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Erschienen in: Osteoporosis International 6/2011

01.06.2011 | Original Article

Racial differences in the relationship between vitamin D, bone mineral density, and parathyroid hormone in the National Health and Nutrition Examination Survey

verfasst von: O. M. Gutiérrez, W. R. Farwell, D. Kermah, E. N. Taylor

Erschienen in: Osteoporosis International | Ausgabe 6/2011

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Abstract

Summary

It is unclear whether optimal levels of 25-hydroxyvitamin D (25(OH)D) in whites are the same as in minorities. In adult participants of NHANES, the relationships between 25(OH)D, bone mineral density (BMD), and parathyroid hormone (PTH) differed in blacks as compared to whites and Mexican-Americans, suggesting that optimal 25(OH)D levels for bone and mineral metabolism may differ by race.

Introduction

Blacks and Hispanics have lower 25-hydroxyvitamin D concentrations than whites. However, it is unclear whether 25(OH)D levels considered “optimal” for bone and mineral metabolism in whites are the same as those in minority populations.

Methods

We examined the relationships between 25(OH)D and parathyroid hormone in 8,415 adult participants (25% black and 24% Mexican-American) in the National Health and Nutrition Examination Surveys 2003–2004 and 2005–2006; and between 25(OH)D and bone mineral density in 4,206 adult participants (24% black and 24% Mexican-American) in the 2003–2004 sample.

Results

Blacks and Mexican-Americans had significantly lower 25(OH)D and higher PTH concentrations than whites (P < 0.01 for both). BMD significantly decreased (P < 0.01) as serum 25(OH)D and calcium intake declined among whites and Mexican-Americans, but not among blacks (P = 0.2). The impact of vitamin D deficiency (25(OH)D ≤ 20 ng/ml) on PTH levels was modified by race/ethnicity (P for interaction, 0.001). Whereas inverse relationships between 25(OH)D and PTH were observed above and below a 25(OH)D level of 20 ng/ml in whites and Mexican-Americans, an inverse association between 25(OH)D and PTH was only observed below this threshold in blacks, with the slope of the relationship being essentially flat (P = 0.7) above this cut-point, suggesting that PTH may be maximally suppressed at lower 25(OH)D levels in blacks than in whites or Mexican-Americans.

Conclusions

The relationships between 25(OH)D, BMD, and PTH may differ by race among US adults. Whether race-specific ranges of optimal vitamin D are needed to appropriately evaluate the adequacy of vitamin D stores in minorities requires further study.
Literatur
2.
Zurück zum Zitat Chapuy MC, Preziosi P, Maamer M, Arnaud S, Galan P, Hercberg S, Meunier PJ (1997) Prevalence of vitamin D insufficiency in an adult normal population. Osteoporos Int 7:439–443PubMedCrossRef Chapuy MC, Preziosi P, Maamer M, Arnaud S, Galan P, Hercberg S, Meunier PJ (1997) Prevalence of vitamin D insufficiency in an adult normal population. Osteoporos Int 7:439–443PubMedCrossRef
3.
Zurück zum Zitat Holick MF, Siris ES, Binkley N, Beard MK, Khan A, Katzer JT, Petruschke RA, Chen E, de Papp AE (2005) Prevalence of Vitamin D inadequacy among postmenopausal North American women receiving osteoporosis therapy. J Clin Endocrinol Metab 90:3215–3224PubMedCrossRef Holick MF, Siris ES, Binkley N, Beard MK, Khan A, Katzer JT, Petruschke RA, Chen E, de Papp AE (2005) Prevalence of Vitamin D inadequacy among postmenopausal North American women receiving osteoporosis therapy. J Clin Endocrinol Metab 90:3215–3224PubMedCrossRef
4.
Zurück zum Zitat Krall EA, Sahyoun N, Tannenbaum S, Dallal GE, Dawson-Hughes B (1989) Effect of vitamin D intake on seasonal variations in parathyroid hormone secretion in postmenopausal women. N Engl J Med 321:1777–1783PubMedCrossRef Krall EA, Sahyoun N, Tannenbaum S, Dallal GE, Dawson-Hughes B (1989) Effect of vitamin D intake on seasonal variations in parathyroid hormone secretion in postmenopausal women. N Engl J Med 321:1777–1783PubMedCrossRef
5.
Zurück zum Zitat Malabanan A, Veronikis IE, Holick MF (1998) Redefining vitamin D insufficiency. Lancet 351:805–806PubMedCrossRef Malabanan A, Veronikis IE, Holick MF (1998) Redefining vitamin D insufficiency. Lancet 351:805–806PubMedCrossRef
6.
Zurück zum Zitat Steingrimsdottir L, Gunnarsson O, Indridason OS, Franzson L, Sigurdsson G (2005) Relationship between serum parathyroid hormone levels, vitamin D sufficiency, and calcium intake. JAMA 294:2336–2341PubMedCrossRef Steingrimsdottir L, Gunnarsson O, Indridason OS, Franzson L, Sigurdsson G (2005) Relationship between serum parathyroid hormone levels, vitamin D sufficiency, and calcium intake. JAMA 294:2336–2341PubMedCrossRef
7.
Zurück zum Zitat Bischoff-Ferrari HA, Giovannucci E, Willett WC, Dietrich T, Dawson-Hughes B (2006) Estimation of optimal serum concentrations of 25-hydroxyvitamin D for multiple health outcomes. Am J Clin Nutr 84:18–28PubMed Bischoff-Ferrari HA, Giovannucci E, Willett WC, Dietrich T, Dawson-Hughes B (2006) Estimation of optimal serum concentrations of 25-hydroxyvitamin D for multiple health outcomes. Am J Clin Nutr 84:18–28PubMed
8.
Zurück zum Zitat Harris SS, Dawson-Hughes B (1998) Seasonal changes in plasma 25-hydroxyvitamin D concentrations of young American black and white women. Am J Clin Nutr 67:1232–1236PubMed Harris SS, Dawson-Hughes B (1998) Seasonal changes in plasma 25-hydroxyvitamin D concentrations of young American black and white women. Am J Clin Nutr 67:1232–1236PubMed
9.
Zurück zum Zitat Harris SS, Soteriades E, Coolidge JA, Mudgal S, Dawson-Hughes B (2000) Vitamin D insufficiency and hyperparathyroidism in a low income, multiracial, elderly population. J Clin Endocrinol Metab 85:4125–4130PubMedCrossRef Harris SS, Soteriades E, Coolidge JA, Mudgal S, Dawson-Hughes B (2000) Vitamin D insufficiency and hyperparathyroidism in a low income, multiracial, elderly population. J Clin Endocrinol Metab 85:4125–4130PubMedCrossRef
10.
Zurück zum Zitat Looker AC, Dawson-Hughes B, Calvo MS, Gunter EW, Sahyoun NR (2002) Serum 25-hydroxyvitamin D status of adolescents and adults in two seasonal subpopulations from NHANES III. Bone 30:771–777PubMedCrossRef Looker AC, Dawson-Hughes B, Calvo MS, Gunter EW, Sahyoun NR (2002) Serum 25-hydroxyvitamin D status of adolescents and adults in two seasonal subpopulations from NHANES III. Bone 30:771–777PubMedCrossRef
11.
Zurück zum Zitat Nesby-O'Dell S, Scanlon KS, Cogswell ME, Gillespie C, Hollis BW, Looker AC, Allen C, Doughertly C, Gunter EW, Bowman BA (2002) Hypovitaminosis D prevalence and determinants among African American and white women of reproductive age: third National Health and Nutrition Examination Survey, 1988–1994. Am J Clin Nutr 76:187–192PubMed Nesby-O'Dell S, Scanlon KS, Cogswell ME, Gillespie C, Hollis BW, Looker AC, Allen C, Doughertly C, Gunter EW, Bowman BA (2002) Hypovitaminosis D prevalence and determinants among African American and white women of reproductive age: third National Health and Nutrition Examination Survey, 1988–1994. Am J Clin Nutr 76:187–192PubMed
12.
Zurück zum Zitat Zadshir A, Tareen N, Pan D, Norris K, Martins D (2005) The prevalence of hypovitaminosis D among US adults: data from the NHANES III. Ethn Dis 15(S5):97–101 Zadshir A, Tareen N, Pan D, Norris K, Martins D (2005) The prevalence of hypovitaminosis D among US adults: data from the NHANES III. Ethn Dis 15(S5):97–101
13.
Zurück zum Zitat Clemens TL, Adams JS, Henderson SL, Holick MF (1982) Increased skin pigment reduces the capacity of skin to synthesise vitamin D3. Lancet 1:74–76PubMedCrossRef Clemens TL, Adams JS, Henderson SL, Holick MF (1982) Increased skin pigment reduces the capacity of skin to synthesise vitamin D3. Lancet 1:74–76PubMedCrossRef
14.
Zurück zum Zitat Harris SS (2006) Vitamin D and African Americans. J Nutr 136:1126–1129PubMed Harris SS (2006) Vitamin D and African Americans. J Nutr 136:1126–1129PubMed
15.
Zurück zum Zitat Giovannucci E, Liu Y, Willett WC (2006) Cancer incidence and mortality and vitamin D in black and white male health professionals. Cancer Epidemiol Biomark Prev 15:2467–2472CrossRef Giovannucci E, Liu Y, Willett WC (2006) Cancer incidence and mortality and vitamin D in black and white male health professionals. Cancer Epidemiol Biomark Prev 15:2467–2472CrossRef
16.
Zurück zum Zitat Barrett-Connor E, Siris ES, Wehren LE, Miller PD, Abbott TA, Berger ML, Santora AC, Sherwood LM (2005) Osteoporosis and fracture risk in women of different ethnic groups. J Bone Miner Res 20:185–194PubMedCrossRef Barrett-Connor E, Siris ES, Wehren LE, Miller PD, Abbott TA, Berger ML, Santora AC, Sherwood LM (2005) Osteoporosis and fracture risk in women of different ethnic groups. J Bone Miner Res 20:185–194PubMedCrossRef
17.
Zurück zum Zitat Nelson DA, Jacobsen G, Barondess DA, Parfitt AM (1995) Ethnic differences in regional bone density, hip axis length, and lifestyle variables among healthy black and white men. J Bone Miner Res 10:782–787PubMedCrossRef Nelson DA, Jacobsen G, Barondess DA, Parfitt AM (1995) Ethnic differences in regional bone density, hip axis length, and lifestyle variables among healthy black and white men. J Bone Miner Res 10:782–787PubMedCrossRef
18.
Zurück zum Zitat Aloia JF, Vaswani A, Ma R, Flaster E (1997) Comparison of body composition in black and white premenopausal women. J Lab Clin Med 129:294–299PubMedCrossRef Aloia JF, Vaswani A, Ma R, Flaster E (1997) Comparison of body composition in black and white premenopausal women. J Lab Clin Med 129:294–299PubMedCrossRef
19.
Zurück zum Zitat Hannan MT, Litman HJ, Araujo AB, McLennan CE, McLean RR, McKinlay JB, Chen TC, Holick MF (2008) Serum 25-hydroxyvitamin D and bone mineral density in a racially and ethnically diverse group of men. J Clin Endocrinol Metab 93:40–46PubMedCrossRef Hannan MT, Litman HJ, Araujo AB, McLennan CE, McLean RR, McKinlay JB, Chen TC, Holick MF (2008) Serum 25-hydroxyvitamin D and bone mineral density in a racially and ethnically diverse group of men. J Clin Endocrinol Metab 93:40–46PubMedCrossRef
20.
Zurück zum Zitat Leder BZ, Araujo AB, Travison TG, McKinlay JB (2007) Racial and ethnic differences in bone turnover markers in men. J Clin Endocrinol Metab 92:3453–3457PubMedCrossRef Leder BZ, Araujo AB, Travison TG, McKinlay JB (2007) Racial and ethnic differences in bone turnover markers in men. J Clin Endocrinol Metab 92:3453–3457PubMedCrossRef
21.
Zurück zum Zitat Bauer RL, Diehl AK, Barton SA, Brender J, Deyo RA (1986) Risk of postmenopausal hip fracture in Mexican American women. Am J Public Health 76:1020–1021PubMedCrossRef Bauer RL, Diehl AK, Barton SA, Brender J, Deyo RA (1986) Risk of postmenopausal hip fracture in Mexican American women. Am J Public Health 76:1020–1021PubMedCrossRef
22.
Zurück zum Zitat Aloia JF (2008) African Americans, 25-hydroxyvitamin D, and osteoporosis: a paradox. Am J Clin Nutr 88:545S–550SPubMed Aloia JF (2008) African Americans, 25-hydroxyvitamin D, and osteoporosis: a paradox. Am J Clin Nutr 88:545S–550SPubMed
23.
Zurück zum Zitat (2003–2004) National Health and Nutrition Examination Survey Data. In. National Center for Health Statistics. U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, Hyattsville, MD. (2003–2004) National Health and Nutrition Examination Survey Data. In. National Center for Health Statistics. U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, Hyattsville, MD.
24.
Zurück zum Zitat National Kidney Foundation (2002) K/DOQI clinical practice guidelines for chronic kidney disease: evaluation, classification, and stratification. Am J Kidney Dis 39:S1–266CrossRef National Kidney Foundation (2002) K/DOQI clinical practice guidelines for chronic kidney disease: evaluation, classification, and stratification. Am J Kidney Dis 39:S1–266CrossRef
25.
Zurück zum Zitat Coresh J, Astor BC, McQuillan G, Kusek J, Greene T, Van Lente F, Levey AS (2002) Calibration and random variation of the serum creatinine assay as critical elements of using equations to estimate glomerular filtration rate. Am J Kidney Dis 39:920–929PubMedCrossRef Coresh J, Astor BC, McQuillan G, Kusek J, Greene T, Van Lente F, Levey AS (2002) Calibration and random variation of the serum creatinine assay as critical elements of using equations to estimate glomerular filtration rate. Am J Kidney Dis 39:920–929PubMedCrossRef
26.
Zurück zum Zitat Looker AC, Melton LJ 3rd, Harris T, Borrud L, Shepherd J, McGowan J (2009) Age, gender, and race/ethnic differences in total body and subregional bone density. Osteoporos Int 20:1141–1149PubMedCrossRef Looker AC, Melton LJ 3rd, Harris T, Borrud L, Shepherd J, McGowan J (2009) Age, gender, and race/ethnic differences in total body and subregional bone density. Osteoporos Int 20:1141–1149PubMedCrossRef
27.
Zurück zum Zitat Bischoff-Ferrari HA, Dietrich T, Orav EJ, Dawson-Hughes B (2004) Positive association between 25-hydroxy vitamin D levels and bone mineral density: a population-based study of younger and older adults. Am J Med 116:634–639PubMedCrossRef Bischoff-Ferrari HA, Dietrich T, Orav EJ, Dawson-Hughes B (2004) Positive association between 25-hydroxy vitamin D levels and bone mineral density: a population-based study of younger and older adults. Am J Med 116:634–639PubMedCrossRef
28.
Zurück zum Zitat Cleveland W, Devlin S (1988) Locally-weighted regression: an approach to regression analysis by local fitting. J Am Stat Assoc 83:596–610CrossRef Cleveland W, Devlin S (1988) Locally-weighted regression: an approach to regression analysis by local fitting. J Am Stat Assoc 83:596–610CrossRef
29.
Zurück zum Zitat Hurvich C, Simonoff J (1998) Smoothing parameter selection in nonparametric regression using an improved Akaike information criterion. J Roy Stat Soc 60:271–293CrossRef Hurvich C, Simonoff J (1998) Smoothing parameter selection in nonparametric regression using an improved Akaike information criterion. J Roy Stat Soc 60:271–293CrossRef
30.
Zurück zum Zitat Aloia JF, Talwar SA, Pollack S, Yeh J (2005) A randomized controlled trial of vitamin D3 supplementation in African American women. Arch Intern Med 165:1618–1623PubMedCrossRef Aloia JF, Talwar SA, Pollack S, Yeh J (2005) A randomized controlled trial of vitamin D3 supplementation in African American women. Arch Intern Med 165:1618–1623PubMedCrossRef
31.
Zurück zum Zitat Chapuy MC, Arlot ME, Duboeuf F, Brun J, Crouzet B, Arnaud S, Delmas PD, Meunier PJ (1992) Vitamin D3 and calcium to prevent hip fractures in the elderly women. N Engl J Med 327:1637–1642PubMedCrossRef Chapuy MC, Arlot ME, Duboeuf F, Brun J, Crouzet B, Arnaud S, Delmas PD, Meunier PJ (1992) Vitamin D3 and calcium to prevent hip fractures in the elderly women. N Engl J Med 327:1637–1642PubMedCrossRef
32.
Zurück zum Zitat Dawson-Hughes B, Dallal GE, Krall EA, Harris S, Sokoll LJ, Falconer G (1991) Effect of vitamin D supplementation on wintertime and overall bone loss in healthy postmenopausal women. Ann Intern Med 115:505–512PubMed Dawson-Hughes B, Dallal GE, Krall EA, Harris S, Sokoll LJ, Falconer G (1991) Effect of vitamin D supplementation on wintertime and overall bone loss in healthy postmenopausal women. Ann Intern Med 115:505–512PubMed
33.
Zurück zum Zitat Bell NH, Yergey AL, Vieira NE, Oexmann MJ, Shary JR (1993) Demonstration of a difference in urinary calcium, not calcium absorption, in black and white adolescents. J Bone Miner Res 8:1111–1115PubMedCrossRef Bell NH, Yergey AL, Vieira NE, Oexmann MJ, Shary JR (1993) Demonstration of a difference in urinary calcium, not calcium absorption, in black and white adolescents. J Bone Miner Res 8:1111–1115PubMedCrossRef
34.
Zurück zum Zitat Bryant RJ, Wastney ME, Martin BR, Wood O, McCabe GP, Morshidi M, Smith DL, Peacock M, Weaver CM (2003) Racial differences in bone turnover and calcium metabolism in adolescent females. J Clin Endocrinol Metab 88:1043–1047PubMedCrossRef Bryant RJ, Wastney ME, Martin BR, Wood O, McCabe GP, Morshidi M, Smith DL, Peacock M, Weaver CM (2003) Racial differences in bone turnover and calcium metabolism in adolescent females. J Clin Endocrinol Metab 88:1043–1047PubMedCrossRef
35.
Zurück zum Zitat Cosman F, Morgan DC, Nieves JW, Shen V, Luckey MM, Dempster DW, Lindsay R, Parisien M (1997) Resistance to bone resorbing effects of PTH in black women. J Bone Miner Res 12:958–966PubMedCrossRef Cosman F, Morgan DC, Nieves JW, Shen V, Luckey MM, Dempster DW, Lindsay R, Parisien M (1997) Resistance to bone resorbing effects of PTH in black women. J Bone Miner Res 12:958–966PubMedCrossRef
36.
Zurück zum Zitat Heaney RP (2002) The importance of calcium intake for lifelong skeletal health. Calcif Tissue Int 70:70–73PubMedCrossRef Heaney RP (2002) The importance of calcium intake for lifelong skeletal health. Calcif Tissue Int 70:70–73PubMedCrossRef
37.
Zurück zum Zitat Bell NH, Greene A, Epstein S, Oexmann MJ, Shaw S, Shary J (1985) Evidence for alteration of the vitamin D-endocrine system in blacks. J Clin Invest 76:470–473PubMedCrossRef Bell NH, Greene A, Epstein S, Oexmann MJ, Shaw S, Shary J (1985) Evidence for alteration of the vitamin D-endocrine system in blacks. J Clin Invest 76:470–473PubMedCrossRef
38.
Zurück zum Zitat Engelman CD, Fingerlin TE, Langefeld CD, Hicks PJ, Rich SS, Wagenknecht LE, Bowden DW, Norris JM (2008) Genetic and environmental determinants of 25-hydroxyvitamin D and 1, 25-dihydroxyvitamin D levels in Hispanic and African Americans. J Clin Endocrinol Metab 93:3381–3388PubMedCrossRef Engelman CD, Fingerlin TE, Langefeld CD, Hicks PJ, Rich SS, Wagenknecht LE, Bowden DW, Norris JM (2008) Genetic and environmental determinants of 25-hydroxyvitamin D and 1, 25-dihydroxyvitamin D levels in Hispanic and African Americans. J Clin Endocrinol Metab 93:3381–3388PubMedCrossRef
39.
Zurück zum Zitat Dawson-Hughes B, Harris S, Kramich C, Dallal G, Rasmussen HM (1993) Calcium retention and hormone levels in black and white women on high- and low-calcium diets. J Bone Miner Res 8:779–787PubMedCrossRef Dawson-Hughes B, Harris S, Kramich C, Dallal G, Rasmussen HM (1993) Calcium retention and hormone levels in black and white women on high- and low-calcium diets. J Bone Miner Res 8:779–787PubMedCrossRef
40.
Zurück zum Zitat Bell NH, Epstein S, Greene A, Shary J, Oexmann MJ, Shaw S (1985) Evidence for alteration of the vitamin D-endocrine system in obese subjects. J Clin Invest 76:370–373PubMedCrossRef Bell NH, Epstein S, Greene A, Shary J, Oexmann MJ, Shaw S (1985) Evidence for alteration of the vitamin D-endocrine system in obese subjects. J Clin Invest 76:370–373PubMedCrossRef
41.
Zurück zum Zitat Aloia JF, Talwar SA, Pollack S, Feuerman M, Yeh JK (2006) Optimal vitamin D status and serum parathyroid hormone concentrations in African American women. Am J Clin Nutr 84:602–609PubMed Aloia JF, Talwar SA, Pollack S, Feuerman M, Yeh JK (2006) Optimal vitamin D status and serum parathyroid hormone concentrations in African American women. Am J Clin Nutr 84:602–609PubMed
42.
Zurück zum Zitat Melamed ML, Michos ED, Post W, Astor B (2008) 25-hydroxyvitamin D levels and the risk of mortality in the general population. Arch Intern Med 168:1629–1637PubMedCrossRef Melamed ML, Michos ED, Post W, Astor B (2008) 25-hydroxyvitamin D levels and the risk of mortality in the general population. Arch Intern Med 168:1629–1637PubMedCrossRef
43.
Zurück zum Zitat Liu PT, Stenger S, Li H, Wenzel L, Tan BH, Krutzik SR, Ochoa MT, Schauber J, Wu K, Meinken C, Kamen DL, Wagner M, Bals R, Steinmeyer A, Zugel U, Gallo RL, Eisenberg D, Hewison M, Hollis BW, Adams JS, Bloom BR, Modlin RL (2006) Toll-like receptor triggering of a vitamin D-mediated human antimicrobial response. Science 311:1770–1773PubMedCrossRef Liu PT, Stenger S, Li H, Wenzel L, Tan BH, Krutzik SR, Ochoa MT, Schauber J, Wu K, Meinken C, Kamen DL, Wagner M, Bals R, Steinmeyer A, Zugel U, Gallo RL, Eisenberg D, Hewison M, Hollis BW, Adams JS, Bloom BR, Modlin RL (2006) Toll-like receptor triggering of a vitamin D-mediated human antimicrobial response. Science 311:1770–1773PubMedCrossRef
44.
Zurück zum Zitat Gutierrez OM, Mannstadt M, Isakova T, Rauh-Hain JA, Tamez H, Shah A, Smith K, Lee H, Thadhani R, Juppner H, Wolf M (2008) Fibroblast growth factor 23 and mortality among patients undergoing hemodialysis. N Engl J Med 359:584–592PubMedCrossRef Gutierrez OM, Mannstadt M, Isakova T, Rauh-Hain JA, Tamez H, Shah A, Smith K, Lee H, Thadhani R, Juppner H, Wolf M (2008) Fibroblast growth factor 23 and mortality among patients undergoing hemodialysis. N Engl J Med 359:584–592PubMedCrossRef
45.
Zurück zum Zitat Ghandur-Mnaymneh L, Cassady J, Hajianpour MA, Paz J, Reiss E (1986) The parathyroid gland in health and disease. Am J Pathol 125:292–299PubMed Ghandur-Mnaymneh L, Cassady J, Hajianpour MA, Paz J, Reiss E (1986) The parathyroid gland in health and disease. Am J Pathol 125:292–299PubMed
Metadaten
Titel
Racial differences in the relationship between vitamin D, bone mineral density, and parathyroid hormone in the National Health and Nutrition Examination Survey
verfasst von
O. M. Gutiérrez
W. R. Farwell
D. Kermah
E. N. Taylor
Publikationsdatum
01.06.2011
Verlag
Springer-Verlag
Erschienen in
Osteoporosis International / Ausgabe 6/2011
Print ISSN: 0937-941X
Elektronische ISSN: 1433-2965
DOI
https://doi.org/10.1007/s00198-010-1383-2

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