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Vitamin D status, parathyroid function and femoral bone density in an elderly Swedish population living at home

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Abstract

The aim of this study was to determine vitamin D status and bone mineral density (BMD) in elderly, independent Scandinavians. A cross-sectional examination was conducted in a sample of 104 subjects (mean age 84.5 years), for possible correlations among anthropometric data, 25-hydroxyvitamin D, 1,25-dihydroxy vitamin D, intact parathyroid hormone (PTH) and femoral neck BMD. Daily dietary calcium and vitamin D intakes were below the recommended levels. Five percent of the subjects were taking calcium, and 30% vitamin D supplements. Previous fragility fracture was reported in 30% of the men, and 55% of the women. Higher mean values of serum 25-hydroxyvitamin D (p=0.03) and femoral neck BMD (p=0.03) were recorded in subjects spending ≥3 hours outdoors weekly. Independently of time spent outdoors, subjects taking daily supplements of vitamin D (on average 5 pig) had higher 25-hydroxyvitamin D (p<0.001) levels, without significant changes in femoral neck BMD values. Serum levels of intact PTH (reference range 8–51 ng/L) were elevated in 41%, of which 5% had mild primary hyperparathyroidism. Serum levels of 25-hydroxyvitamin D (reference range 10–65 ng/mL) and 1,25-dihydroxy vitamin D (reference range 15–55 pg/mL) were below the reference ranges in 4% and 5% of the subjects, respectively. When serum levels of 25-hydroxyvitamin D were lower than approximately 30 ng/mL, the serum intact PTH values began to increase from a level of 43 pg/mL. This threshold most probably reflected a more relevant value of vitamin D insufficiency, indicating that 45% of our subjects rather than 4% actually had hypovitaminosis. Multiple regression analysis demonstrated femoral neck BMD to be significantly and positively associated with higher body mass index, male gender, no history of fragility fracture and 25-hydroxyvitamin D (R2=0.39). It is concluded that in this sample of healthy elderly people who regularly spend time outdoors, vitamin D levels leading to secondary hyperparathyroidism seem to be a major cause of osteoporosis. Correcting chronic dietary calcium deficiency is likely to eliminate another factor contributing to poor bone health.

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Authors and Affiliations

  1. Research and Development Unit, Serafen, Department of Primary Health Care, FoU, Hantverkargatan 2D, 112 83, S-Stockholm, Sweden

    A. L. Melin M.D.

  2. Department of Internal Medicine, Fredrikshavn Hospital, Fredrikshavn, Denmark

    J. Wilske

  3. Department of Radiology, Karolinska Hospital, Stockholm, Sweden

    H. Ringertz

  4. Department of Diabetology and Endocrinology, Karolinska Hospital, Stockholm, Sweden

    M. Sääf

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  1. A. L. Melin M.D.
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Melin, A.L., Wilske, J., Ringertz, H. et al. Vitamin D status, parathyroid function and femoral bone density in an elderly Swedish population living at home. Aging Clin Exp Res 11, 200–207 (1999). https://doi.org/10.1007/BF03399663

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