Prevalence of Vitamin D insufficiency and low bone mineral density in elderly Thai nursing home residents
Tóm tắt
Numerous emerging data from research on osteoporosis among Asians found differences from Caucasians. Therefore, the aim of this study was to determine the prevalence of vitamin D insufficiency and osteoporosis in elderly participants from two nursing homes in Thailand, a country located near the equator. The subjects of this cross-sectional study comprised 93 elderly Thai women who were living in institutional long-term nursing homes for the aged. Demographic data, daily food and calcium intake, physical activity, and sunlight exposure were measured. Lumbar spine and femoral neck bone mineral density (BMD) and biochemical levels including serum 25 hydroxyvitamin D [25(OH)D] and bone turnover markers were assessed. Vitamin D insufficiency was defined as 25(OH)D level < 70 nmol/l. The mean age of subjects was 75.2 ± 6.0 (SD) years. Dietary calcium intake was low (322 ± 158 mg/day) The mean 25(OH)D level was 64.3 ± 14.9 nmol/L and the prevalence of vitamin D insufficiency was 38.7% (95% CI: 28.8%, 49.4%). There was no correlation between serum 25(OH)D concentrations and age (r = −.11, p = 0.3). The mean BMD of lumbar spine and femoral neck were 0.92 ± 0.19 and 0.65 ± 0.10 g/cm2, respectively. Nearly a half of the subjects had osteopenia (44.1%, 95% CI: 33.8%, 54.8%) and osteoporosis (47.3%, 95% CI: 36.9%, 57.9%). Circulating C-terminal telopeptide of type I collagen (CTx) level correlated significantly with both lumbar spine (r = −0.26, p = 0.01) and femoral neck BMD (r = −0.25, p = 0.02). More than one-third of Thai elderly women residing in nursing homes had vitamin D insufficiency. Almost all nursing home residents had osteoporosis and/or osteopenia.
Tài liệu tham khảo
Johnell O, Kanis JA: An estimate of the worldwide prevalence and disability associated with osteoporotic fractures. Osteoporos Int. 2006, 17 (12): 1726-1733. 10.1007/s00198-006-0172-4.
Pfeifer M, Begerow B, Minne HW, Schlotthauer T, Pospeschill M, Scholz M, Lazarescu AD, Pollahne W: Vitamin D status, trunk muscle strength, body sway, falls, and fractures among 237 postmenopausal women with osteoporosis. Exp Clin Endocrinol Diabetes. 2001, 109 (2): 87-92. 10.1055/s-2001-14831.
Gerdhem P, Ringsberg KA, Obrant KJ, Akesson K: Association between 25-hydroxy vitamin D levels, physical activity, muscle strength and fractures in the prospective population-based OPRA Study of Elderly Women. Osteoporos Int. 2005, 16 (11): 1425-1431. 10.1007/s00198-005-1860-1.
Rizzoli R, Eisman JA, Norquist J, Ljunggren O, Krishnarajah G, Lim SK, Chandler J: Risk factors for vitamin D inadequacy among women with osteoporosis: an international epidemiological study. Int J Clin Pract. 2006, 60 (8): 1013-1019. 10.1111/j.1742-1241.2006.01066.x.
MacLaughlin J, Holick MF: Aging decreases the capacity of human skin to produce vitamin D3. J Clin Invest. 1985, 76 (4): 1536-1538. 10.1172/JCI112134.
Holick MF, Matsuoka LY, Wortsman J: Age, vitamin D, and solar ultraviolet. Lancet. 1989, 2 (8671): 1104-1105.
Cali CM, Kiel DP: An epidemiologic study of fall-related fractures among institutionalized older people. J Am Geriatr Soc. 1995, 43 (12): 1336-1340.
Chandler JM, Zimmerman SI, Girman CJ, Martin AR, Hawkes W, Hebel JR, Sloane PD, Holder L, Magaziner J: Low bone mineral density and risk of fracture in white female nursing home residents. JAMA. 2000, 284 (8): 972-977. 10.1001/jama.284.8.972.
Elliott ME, Binkley NC, Carnes M, Zimmerman DR, Petersen K, Knapp K, Behlke JM, Ahmann N, Kieser MA: Fracture risks for women in long-term care: high prevalence of calcaneal osteoporosis and hypovitaminosis D. Pharmacotherapy. 2003, 23 (6): 702-710. 10.1592/phco.23.6.702.32182.
Koh LK: An Asian perspective to the problem of osteoporosis. Ann Acad Med Singapore. 2002, 31 (1): 26-29.
Wiriyapanich T, Banjong O, Tamachotipong S, Akekantrong P, Wanichakul C, Tanvejasil P: Food composition database for IMMUCAL program. 2002, Thailand: Institute of Nutrition, Mahidol University, January, 2
Ainsworth BE, Haskell WL, Whitt MC, Irwin ML, Swartz AM, Strath SJ, O'Brien WL, Bassett DR, Schmitz KH, Emplaincourt PO, et al: Compendium of physical activities: an update of activity codes and MET intensities. Med Sci Sports Exerc. 2000, 32 (9 Suppl): S498-S504.
Chailurkit LO, Kruavit A, Rajatanavin R: Vitamin D status and bone health in healthy Thai elderly women. Nutrition. 2011, 27 (2): 160-164. 10.1016/j.nut.2009.12.001.
WHO: Study Group on Assessment of Fracture Risk and its Application to Screening for Postmenopausal Osteoporosis; World Health Organization: Assessment of fracture risk and its application to screening for postmenopausal osteoporosis: report of a WHO study group 1994. 1994, Geneva: World Health Organization, 1129-
Ross AC, Manson JE, Abrams SA, Aloia JF, Brannon PM, Clinton SK, Durazo-Arvizu RA, Gallagher JC, Gallo RL, Jones G, et al: The 2011 report on dietary reference intakes for calcium and vitamin D from the Institute of Medicine: what clinicians need to know. J Clin Endocrinol Metab. 2011, 96 (1): 53-58. 10.1210/jc.2010-2704.
Holick MF, Binkley NC, Bischoff-Ferrari HA, Gordon CM, Hanley DA, Heaney RP, Murad MH, Weaver CM: Evaluation, treatment, and prevention of vitamin D deficiency: an Endocrine Society clinical practice guideline. J Clin Endocrinol Metab. 2011, 96 (7): 1911-1930. 10.1210/jc.2011-0385.
Chailurkit L, Piaseu N, Rajatanavin R: Influence of normal ageing on mechanism of bone loss in women and men in Bangkok. J Med Assoc Thai. 2002, 85 (8): 915-921.
Calvo MS, Whiting SJ, Barton CN: Vitamin D fortification in the United States and Canada: current status and data needs. Am J Clin Nutr. 2004, 80 (6 Suppl): 1710S-1716S.
Nashimoto M, Nakamura K, Matsuyama S, Hatakeyama M, Yamamoto M: Hypovitaminosis D and hyperparathyroidism in physically inactive elderly Japanese living in nursing homes: relationship with age, sunlight exposure and activities of daily living. Aging Clin Exp Res. 2002, 14 (1): 5-12.
Pongchaiyakul C, Nguyen TV, Kosulwat V, Rojroongwasinkul N, Charoenkiatkul S, Eisman JA, Rajatanavin R: Effects of physical activity and dietary calcium intake on bone mineral density and osteoporosis risk in a rural Thai population. Osteoporos Int. 2004, 15 (10): 807-813.
Piaseu N, Komindr S, Chailurkit L, Ongphiphadhanakul B, Chansirikarn S, Rajatanavin R: Differences in bone mineral density and lifestyle factors of postmenopausal women living in Bangkok and other provinces. J Med Assoc Thai. 2001, 84 (6): 772-781.
Deplas A, Debiais F, Alcalay M, Bontoux D, Thomas P: Bone density, parathyroid hormone, calcium and vitamin D nutritional status of institutionalized elderly subjects. J Nutr Health Aging. 2004, 8 (5): 400-404.
Jarvis JK, Miller GD: Overcoming the barrier of lactose intolerance to reduce health disparities. J Natl Med Assoc. 2002, 94 (2): 55-66.
NIH Consensus conference: Optimal calcium intake. NIH Consensus Development Panel on Optimal Calcium Intake. JAMA. 1994, 272 (24): 1942-1948.
Uenishi K, Ishida H, Kamei A, Shiraki M, Ezawa I, Goto S, Fukuoka H, Hosoi T, Orimo H: Calcium requirement estimated by balance study in elderly Japanese people. Osteoporos Int. 2001, 12 (10): 858-863. 10.1007/s001980170037.
Gloth FM, Gundberg CM, Hollis BW, Haddad JG, Tobin JD: Vitamin D deficiency in homebound elderly persons. JAMA. 1995, 274 (21): 1683-1686. 10.1001/jama.1995.03530210037027.
Semba RD, Garrett E, Johnson BA, Guralnik JM, Fried LP: Vitamin D deficiency among older women with and without disability. Am J Clin Nutr. 2000, 72 (6): 1529-1534.
Nakamura K, Nashimoto M, Hori Y, Yamamoto M: Serum parathyroid hormone in healthy Japanese women in relation to serum 25-hydroxyvitamin D. Int J Vitam Nutr Res. 2000, 70 (6): 287-292. 10.1024/0300-9831.70.6.287.
Chan EL, Lau E, Shek CC, MacDonald D, Woo J, Leung PC, Swaminathan R: Age-related changes in bone density, serum parathyroid hormone, calcium absorption and other indices of bone metabolism in Chinese women. Clin Endocrinol (Oxf). 1992, 36 (4): 375-381. 10.1111/j.1365-2265.1992.tb01463.x.
Woo J, Lau E, Swaminathan R, MacDonald D, Chan E, Leung PC: Association between calcium regulatory hormones and other factors and bone mineral density in elderly Chinese men and women. J Gerontol. 1994, 49 (4): M189-M194.
Tsai KS, Hsu SH, Cheng JP, Yang RS: Vitamin D stores of urban women in Taipei: effect on bone density and bone turnover, and seasonal variation. Bone. 1997, 20 (4): 371-374. 10.1016/S8756-3282(97)00010-0.
del Puente A, Esposito A, Savastano S, Carpinelli A, Postiglione L, Oriente P: Dietary calcium intake and serum vitamin D are major determinants of bone mass variations in women. A longitudinal study. Aging Clin Exp Res. 2002, 14 (5): 382-388.
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 (9): 634-639. 10.1016/j.amjmed.2003.12.029.
Ooms ME, Lips P, Roos JC, van der Vijgh WJ, Popp-Snijders C, Bezemer PD, Bouter LM: 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 (8): 1177-1184.
Zimmerman SI, Girman CJ, Buie VC, Chandler J, Hawkes W, Martin A, Holder L, Hebel JR, Sloane PD, Magaziner J: The prevalence of osteoporosis in nursing home residents. Osteoporos Int. 1999, 9 (2): 151-157. 10.1007/s001980050129.
Reginster JY, Deroisy R, Pirenne H, Frederick I, Dewe W, Albert A, Collette J, Zheng SX, Gosset C: High prevalence of low femoral bone mineral density in elderly women living in nursing homes or community-dwelling: a plausible role of increased parathyroid hormone secretion. Osteoporos Int. 1999, 9 (2): 121-128. 10.1007/s001980050124.
Schmitt NM, Schmitt J, Doren M: The role of physical activity in the prevention of osteoporosis in postmenopausal women-An update. Maturitas. 2009, 63 (1): 34-38. 10.1016/j.maturitas.2009.03.002.
Vasikaran S, Eastell R, Bruyere O, Foldes AJ, Garnero P, Griesmacher A, McClung M, Morris HA, Silverman S, Trenti T, et al: Markers of bone turnover for the prediction of fracture risk and monitoring of osteoporosis treatment: a need for international reference standards. Osteoporos Int. 2011, 22 (2): 391-420. 10.1007/s00198-010-1501-1.
Chailurkit L, Ongphiphadhanakul B, Piaseu N, Saetung S, Rajatanavin R: Biochemical markers of bone turnover and response of bone mineral density to intervention in early postmenopausal women: an experience in a clinical laboratory. Clin Chem. 2001, 47 (6): 1083-1088.
Irwin ML, Ainsworth BE, Conway JM: Estimation of energy expenditure from physical activity measures: determinants of accuracy. Obes Res. 2001, 9 (9): 517-525. 10.1038/oby.2001.68.
The pre-publication history for this paper can be accessed here:http://www.biomedcentral.com/1471-2318/12/49/prepub