A high prevalence of hypovitaminosis D in Finnish medical in‐ and outpatients

Kauppinen‐Mäkelin, Ritva; Tähtelä, Riitta; Löyttyniemi, Eliisa; Kärkkäinen, Jorma; Välimäki, Matti

doi:10.1046/j.1365-2796.2001.00847.x

Cited by 60 publications

(35 citation statements)

References 17 publications

(23 reference statements)

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“…Hypovitaminosis D was defined as a serum level of 25(OH)D, at which serum parathyroid hormone concentration has started to increase in cross-sectional studies. 20 In part, the finding reflects the poor vitamin D status of the Finnish population; 21 when studied in October, 40% of middle-aged healthy Finnish men and women had hypovitaminosis D. In the present patients the vitamin D levels were, however, significantly lower than in controls. Schulte et al 5 pointed out that serum 25(OH)D levels were low even before BMT and were further decreased 4 weeks afterwards when the PTH levels rose.…”

Section: Discussionmentioning

confidence: 49%

Recovery of bone mass and normalization of bone turnover in long-term survivors of allogeneic bone marrow transplantation

Kananen

Volin

Tähtelä

et al. 2002

Bone Marrow Transplant

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Summary:Osteoporotic fractures are potential long-term complications of bone marrow transplantation (BMT). We previously reported that bone mineral density (BMD) of patients undergoing allogeneic BMT decreased by 6% to 9% during the first 6 months after BMT and that bone turnover rate was still increased 1 year after BMT. BMT patients do not need lifelong immunosuppressive treatment, which should offer favorable circumstances for the recovery of BMD. Thus, 27 (14 women, 13 men) of 29 long-term survivors of our previous study were invited to a follow-up study at a median of 75 months after BMT. From 12 months after BMT the BMD of the lumbar spine had increased by 2.4% (P ‫؍‬ 0.002). The respective changes in femoral sites were ؉4.1% in the femoral neck (P ‫؍‬ 0.087), 4.0% in the trochanter (P ‫؍‬ 0.095), ؉4.7% in Ward's triangle (P ‫؍‬ 0.072) and ؉1.4% in the total hip (P ‫؍‬ 0.23). The markers of bone formation, serum osteocalcin and type I procollagen aminoterminal propeptide (PINP) had returned to control levels, but out of the markers of bone resorption the mean level of serum type I carboxyterminal telopeptide (ICTP) was 41% higher (P ‫؍‬ 0.0001) and that of urinary type I collagen N-terminal telopeptide/creatinine (NTx) 41% lower (P ‫؍‬ 0.0002) in patients than in con Keywords: bone marrow transplantation; osteoporosis; bone mineral density; bone markers; vitamin D Osteoporosis and osteoporotic fractures are potential longterm complications of not only solid organ transplants 1 but also of the bone marrow. 2,3 In our prospective study of 44 patients undergoing allogeneic bone marrow transplantation (BMT) bone mineral density (BMD) decreased by 6% in the lumbar spine and by 7% to 9% in the three femoral sites during the first 6 post-transplant months; no significant further decline occurred between 6 and 12 months. 2 Shortly after BMT bone loss was explained by uncoupling between increased bone resorption and decreased bone formation. 2 At the end of 1-year follow-up both resorption and formation markers were elevated, indicating accelerated bone turnover in survivors. 2 Unlike transplant recipients of solid organs, recipients of hemopoietic transplants do not need lifelong immunosuppression, and glucocorticoids and cyclosporine A can usually be stopped. This fact, together with a relatively young age of BMT recipients offer the bone favourable circumstances to recover, the magnitude of which has not been addressed in previous studies. Thus, we invited the long-term survivors of our original patient population to a follow-up study, in which their BMD and bone turnover state were re-evaluated at a median of 6 years after BMT. The values were compared to those obtained at the end of the previous 1-year follow-up, and biochemical data were compared to those produced by sex-matched controls. The vitamin D status of the patients was also evaluated. Patients and methods PatientsTwenty-nine of 44 patients who had received an allogeneic bone marrow transplant and taken part in our previous study were still alive and...

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Section: Discussionmentioning

confidence: 49%

Recovery of bone mass and normalization of bone turnover in long-term survivors of allogeneic bone marrow transplantation

Kananen

Volin

Tähtelä

et al. 2002

Bone Marrow Transplant

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“…However, the threshold for the increase in PTH with declining 25-OHD varies with different studies. In our earlier study of middle-aged and elderly Finnish people, a dramatic rise in serum iPTH occurred when serum 25-OHD concentrations fell below 12.5 nmol/l, although a significant rise was observed already below a level of 50 nmol/l (Kauppinen-Mäkelin et al, 2001). In a French adult population, serum iPTH levels began to increase already when serum 25-OHD fell below 78 nmol/l (Chapuy et al, 1997).…”

Section: Vitamin D Fortification and Serum 25-ohd Levels V-v Välimäkimentioning

confidence: 77%

Vitamin D fortification of milk products does not resolve hypovitaminosis D in young Finnish men

2006

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Nineteen men (29.2%) had vitamin D deficiency (25-OHDp20 nmol/l) and 48 men (73.8%) had hypovitaminosis D (25-OHDp37.5 nmol/l). Serum 25-OHD and iPTH levels correlated inversely (r ¼ À0.30; P ¼ 0.017). Serum 25-OHD levels were 52.0% higher for 13 vitamin D supplement users than for 51 non-users (P ¼ 0.0001). After exclusion of supplement users, an association between 25-OHD level and consumption of milk products was found (P ¼ 0.011), with the median vitamin D level being 6.5 nmol/l higher for those consuming four glasses of milk products or more daily than for those consuming one or less. Likewise, the higher the milk consumption, the higher the difference in 25-OHD between years 2004 and 2001 (P ¼ 0.0025). Conclusion: Vitamin D fortification of milk products slightly but insufficiently improved the poor vitamin D status of young Finnish men during winter. Further supplementation is warranted in order to normalize vitamin D levels and to support achievement of maximum peak bone mass.

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“…Based on D-25 levels by diagnosis group, mean levels ranged between 70 and 86 (sufficient/optimal range). Patients with vasculitis and CTDs were found to have the highest levels of mean and median D-25 levels across all diagnosis groups, which could reflect more targeted supplementation in patients at risk or with known autoimmune diseases such as systemic lupus erythematosus and with potentially higher glucocorticoid requirements [18,19].…”

Section: Discussionmentioning

confidence: 95%

A cross-sectional study of vitamin D levels in a large cohort of patients with rheumatic diseases

2017

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The objective of this study is to examine 25-hydroxyvitamin D [25(OH)D] (D-25) levels and associations with patient-and disease-related factors in rheumatic diseases. This is a register-based study of D-25 levels in adult patients seen at the Central Finland Hospital rheumatology clinic (January 2011-April 2015. Demographic, clinical, laboratory, and patient-reported outcomes (PROs) were collected as part of the normal infrastructure of the outpatient clinic and examined for their association with D-25 level. Statistical analysis included descriptive statistics and univariable and multivariable regression analyses adjusting for age and gender. D-25 was measured in 3203 patients (age range 15-91 years, mean 54; 68% female) with diagnoses including RA (n = 1386), unspecified arthralgia/myalgia (n = 413), and connective tissues diseases (n = 213). The overall D-25 mean (SD) level was 78 (31) and median (IQR) 75 (55, 97). At baseline, 17.8% had D-25 deficiency, and only 1.6% severe deficiency (< 25 nmol/l); 34%/49% had sufficient/optimal D-25 levels. Higher D-25 levels were associated with older age, lower BMI, and regular exercise (all p < 0.001) among other factors. In multivariable analyses, younger age, non-white background, higher BMI, smoking, less frequent exercise (p < 0.001), and first visit to the clinic (p = 0.033) remained significantly associated with D-25 deficiency. Among those with sub-optimal D-25 levels, 64% had improved to sufficient/optimal levels after a median (IQR) of 13 (7.8, 22) months. The proportion of patients with D-25 deficiency in this study was generally low. Older patients had considerably higher D-25 levels compared to younger patients. Lower physical exercise and higher BMI were associated with higher risk of deficiency. The study supports the benefit of strategies to help minimize the risk of D-25 deficiency.

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A high prevalence of hypovitaminosis D in Finnish medical in‐ and outpatients

Cited by 60 publications

References 17 publications

Recovery of bone mass and normalization of bone turnover in long-term survivors of allogeneic bone marrow transplantation

Recovery of bone mass and normalization of bone turnover in long-term survivors of allogeneic bone marrow transplantation

Vitamin D fortification of milk products does not resolve hypovitaminosis D in young Finnish men

A cross-sectional study of vitamin D levels in a large cohort of patients with rheumatic diseases

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