Health  Vol.6 No.11 , May 2014
Hypovitaminosis D and Associated Risk Factors in Postmenopausal Women
ABSTRACT
Given the relevance of vitamin D in calcium metabolism homeostatic control, as well as its role as differentiation and cell proliferation modulator, it is important to study its circulating level in patients considered at risk, in order to develop prevention strategies. We studied 77 postmenopausal women with no history of osteoactive drug therapy, corticosteroid intake or diseases that could alter bone metabolism, attending the Menopause Center at the Hospital Provincial del Centenario, Rosario, Argentina. A medical history was taken, and a food consumption frequency questionnaire was applied in order to estimate daily calcium intake. To assess daily physical exercise, work and sports activities were investigated. Serum parathyroid hormone (PTH) and 25(OH)D were measured, and a hip DXA scan was performed in every patient. An inappropriate level of 25(OH)D was observed in 86.3% of patients. The 25(OH)D average value was found within the insufficiency range (<30 ng/ml) whereas PTH average concentration fell within the normal range, and bone mineral density average value was found within the osteopenic category. A statistically significant negative logarithmic association was observed between serum PTH level and vitamin D status (p = 0.01). Mean 25(OH)D concentration among patients who had reported fractures was significantly lower than the corresponding to women who had not suffered this type of event. Patients with vitamin D deficiency had significantly wider mean Cobb angle; higher sum of wedge angles of T4 - T12 vertebral bodies mean values, and higher uncompromised vertebrae wedge angle values than non-deficient women. This study shows high hypovitaminosis D occurrence among these postmenopausal women.

Cite this paper
Masoni, A. , Menoyo, I. , Bocanera, R. , Pezzotto, S. and Morosano, M. (2014) Hypovitaminosis D and Associated Risk Factors in Postmenopausal Women. Health, 6, 1180-1190. doi: 10.4236/health.2014.611145.
References
[1]   Chen, T.C., Chimeh, F., Lu, Z., Mathieu, J., Person, K.S., Zhang, A., Kohn, N., Matinello, S., Berkowitz, R. and Holick, M.F. (2007) Factors That Influence the Cutaneous Synthesis and Dietary Sources of Vitamin D. Archives of Biochemistry and Biophysics, 460, 213-217.
http://dx.doi.org/10.1016/j.abb.2006.12.017

[2]   Holick, M.F. (2007) Vitamin D Deficiency. New England Journal of Medicine, 357, 266-281.
http://dx.doi.org/10.1056/NEJMra070553

[3]   Haroon, M. and Regan, M.J. (2010) Vitamin D Deficiency: The Time to Ignore It Has Passed. International Journal of the Rheumatic Diseases, 13, 318-323.
http://dx.doi.org/10.1056/NEJMra070553

[4]   Audran, M. and Briot, K. (2010) Critical Reappraisal of Vitamin D Deficiency. Joint Bone Spine, 77, 115-119.
http://dx.doi.org/10.1016/j.jbspin.2009.12.003

[5]   Binkley, N., Krueger, D. and Lensmeyer, G. (2009) 25-Hidroxy Vitamin D Measurement, 2009: A Review for Clinicians. Journal of Clinical Densitometry, 12, 417-427.
http://dx.doi.org/10.1016/j.jocd.2009.06.001

[6]   Dawson-Hughes, B., Heaney, R.P., Holick, M.F., Lips, P., Meunier, P.J. and Vieth, R. (2005) Estimates of Optimal Vitamin D Status. Osteoporosis International, 16, 713-716.
http://dx.doi.org/10.1007/s00198-005-1867-7

[7]   Holick, M.F. (2009) Vitamin D Status: Measurement, Interpretation, and Clinical Application. Annals of Epidemiology, 19, 73-78.
http://dx.doi.org/10.1016/j.annepidem.2007.12.001

[8]   Holick, M.F. (2006) High Prevalence of Vitamin D Inadequacy and Implications for Health. Mayo Clinic Proceedings, 81, 353-373.
http://dx.doi.org/10.4065/81.3.353

[9]   Pérez-López, F.R., Chedraui, P. and Fernández Alonso, A.M. (2011) Vitamin D and Aging: Beyond Calcium and Bone Metabolism. Maturitas, 69, 27-36.
http://dx.doi.org/10.1016/j.maturitas.2011.02.014

[10]   Mithal, A., Wahl, D.A., Bonjour, J.P., Burckhardt, P., Dawson-Hughes, B., Eisman, J.A., El-Hajj Fuleihan, G., Josse, R.G., Lips, P., Morales-Torres, J., On Behalf of the IOF Committee of Scientific Advisors (CSA) Nutrition Working Group (2009) Global Vitamin D Status and Determinants of Hipovitaminosis D. Osteoporosis International, 20, 1807-1820.
http://dx.doi.org/10.1007/s00198-009-0954-6

[11]   Gaugris, S., Heaney, R.P., Boonen, S., Kurth, H., Bentkover, J.D. and Sen, S.S. (2005) Vitamin D Inadequacy among Postmenopausal Women: A Systematic Review. QJM, 98, 667-676.
http://dx.doi.org/10.1093/qjmed/hci096

[12]   Rizzoli, R., Eisman, J.A., Norquist, J., Ljunggren, O., Krishnarajah, G., Lim, S.K. and Chandler, J. (2007) Risk Factors for Vitamin D Inadequacy among Women with Osteoporosis: An International Epidemiological Study. International Journal of Clinical Practice, 60, 1013-1019.
http://dx.doi.org/10.1111/j.1742-1241.2006.01066.x

[13]   López Giovanelli, J., Ponce, G., Nieva, A., Chaperón, A., Ladizesky, M., Somoza, J., Casco, C., Zeni1, S., Parisi, M.S. and Mautalen, C.A. (2004) High Prevalence of Vitamin D Insufficiency in Healthy Elderly People Living at Home in Argentina. European Journal of Clinical Nutrition, 58, 337-342.
http://dx.doi.org/10.1038/sj.ejcn.1601786

[14]   Kuchuk, N.O., Pluijm, S.M.F., van Schoor, N.M., Looman, C.W., Smit, J.H. and Lips, P. (2009) Relationships of Serum 25-Hidroxyvitamin D to Bone Mineral Density and Serum Parathyroid Hormone and Markers of Bone Turnover in Older Persons. The Journal of Clinical Endocrinology and Metabolism, 94, 1244-1250.
http://dx.doi.org/10.1210/jc.2008-1832

[15]   Masoni, A., Morosano, M., Pezzotto, S.M., Tomat, F., Bentancur, F., Bocanera, R., Tozzini, R. and Puche, R.C. (2005) Construction of Two Instruments for the Presumptive Detection of Post-Menopausal Women with Low Spinal Bone Mass by Means of Clinical Risk Factors. Maturitas, 51, 314:324.

[16]   Genant, H.K., Wu, C.Y., Van Kuijk, C. and Nevitt, M.C. (1993) Vertebral Fracture Assessment Using a Semiquantitative Technique. Journal of Bone and Mineral Research, 8, 1137-1148.
http://dx.doi.org/10.1002/jbmr.5650080915

[17]   Morosano, M., Menoyo, I., Caferra, D., Sánchez, A., Tomat, F., Bocanera, R., Pezzotto, S.M. and Masoni, A.M. (2011) Vulnerability of Healthy Vertebrae in Patients with and without Previous Vertebral Fracture. Bone, 48, 820-827.
http://dx.doi.org/10.1016/j.bone.2010.12.014

[18]   Stata Corporation. STATA 8.0. Statistics/Data Analysis.

[19]   Fradinger, E.E. and Zanchetta, J.R. (2001) Vitamin D and Bone Mineral Density in Ambulatory Women Living in Buenos Aires, Argentina. Osteoporosis International, 12, 24-27.
http://dx.doi.org/10.1007/s001980170153

[20]   González, G., Alvarado, J.N., Rojas, A., Navarrete, C., Velásquez, C.G. and Arteaga, E. (2007) High Prevalence of Vitamin D Deficiency in Chilean Healthy Postmenopausal Women with Normal Sun Exposure: Additional Evidence for a Worldwide Concern. Menopause, 14, 455-461.
http://dx.doi.org/10.1097/GME.0b013e31802c54c0

[21]   Freedman, D.M., Cahoon, E.K., Rajaraman, P., Major, J.M., Doody, M.M., Alexander, B.H., Hoffbeck, R.W., Kimlin, M.G., Graubard, B.I. and Linet, M.S. (2013) Sunlight and Other Determinants of Circulating 25-Hydroxyvitamin D Levels in Black and White Participants in a Nationwide US Study. American Journal of Epidemiology, 77, 180-192.
http://dx.doi.org/10.1093/aje/kws223

[22]   Millen, A.E., Wactawski-Wende, J., Pettinger, M., Melamed, M.L., Tylavsky, F.A., Liu, S., Robbins, J., LaCroix, A.Z., LeBoff, M.S. and Jackson, R.D. (2010) Predictors of Serum 25-Hydroxyvitamin D Concentrations among Postmenopausal Women: The Women’s Health Initiative Calcium plus Vitamin D Clinical Trial. The American Journal of Clinical Nutrition, 91, 1324-1335.
http://dx.doi.org/10.3945/ajcn.2009.28908

[23]   Bandeira, F., Griz, L., Freese, E., Castro Lima, D., Thé, A.C., Trovào Diniz, E., Marques, T.F. and Lucena, C.S. (2010) Vitamin D Deficiency and Its Relationship with Bone Mineral Density among Postmenopausal Women Living in the Tropics. Arquivos Brasileiros de Endocrinologia & Metabologia, 54, 227-232.
http://dx.doi.org/10.1590/S0004-27302010000200020

[24]   Bischoff-Ferrari, H.A., Kiel, D.P., Dawson Hughes, B., Orav, J.E., Li, R., Spiegelman, D., Dietrich, T. and Willett, W.C. (2009) Dietary Calcium and Serum 25-Hydroxyvitamin D Satus in Relation to BMD among US Adults. Journal of Bone and Mineral Research, 24, 935-942.
http://dx.doi.org/10.1359/jbmr.081242

[25]   Chacko, S.A., Song, Y., Manson, J.E., Van Horn, L., Eaton, C. and Martin, L.W. (2011) Serum 25-Hydroxyvitamin D Concentrations in Relation to Cardiometabolic Risk Factors and Metabolic Syndrome in Postmenopausal Women. The American Journal of Clinical Nutrition, 94, 209-217.
http://dx.doi.org/10.3945/ajcn.110.010272

[26]   McCullough, M.L., Weinstein, S.J., Freedman, D.M., Helzlsouer, K., Flanders, W.D. and Koenig, K. (2010) Correlates of Circulating 25-Hydroxyvitamin D. American Journal of Epidemiology, 172, 21-35.
http://dx.doi.org/10.1093/aje/kwq113

[27]   Young, K.A., Engelman, C.D., Langefeld, C.D., Hairston, K.G., Haffner, S.M., Bryer-Ash, M. and Norris, J.M. (2009) Association of Plasma Vitamin D Levels with Adiposity in Hispanic and African Americans. The Journal of Clinical Endocrinology and Metabolism, 94, 3306-3313.
http://dx.doi.org/10.1210/jc.2009-0079

[28]   Macdonald, H.M. (2013) Contributions of Sunlight and Diet to Vitamin D Status. Calcified Tissue International, 92, 163-176.
http://dx.doi.org/10.1007/s00223-012-9634-1

[29]   Hanley, D.A., Cranney, A., Jones, G., Whiting, S.G., Leslie, W.D. and Cole, D.E.C. (2010) Guidelines Committee of the Scientific Advisory Council of Osteoporosis Canada. Vitamin D in Adult Health and Disease: A Review and Guideline Statement from Osteoporosis Canada. CMAJ, 182, E611-E618.
http://dx.doi.org/10.1503/cmaj.091062

[30]   Pérez-López, F.R., Brincat, M., Tamer Erel, C., Tremollieres, F., Gambacciani, M., Lambrinoudaki, I., Moen, M.H., Schenck-Gustafsson, K., Vujovic, S., Rozenberg, S. and Rees, M. (2012) EMAS Position Statement: Vitamin D and Postmenopausal Health. Maturitas, 71, 83-88.
http://dx.doi.org/10.1016/j.maturitas.2011.11.002

[31]   Binkley, N., Novotny, R., Krueger, D., Kawahara, T., Daida, Y.G., Lensmeyer, G., Hollis, B.W. and Drezner, M.K. (2007) Low Vitamin D Status Despite Abundant Sun Exposure. The Journal of Clinical Endocrinology and Metabolism, 92, 2130-2135.
http://dx.doi.org/10.1210/jc.2006-2250

[32]   Jacobs, E.T., Alberts, D.S., Foote, J.A., Green, S.B., Hollis, B.W., Yu, Z. and Martinez, M.E. (2008) Vitamin D Insufficiency in Southern Arizona. The American Journal of Clinical Nutrition, 87, 608-613.

[33]   Oren, Y., Shapira, Y., Agmon-Levin, N., Kivity, S., Zafrir, Y., Altman, A., Lerner, A. and Shoenfeld, Y. (2010) Vitamin D Insufficiency in a Sunny Environment: A Demographic and Seasonal Analysis. IMAJ, 12, 751-756.

[34]   Holick, M., Chen, T.C., Lu, Z. and Sauter, E. (2007) Vitamin D and Skin Physiology: A D-Lightful Story. Journal of Bone and Mineral Research, 22, V28-V32.
http://dx.doi.org/10.1359/jbmr.07s211

[35]   Tsiaras, W.G. and Weinstock, M.A. (2011) Factors Influencing Vitamin D Status. Acta Dermato-Venereologica, 91, 115-124.

[36]   Gannagé-Yared, M.H., Chemali, R., Yaacoub, N. and Halaby, G. (2000) Hypovitaminosis D in Sunny Country: Relation to Lifestyle and Bone Markers. Journal of Bone and Mineral Research, 15, 1856-1862.
http://dx.doi.org/10.1359/jbmr.2000.15.9.1856

[37]   Manicourt, D.H. and Devogelaer, J.P. (2008) Urban Tropospheric Ozone Increases the Prevalence of Vitamin D Deficiency among Belgian Postmenopausal Women with Outdoor Activities during Summer. The Journal of Clinical Endocrinology and Metabolism, 93, 3893-899.
http://dx.doi.org/10.1210/jc.2007-2663

[38]   Hosseinpanah, F., Pour, S.H., Heibatollahi, M., Moghbel, N., Asefzade, S. and Azizi, F. (2010) The Effects of Air Pollution on Vitamin D Status in Healthy Women: A Cross Sectional Study. BMC Public Health, 10, 519-524.
http://dx.doi.org/10.1186/1471-2458-10-519

[39]   Holick, M.F. and Chen, T.C. (2008) Vitamin D Deficiency: A Worldwide Problem with Health Consequences. American Journal of Clinical Nutrition, 87, 1080S-1086S.

[40]   Heaney, R.P., Davies, K.M., Chen, T.C., Holick, M.F. and Barger-Lux, M.J. (2003) Human Serum 25-Hydroxycholecalciferol Response to Extended Oral Dosing with Cholecalciferol. American Journal of Clinical Nutrition, 77, 204-210.

[41]   Valcour, A., Blocki, F., Hawkins, D.M. and Rao, S.D. (2012) Effects of Age and Serum 25-OH-Vitamin D on Serum Parathyroid Hormone Levels. The Journal of Clinical Endocrinology and Metabolism, 97, 3989-3995.
http://dx.doi.org/10.1210/jc.2012-2276

[42]   Need, A.G., O’Loughlin, P.D., Morris, H.A., Horowitz, M. and Nordin, B.E.C. (2004) The Effects of Age and Other Variables on Serum Parathyroid Hormone in Postmenopausal Women Attending an Osteoporosis Center. The Journal of Clinical Endocrinology and Metabolism, 89, 1646-1949.
http://dx.doi.org/10.1210/jc.2003-031539

[43]   Yamauchi, M., Kaji, H., Nawata, K., Takaoka, S., Yamaguchi, T. and Sugimoto, T. (2011) Role of Parathyroid Hormone in Bone Fragility of Postmenopausal Women with Vitamin D Insufficiency. Calcified Tissue International, 88, 362-369.
http://dx.doi.org/10.1007/s00223-011-9464-6

[44]   Jang, W.Y., Chung, M.S., Baek, G.H., Song. C-H., Cho, H.E. and Gong, H.S. (2011) Vitamin D Levels in Post-Menopausal Korean Women with a Distal Radius Fracture. Injury, 43, 237-241.
http://dx.doi.org/10.1016/j.injury.2011.10.020

[45]   Dhanwal, D.K., Sahoo, S., Gautam, V.K. and Saha, R. (2013) Hip Fracture Patients in India Have Vitamin D Deficiency and Secondary Hyperparathyroidism. Osteoporosis International, 24, 553-557.
http://dx.doi.org/10.1007/s00198-012-1993-y

[46]   Seitz, S., Koehne, T., Ries, C., De Novo Oliveira, A., Barvencik, F., Busse, B., Eulenburg, C., Schinke, T., Püschel, K., Rueger, J.M., Amling, M. and Pogoda, P. (2013) Impaired Bone Mineralization Accompanied by Low Vitamin D and Secondary Hyperparathyroidism in Patients with Femoral Neck Fracture. Osteoporosis International, 24, 641-649.
http://dx.doi.org/10.1007/s00198-012-2011-0

[47]   Hernández, J.L., Olmos, J.M., Pariente, E., Nan, D., Martínez, J., Llorca, J., Valero, C., Obregón, E. and González-Macías, J. (2013) Influence of Vitamin D Status on Vertebral Fractures, Bone Mineral Density and Bone Turnover Markers in Normocalcemic Postmenopausal Women with High Parathyroid Hormone Levels. The Journal of Clinical Endocrinology and Metabolism, 98, 1711-1717.
http://dx.doi.org/10.1210/jc.2012-3931

[48]   Rejnmark, L., Vestergaard, P., Brot, C. and Mosekilde, L. (2011) Increased Fracture Risk in Normocalcemic Postmenopausal Women with High Parathyroid Hormone Levels: A 16-Year Follow-Up Study. Calcified Tissue International, 88, 238-245.
http://dx.doi.org/10.1007/s00223-010-9454-0

[49]   Ministerio de Salud (2011) Indicadores básicos 2011. Presidencia de la Nación, Argentina.
http://www.msal.gov.ar/images/stories/pdf/indicadores-nacion-2011.pdf

 
 
Top