Low bone mineral density and vitamin D deficiency in patients with benign positional paroxysmal vertigo

Abstract

Several studies indicated the association between benign paroxysmal positional vertigo (BPPV) with osteoporosis and vitamin D deficiency implying that abnormal calcium metabolism may underlie BPPV. The aim of the present study is to confirm the correlation between BPPV and both decrease in bone mineral density (BMD) and vitamin D deficiency. The study group included 80 patients with idiopathic BPPV (52 females, 28 males), with age range 31-71 years (47.6 ± 9.1). The patients were divided into two groups; recurrent BPPV group including 36 subjects and non-recurrent group including 44 subjects. The control group included 100 healthy volunteers with age and gender distribution similar to the study group. All the subjects in the study were examined using Dual-energy X-ray absorptiometry to assess BMD, and serum 25-hydroxyvitamin D for vitamin D assessment. The accepted normal levels were T-score > -1, and 25-hydroxyvitamin D > 30 ng/ml. Twenty-six (26 %) subjects showed abnormal T-score in the control group; 26 (59 %) in the non-recurrent BPPV and 22 (61 %) in the recurrent BPPV group. Chi square test showed significant difference between the control group and both BPPV groups. The control group had significantly higher 25-hydroxyvitamin D levels than the BPPV subgroups (p < 0.05). Moreover, the 25-hydroxyvitamin D was significantly lower in the recurrent BPPV than it was in the non-recurrent subgroup (p < 0.05). The results of the current study associate between reduced BMD and development/recurrence of BPPV. Moreover, low levels of vitamin D were related to development of BPPV while very low levels were associated with recurrence of BPPV. The co-occurrence of two morbidities is not by itself supportive of a relationship, but the cumulating studies correlating between BPPV and both vitamin D deficiency and low BMD indicate the investigation and treatment of those disorders in cases with recurrent BPPV.

The Role of Oxidative Stress and Inflammatory Mediators in Benign Paroxysmal Positional Vertigo

“…Human otoconia are the sensory detector organs found in the utriculus and sacculus for the detection of linear acceleration and head tilt movements against gravity. They contain more than 90% calcite (crystalized calcium carbonate), and they are the only calcite-based biological structures acting in physiological processes in human beings, whereas other two systems, bone and teeth, contain calcium phosphate [12,13] . Calcium and carbonate levels in the endolymph are critical for normal otoconial function, which is primarily provided by a calcium channel transport system expressed in the inner ear [14] .…”

“…In addition to the ultrastructural and animal studies, clinical studies have also investigated the probable relationship between BPPV and calcium metabolism. Talaat et al [13] demonstrated that BPPV may be associated with low bone mineral density and vitamin D deficiency. Calcium metabolism and oxidative stress are closely linked.…”

Association of Benign Paroxysmal Positional Vertigo with Osteoporosis and Vitamin D Deficiency: A Case Controlled Study

“…In 2003, Vibert et al [4] observed that osteoporosis, osteopenia, and disorders of calcium metabolism presented more often in female BPPV patients Association of Benign Paroxysmal Positional Vertigo with Osteoporosis and Vitamin D Deficiency: A Case Controlled Study over 50 years of age and concluded that osteopenia and osteoporosis could be potential etiological factors in BPPV. In consequent years, studies conducted in several regions reported a prevalence of osteoporosis and vitamin D (vit D) deficiency in BPPV patients [3,[14][15][16][17] . However, these studies all had major selection bias in that the control group did not represent the population [3,6,14,15] .…”

“…In consequent years, studies conducted in several regions reported a prevalence of osteoporosis and vitamin D (vit D) deficiency in BPPV patients [3,[14][15][16][17] . However, these studies all had major selection bias in that the control group did not represent the population [3,6,14,15] . Bone mineral density (BMD) and serum 25-hydroxy vitamin D (25-OH vit D) levels might be affected by various factors such as age, hormonal factors, sex, nutrition and lifestyle habits, and pre-existing metabolic disorders [18][19][20] .…”

Benign Paroxysmal Positional Vertigo in Pregnancy

“…Calcium and vitamin D metabolism is usually affected in pregnancy, especially in the late trimesters due to the rapid growth of the fetus. This may be another risk factor for pregnant women suffering from BPPV (13). However, according to the guidelines of American College of Obstetricians and Gynecologists, vitamin D supplementation should only be recommended to pregnant women at an increased risk (14).…”