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High prevalence of vitamin D deficiency, secondary hyperparathyroidism and generalized bone pain in Turkish immigrants in Germany: identification of risk factors

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Abstract

Introduction

The aim of the study was to determine the prevalence of vitamin D deficiency, secondary hyperparathyroidism (sHPT), generalized bone pain and predictors of vitamin D deficiency in a cohort of 994 healthy adult urban residents (589 males, 405 females; age range: 16–69 years) consisting of 101 Germans, 327 Turkish residents of Turkey and 566 Turkish immigrants living in Germany.

Methods

The mean (± standard deviation) for 25-hydroxyvitamin D [25(OH)D] and biointact parathyroid hormone (BioPTH) for the German men and women was 68.4 nmol/l and 26.7 pg/ml, respectively. Turkish residents of Turkey had a mean 25(OH)D and BioPTH of 40.6 nmol/l and 27.5 pg/ml, respectively, whereas Turkish residents of Germany had a 25(OH)D of 38.1 nmol/l and a BioPTH of 35.6 pg/ml.

Results

Vitamin D insufficiency was common among Turkish nationals independent of whether they lived in Turkey or Germany; 75% had 25(OH)D levels of <50 nmol/l. Turkish females had a higher prevalence of 25(OH)D deficiency (<25 nmol/l) than Turkish males: 30 and 19% of Turkish females living in Germany and Turkey were severely vitamin D deficient compared to 8% and 6% of Turkish males living in Germany and Turkey, respectively. With respect to BioPTH levels, 31% of Turkish females and 21% of Turkish males had elevated BioPTH levels in contrast to only 15% of females and 4% of males living in Turkey. Unconditional logistic regression analysis identified the most important predictors for low 25(OH)D levels as sex, body mass index, lack of sun exposure and living at a higher latitude. Additionally, wearing a scarf and number of children were found to be an independent risk factor for vitamin D deficiency in Turkish women living in Turkey and Germany. A strong correlation between low 25(OH)D levels and higher rates and longer duration of generalized bone and/or muscle aches and pains (often diagnosed as fibromyalgia) was observed.

Conclusion

Secondary hyperparathyroidism and vitamin D deficiency was found to be common among Turkish immigrants living in Germany, especially in veiled women. Therefore, the monitoring of vitamin D status – i.e. 25(OH)D and PTH – in Turkish immigrants is warranted and once a deficiency is identified, it should be appropriately treated.

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Acknowledgement

Reagents for 25(OH)D and PTH determinations were generously provided by the Nichols Institute Diagnostika GmbH, Bad Vilbel, Germany.

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Authors and Affiliations

  1. Third Medical Department and Policlinic, University of Giessen Medical Centre, Giessen, Germany

    M. Z. Erkal, Y. Bilgin, A. Akinci, R. G. Bretzel & H. Stracke

  2. Nichols Institute Diagnostika GmbH, Bad Vilbel, Germany

    J. Wilde

  3. Protestant Hospital Giessen, Giessen, Germany

    M. Z. Erkal

  4. Turkish-German Health-Foundation, Giessen, Germany

    Y. Bilgin, A. Akinci & E. Demir

  5. AG Medical Statistics/Department for Medical Informatics, University of Giessen, Giessen, Germany

    R. H. Bödeker & M. Mann

  6. Boston University Medical Center, Department of Medicine, 715 Albany Street, M-1013, Boston, MA, USA

    M. F. Holick

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  1. M. Z. Erkal
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  2. J. Wilde
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  3. Y. Bilgin
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  4. A. Akinci
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  7. M. Mann
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  10. M. F. Holick
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Correspondence to M. F. Holick.

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Erkal, M.Z., Wilde, J., Bilgin, Y. et al. High prevalence of vitamin D deficiency, secondary hyperparathyroidism and generalized bone pain in Turkish immigrants in Germany: identification of risk factors. Osteoporos Int 17, 1133–1140 (2006). https://doi.org/10.1007/s00198-006-0069-2

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  • DOI: https://doi.org/10.1007/s00198-006-0069-2

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