Modifiable factors associated with low bone mineral content in underprivileged premenarchal Indian girls

Abstract

Low adolescent peak bone mass is associated with bone problems in adulthood. Our aim was to assess underprivileged premenarchal Indian girls for low bone mineral content and to study the infl uence of anthropometric, lifestyle factors on bone health. Data on anthropometry, diet, lifestyle, total body bone mineral content (TBBMC), bone area, bone mineral density, and biochemical parameters [parathyroid hormone, vitamin D (25OH-D), calcium, and zinc] were assessed in 214 premenarchal girls (8 -12 years). Compared with the Indian reference database, 15.6 % girls had TBBMC for age Z-scores below -2 and 37.5 % had Z-scores between -2 and -1. The TBBMC for total body bone area Z-scores were below -2 for one fi fth of girls, indicating undermineralized bones. Mean rate of increase in TBBMC with age and Tanner stage was lower in our study population (11.6 % and 20.7 % , respectively) than reference database (14.2 % and 33.4 % , respectively). Low weight, 25OH-D, and intake of protein, calcium, and zinc adversely affected TBBMC (p < 0.05). Many underprivileged premenarchal Indian girls are at risk of achieving low bone mass. Steps to improve underweight, 25OH-D, intakes of protein, calcium, and zinc might improve bone health.

Dietary calcium intake influences the relationship between serum 25-hydroxyvitamin D3 (25OHD) concentration and parathyroid hormone (PTH) concentration

“…These results are in line with other studies 8 9 11. Our study also showed a negative correlation between serum 25OHD and intact serum PTH concentrations, as has been observed in other cross-sectional studies 2 10 20 21…”

“…Previous studies on Indian children and adolescents have found that they have lower bone mass than their Caucasian counterparts 7 8. Although India is a sun-rich country, there are many reports suggesting low vitamin D concentrations in Indian adolescents 9 10.…”

Vitamin D deficiency in India

“…in 2011. It showed a prevalence of 34.2% of Vitamin D.[ 47 ] Another school-based study done by Kapil et al . in 2017 on 1222 school children aged 6–18 years in Kangra and Kullu districts of Himachal Pradesh, showed the prevalence of 81% and 80% respectively.…”

Do Healthy Pre-pubertal Girls Need Supplementation with Vitamin D?

“…There is scant information on prevalence of asymptomatic vitamin D deficiency in prepubertal age group from India, and even less on symptomatic deficiency. A study from Pune in this age group reported a mean serum 25-hydroxy vitamin D (25(OH)D) level of 24.6 ng/mL with 34.2% prevalence of vitamin D deficiency [6], while a higher prevalence in school children has been reported from Delhi by Marwaha, et al [7]. Limited evidence indicates that the risk of vitamin D deficiency may be lower in this age group as compared to pre-school children [8].…”