript

Abstract

Background: Bone mineral density (BMD) is known to be affected by serum 25-hydroxyvitamin D (25(OH) D) levels, intact parathyroid hormone (iPTH) levels. Indian data pertinent to above observation is scant. Our study aimed to investigate the relationships between serum 25-hydroxyvitamin D (25(OH) D) levels, intact parathyroid hormone (iPTH) levels and bone mineral density (BMD) in a cohort of Indian patients.

Materials and Methods: Adults with or without fragility fractures with low BMD at the hip or lumbar spine were evaluated clinically along with laboratory investigations. T-scores of the hip and spine were derived from BMD-DEXA (dual-energy X-ray absorptiometry). Multivariate regression models were used to investigate the relationships between serum 25(OH) D, iPTH and BMD.

Results: Total of 102 patients (male:female = 38:64) with a mean age of 62.5 ± 6.4 years were included in the study. Forty-four patients had osteopenia. Osteoporosis was present in 58 patients. The mean values for serum 25(OH) D and iPTH levels were 21.3 ± 0.5 ng/ml and 53.1 ± 22.3 pg/ml, respectively. In 84.3% of patients, serum 25(OH) D levels were below 30 ng/ml (Normal = 30–74 ng/ml), confirming vitamin D deficiency. There was no association between 25(OH) D levels and BMD at the hip or lumbar spine (P = 0.473 and 0.353, respectively). Both at the hip and lumbar spine; iPTH levels, male gender, body mass index (BMI) and age were found to be significant predictors of BMD. Patients with higher BMI had significantly lower BMD and T-score. At levels <30 ng/ml, 25(OH) D was negatively associated with iPTH (P = 0.041).

Conclusion: Among our cohort of patients with low BMD, no direct relationship between serum 25(OH) D levels and BMD was observed. However, a negative correlation between iPTH and 25(OH) D at serum 25(OH) D concentrations <30 ng/ml. Serum iPTH levels showed a significant negative association with BMD at the hip and lumbar spine. Our findings underscore the critical role of parathyroid hormone in bone metabolism and health.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Malhotra N, Mithal A. Osteoporosis in Indians. Indian J Med Res 2008;127:263–8.

    PubMed  CAS  Google Scholar 

  2. Londhey V. Vitamin D deficiency: Indian scenario. J Assoc Physicians India 2011;59:695–6.

    PubMed  Google Scholar 

  3. Ooms ME, Lips P, Roos JC, van der Vijgh WJ, Popp-Snijders C, Bezemer PD, et al. Vitamin D status and sex hormone binding globulin: Determinants of bone turnover and bone mineral density in elderly women. J Bone Miner Res 1995;10:1177–84.

    Article  PubMed  CAS  Google Scholar 

  4. Dawson-Hughes B. Calcium, vitamin D and vitamin D metabolites. In: Papapoulos SE, Lips P, Pols HA, Johnston CC, Delmas PD, editors. Osteoporosis 1996: Proceedings of the 1996 World Congress on Osteoporosis. Excerpt Med Int Congr Ser 118. Amsterdam, the Netherlands: Elsevier; 1996. p. 299–303.

    Google Scholar 

  5. Rahman SA, Chee WS, Yassin Z, Chan SP. Vitamin D status among postmenopausal Malaysian women. Asia Pac JClin Nutr 2004;13:255–60.

    CAS  Google Scholar 

  6. Wat WZ, Leung JY, Tarn S, Kung AW. Prevalence and impact of vitamin D insufficiency in southern Chinese adults. Ann Nutr Metab 2007;51:59–64.

    Article  PubMed  CAS  Google Scholar 

  7. Nakamura K, Tsugawa N, Saito T, Ishikawa M, Tsuchiya Y, Hyodo K, et al. Vitamin D status, bone mass and bone metabolism in home-dwelling postmenopausal Japanese women: Yokogoshi Study. Bone 2008;42:271–7.

    Article  PubMed  CAS  Google Scholar 

  8. Chapuy MC, Preziosi P, Maamer M, Arnaud S, Galan P, Hercberg S, et al. Prevalence of vitamin D insufficiency in an adult normal population. Osteoporos Int 1997;7:439–43.

    Article  PubMed  CAS  Google Scholar 

  9. Lips P, Wiersinga A, van Ginkel FC, Jongen MJ, Netelenbos JC, Hackeng WH, et al. The effect of vitamin D supplementation on vitamin D status and parathyroid function in elderly subjects. J Clin Endocrinol Metab 1988;67:644–50.

    Article  PubMed  CAS  Google Scholar 

  10. Sahota O, Mundey MK, San P, Godber IM, Lawson N, Hosking DJ. The relationship between vitamin D and parathyroid hormone: Calcium homeostasis, bone turnover and bone mineral density in postmenopausal women with established osteoporosis. Bone 2004;35:312–9.

    Article  PubMed  CAS  Google Scholar 

  11. Chailurkit LO, Kruavit A, Rajatanavin R. Vitamin D status and bone health in healthy Thai elderly women. Nutrition 2011;27:160–4.

    Article  PubMed  CAS  Google Scholar 

  12. Raso AA, Navarra SV, Li-Yu J, Torralba TP. Survey of vitamin D levels among postmenopausal Filipino women with osteoporosis. Int J Rheum Dis 2009;12:225–9.

    Article  PubMed  Google Scholar 

  13. Lips P, Duong T, Oleksik A, Black D, Cummings S, Cox D, et al. A global study of vitamin D status and parathyroid function in postmenopausal women with osteoporosis: Baseline data from the multiple outcomes of raloxifene evaluation clinical trial. J Clin Endocrinol Metab 2001;86:1212–21.

    Article  PubMed  CAS  Google Scholar 

  14. Kuchuk NO, van Schoor NM, Pluijm SM, Chines A, Lips P. Vitamin D status, parathyroid function, bone turnover and BMD in postmenopausal women with osteoporosis: Global perspective. J Bone Miner Res 2009;24:693–701.

    Article  PubMed  CAS  Google Scholar 

  15. Serhan E, Newton P, Ali HA, Walford S, Singh BM. Prevalence of hypovitaminosis D in Indo-Asian patients attending a rheumatology clinic. Bone 1999;5:609–11.

    Article  Google Scholar 

  16. Walts NB. T-scores and Osteoporosis. Menopause Med 2002;10:1–4.

    Google Scholar 

  17. Chandran M, Hoeck HC, Wong HC, Zhang RF, Dimai HP. Vitamin D status and its relationship with bone mineral density and parathyroid hormone in Southeast Asian adults with low bone density. Endocr Pract 2011;17:226–34.

    Article  PubMed  Google Scholar 

  18. Francis RM, Peacock M, Barkworth SA. Renal impairment and its effects on calcium metabolism in elderly women. Age Ageing 1984;13:14–20.

    Article  PubMed  CAS  Google Scholar 

  19. Arya V, Bhambri R, Godbole MM, Mithal A. Vitamin D status and its relationship with bone mineral density in healthy Asian Indians. Osteoporos Int 2004;15:56–61.

    Article  PubMed  CAS  Google Scholar 

  20. Fuleihan GE, Deeb M. Hypovitaminosis D in a sunny country. N Engl J Med 1999;340:1840–1.

    Article  PubMed  CAS  Google Scholar 

  21. Mithal A, Wahl DA, Bonjour JP, Burckhardt P, Dawson-Hughes B, Eisman JA, et al. Global vitamin D status and determinants of hypovitaminosis D. Osteoporos Int 2009;20:1807–20.

    Article  PubMed  CAS  Google Scholar 

  22. Holick MF, Binkley NC, Bischoff-Ferrari HA, Gordon CM, Hanley DA, Heaney RP, et al. Evaluation, treatment and prevention of vitamin D deficiency: An Endocrine Society clinical practice guideline. J Clin Endocrinol Metab 2011;96:1911–30.

    Article  PubMed  CAS  Google Scholar 

  23. Harinarayan CV, Sachan A, Reddy PA, Satish KM, Prasad UV, Srivani P. Vitamin D status and bone mineral density in women of reproductive and postmenopausal age groups: A cross-sectional study from south India. J Assoc Physicians India 2011;59:698–704.

    PubMed  CAS  Google Scholar 

  24. Marwaha RK, Tandon N, Garg MK, Kanwar R, Narang A, Sastry A, et al. Vitamin D status in healthy Indians aged 50 years and above. J Assoc Physicians India 2011;59:706–9.

    PubMed  CAS  Google Scholar 

  25. Lips P. Vitamin D deficiency and secondary hyperparathyroidism in the elderly: Consequences for bone loss and fractures and therapeutic implications. Endocr Rev 2001;22:477–501.

    Article  PubMed  CAS  Google Scholar 

  26. Holick MF. McCollum Award Lecture, 1994: Vitamin D-new horizons for the 21st century. Am J Clin Nutr 1994;60:619–30.

    Article  PubMed  CAS  Google Scholar 

  27. Kota SK, Kota SK, Jammula S, Meher LK, Panda S, Tripathy PR, et al. Renin-angiotensin system activity in vitamin D deficient, obese individuals with hypertension: An urban Indian study. Indian J Endocrinol Metab. 2011;15 Suppl 4:S395–401.

    Article  Google Scholar 

  28. Kota SK, Jammula S, Kota SK, Tripathy PR, Panda S, Modi KD. Effect of vitamin D supplementation in type 2 diabetes patients with pulmonary tuberculosis. Diab Met Syndr: Clin Res Rev 2011;5:85–9.

    Article  Google Scholar 

  29. Thoo FL, Chng SM, Lam KS, Lee JB, Tan MC, Teh HS, et al. To establish the normal bone mineral density reference database for the Singapore male. Ann Acad Med Singapore 2002;31:21–5.

    PubMed  CAS  Google Scholar 

  30. Leong KH, Feng PH. Bone mineral density measurements using the Hologic QD2000 in 175 Singaporean women aged 20-80. Singapore Med J 1997;38:25–6.

    PubMed  CAS  Google Scholar 

  31. Wu XP, Liao EY, Zhang H, Dai RC, Shan PF, Cao XZ, et al. Determination of age-specific bone mineral density and comparison of diagnosis and prevalence of primary osteoporosis in Chinese women based on both Chinese and World Health Organization criteria. J Bone Miner Metab 2004;22:382–91.

    PubMed  Google Scholar 

  32. Lau EM, Lee JK, Suriwongpaisal P, Saw SM, Das De S, Khir A, et al. The incidence of hip fracture in four Asian countries: the Asian Osteoporosis Study (AOS). Osteoporos Int 2001;12:239–43.

    Article  PubMed  CAS  Google Scholar 

  33. Roy DK, Berry JL, Pye SR, Adams JE, Swarbrick CM, King Y, et al. Vitamin D status and bone mass in UK South Asian women. Bone 2007;40:200–4.

    Article  PubMed  CAS  Google Scholar 

  34. Holick MF, Siris ES, Binkley N, Beard MK, Khan A, Katzer JT, et al. Prevalence ofvitamin D inadequacy among postmenopausal North American women receiving osteoporosis therapy. J Clin Endocrinol Metab 2005;90:3215–24.

    Article  PubMed  CAS  Google Scholar 

  35. Khaw KT, Sneyd MJ, Compston J. Bone density parathyroid hormone and 25-hydroxyvitamin D concentrations in middle aged women. BMJ 1992;305:273–7.

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  36. Saadi HF, Nagelkerke N, Benedict S, Qazaq HS, Zilahi E, Mohamadiyeh MK, et al. Predictors and relationships of serum 25 hydroxyvitamin D concentration with bone turnover markers, bone mineral density and vitamin D receptor genotype in Emirati women. Bone 2006;39:1136–43.

    Article  PubMed  CAS  Google Scholar 

  37. Aguado P, del Campo MT, Garces MV, Gonzalez-Casaus ML, Bernad M, Gijon-Banos J, et al. Low vitamin D levels in outpatient postmenopausal women from a rheumatology clinic in Madrid, Spain: Their relationship with bone mineral density. Osteoporos Int 2000; 11:739–44.

    Article  PubMed  CAS  Google Scholar 

  38. Bischoff-Ferrari HA, Dietrich T, Orav EJ, Dawson-Hughes B. Positive association between 25-hydroxy vitamin D levels and bone mineral density: A population-based study of younger and older adults. Am J Med 2004;116:634–9.

    Article  PubMed  CAS  Google Scholar 

  39. Gutierrez OM, Farwell WR, Kermah D, Taylor EN. Racial differences in the relationship between vitamin D, bone mineral density and parathyroid hormone in the National Health and Nutrition Examination Survey. Osteoporos Int 2011;22:1745–53.

    Article  PubMed  CAS  Google Scholar 

  40. Harris SS. Vitamin D and African Americans. J Nutr 2006;136:1126–9.

    Article  PubMed  CAS  Google Scholar 

  41. Melton LJ 3rd, Khosla S, Achenbach SJ, O’Connor MK, O’Fallon WM, Riggs BL. Effects of body size and skeletal site on the estimated prevalence of osteoporosis in women and men. Osteoporosis Int 2000;11:977–83.

    Article  Google Scholar 

  42. Seeman E. Clinical review 137: Sexual dimorphism in skeletal size, density and strength. J Clin Endocrinol Metab 2001;86:4576–84.

    Article  PubMed  CAS  Google Scholar 

  43. Douchi T, Yamamoto S, Oki T, Maruta K, Kuwahata R, Yamasaki H, et al. Difference in the effect of adiposity on bone density between pre- and postmenopausal women. Maturitas 2000;34:261–6.

    Article  PubMed  CAS  Google Scholar 

  44. Slemenda CW. Body composition and skeletal density: Mechanical loading or something more? J Clin Endocrinol Metab 1995;80:1761–3.

    Article  PubMed  CAS  Google Scholar 

  45. Liel Y, Edwards J, Shary J, Spicer KM, Gordon L, Bell NH. The effects of race and body habitus on bone mineral density of the radius, hip and spine in premenopausal women. J Clin Endocrinol Metab 1988;66:1247–50.

    Article  PubMed  CAS  Google Scholar 

  46. Papakitsou EF, Margioris AN, Dretakis KE, Trovas G, Zoras U, Lyritis G, et al. Body mass index (BMI) and parameters of bone formation and resorption in postmenopausal women. Maturitas 2004;47:185–93.

    Article  PubMed  CAS  Google Scholar 

  47. Zhao LJ, Liu YJ, Liu PY, Hamilton J, Recker RR, Deng HW. Relationship of obesity with osteoporosis. J Clin Endocrinol Metab 2007;92:1640–6.

    Article  PubMed  CAS  Google Scholar 

  48. Krall EA, Sahyoun N, Tannenbaum S, Dallal GE, Dawson-Hughes B. Effect of vitamin D intake on seasonal variations in parathyroid hormone secretion in postmenopausal women. N Engl J Med 1989;321:1777–83.

    Article  PubMed  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Pharmaceutics, Ronald Institute of Pharmaceutical Sciences, Berhampur, Orissa, India

    Sruti Jammula

  2. Department of Anaesthesia, Central Security Hospital, Riyadh, Saudi Arabia

    Siva Kota

  3. Department of Medicine, Maharaja Krishna Chandra Gajapati Medical College, Behrampur, Orissa, India

    Lalit Meher

  4. Department of Endocrinology, Medwin Hospital, Chirag Ali Lane, Nampally, Hyderabad, 500 001, Andhra Pradesh, India

    Sunil Kumar Kota & Kirtikumar Modi

Authors
  1. Sunil Kumar Kota
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Sruti Jammula
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Siva Kota
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Lalit Meher
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Kirtikumar Modi
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Sunil Kumar Kota.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Kota, S.K., Jammula, S., Kota, S. et al. Correlation of vitamin D, bone mineral density and parathyroid hormone levels in adults with low bone density. IJOO 47, 402–407 (2013). https://doi.org/10.4103/0019-5413.114932

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.4103/0019-5413.114932

Key words

Search

Navigation