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Title: Impact of calcium and vitamin D insufficiencies on serum parathyroid hormone and bone mineral density: analysis of the 4th & 5th Korean National Health and Nutrition Examination Survey

Author
item JOO, NAM-SEOK - Jean Mayer Human Nutrition Research Center On Aging At Tufts University
item DAWSON-HUGHES, BESS - Jean Mayer Human Nutrition Research Center On Aging At Tufts University
item KIM, YOUNG-SANG - Cha University
item OH, KYUNGWON - Korea Centers For Disease Control And Prevention
item YEUM, KYUNG-JIN - Jean Mayer Human Nutrition Research Center On Aging At Tufts University

Submitted to: Journal of Bone and Mineral Research
Publication Type: Peer Reviewed Journal
Publication Acceptance Date: 10/1/2012
Publication Date: 4/1/2013
Citation: Joo, N., Dawson-Hughes, B., Kim, Y., Oh, K., Yeum, K. 2013. Impact of calcium and vitamin D insufficiencies on serum parathyroid hormone and bone mineral density: analysis of the 4th & 5th Korean National Health and Nutrition Examination Survey. Journal of Bone and Mineral Research. 28(4):764-770.

Interpretive Summary: The relative contributions of calcium and vitamin D to bone health have been studied, but not in a population with very low calcium intake. To determine the relative importance of dietary calcium intake and blood levels of vitamin D to how calcium is used in the body and bone mass in a population with low calcium intake, a total of 4662 Korean adults (2567 men and 2095 women) greater than or equal to 50 years of age were divided into groups according to dietary calcium intakes and blood vitamin D concentrations. Serum intact parathyroid hormone (PTH, a hormone that increases blood levels of calcium) and bone density were evaluated according to dietary calcium intake and blood vitamin D. Lower dietary calcium intakes were significantly associated with higher serum PTH concentrations and lower bone density, not only at lower but also at higher blood vitamin D concentrations. Blood PTH was highest and bone density was lowest in the group, with the lowest blood vitamin D. In this low-intake population, calcium intake is a significant determinant of PTH and bone density at higher as well as blood vitamin D levels. This finding indicates that low calcium intake cannot be compensated for with higher vitamin D levels alone. As expected, blood vitamin D levels were inversely associated with PTH and bone density. Adequate calcium intake and blood vitamin D levels may be needed to maintain bone mass in this calcium deficient population.

Technical Abstract: The relative contributions of calcium and vitamin D to calcium metabolism and bone mineral density (BMD) have been examined previously, but not in a population with very low calcium intake. To determine the relative importance of dietary calcium intake and serum 25-hydroxyvitamin D [25(OH)D] concentration to calcium metabolism and bone mass in a population with low calcium intake, a total of 4662 adults (2567 men and 2095 women) greater than or equal to 50 years of age from the 2009-2010 Korea National Health and Nutrition Examination Survey (KNHANES) were divided into groups according to dietary calcium intakes (quintiles means: 154, 278, 400, 557, and 951'mg/d) and serum 25(OH)D concentrations (<50, 50-75, and >75'nmol/L). Serum intact parathyroid hormone (PTH) and femoral neck and lumbar spine BMD were evaluated according to dietary calcium intake and serum 25(OH)D. Mean calcium intake was 485'mg/d; mean serum 25(OH)D concentration was 48.1'nmol/L; PTH was 68.4'pg/mL; femoral neck BMD was 0.692'g/cm(2) ; and lumbar spine BMD was 0.881'g/cm(2) . Lower dietary calcium intakes were significantly associated with higher serum PTH concentrations and lower femoral neck BMD, not only at lower (<50'nmol/L) but also at higher (>75'nmol/L) serum 25(OH)D concentrations. Serum PTH was highest and femoral neck BMD was lowest in the group, with a serum 25(OH)D less than 50'nmol/L. In this low-intake population, calcium intake is a significant determinant of serum PTH and BMD at higher as well as lower 25(OH)D levels. This finding indicates that low calcium intake cannot be compensated for with higher 25(OH)D levels alone. As expected, serum 25(OH)D levels were inversely associated with serum PTH and BMD. A calcium intake of at least 668'mg/d and a serum 25(OH)D level of at least 50'nmol/L may be needed to maintain bone mass in this calcium deficient population.