High Prevalence of Hypovitaminosis D in Morocco: Relationship to Lifestyle, Physical Performance, Bone Markers, and Bone Mineral Density

doi:10.1016/j.semarthrit.2008.01.009

Seminars in Arthritis and Rheumatism

Volume 38, Issue 6, June 2009, Pages 444-451

https://doi.org/10.1016/j.semarthrit.2008.01.009 Get rights and content

Objectives

We undertook this study to determine the prevalence of hypovitaminosis D, its determinants, and its relationships to physical performance, serum parathyroid hormone (PTH) concentration, bone mineral density, and biochemical markers of bone turnover in healthy, ambulatory, pre- and postmenopausal women.

Methods

The group studied included 415 women aged 24 to 77 years. Between July and September, we assessed calcium intake and measured serum calcium, phosphorus, albumin, alkaline phosphate, 25-hydroxyvitamin D (25(OH)D), PTH, osteocalcin, and C-terminal cross-linking telopeptide of Type I collagen. We also measured bone mineral density (BMD) by dual-energy radiograph absorptiometry in the spine and total femur. Three tests were used to assess physical performance: timed get-up-and-go test, 5-times-sit-to-stand test, and 2.4 m speed walk.

Results

The prevalence of vitamin D insufficiency (<30 ng/mL) was 91%. In multiple logistic regression, the main determinants of hypovitaminosis D were age >55 years (OR 2.14 [95% IC, 1.1-4.1; P = 0.026)], wearing a veil [OR 2 (95% IC, 1.1-4; P = 0.04)], time spent outdoors less than 30 min/d [OR 2.8 (95% IC: 1.4-5.7; P = 0.003)], and daily calcium intake less than 700 mg [OR 2.39 (95% IC, 1.2-4.7; P < 0.01)]. A significant inverse correlation between 25 OH and osteocalcin (r = −0,18, P < 0001), 25 OH, and Type I collagen (r = −0,15, P = 0003) were observed. By Locally Weighted Regression and Scatterplot Smoothing technique, there was an increase in PTH level when S-25(OH)D was below 30 ng/mL. After adjustment for age, both spine BMD and total femoral BMD failed to show any significant correlation with serum 25(OH)D and PTH. There was no correlation between any physical performance tests and 25(OH)D levels.

Conclusions

Our study showed that during the summer season, vitamin D insufficiency is very common in healthy adult Moroccan women. Lack of sun exposure and veiled clothing style were the most important factors that influenced hypovitaminosis D. Patients with hypovitaminosis D had a high bone turnover, whereas there was no effect on BMD and physical performance. Further research is needed to evaluate the clinical impact of the above findings.

Section snippets

Subjects

Between June and August, 415 healthy Moroccan volunteer women were recruited from the city of Rabat through advertisements in local hospitals. Informed consent was obtained from all subjects and the study was approved by the Ethics Committee of our university hospital. We excluded from the study all patients with a history of the following: (1) taking drugs known to influence bone metabolism in the past 2 years, such as vitamin D, calcium, corticosteroids, bisphosphonates, and hormone

Clinical Characteristics

The characteristics of the patients are shown in Table 1. The mean age of the patients in the entire population was 50 ± 9.3 years. All patients were residing in urban areas. Seventy-four percent were menopausal with a mean age of 56 ± 9.6 years. Fifty-six percent of patients had a paid job. Eighty-five percent had never practiced any sporting activity, but 90% walked over 30 minutes at least once a week.

The mean ± SD serum 25(OH)D concentration for all 415 patients was 18.4 ± 7.9 ng/mL. The

Discussion

This study suggests that during the summer season, vitamin D insufficiency is very common in adult healthy Moroccan women. Age, the lack of sun exposure, veiled clothing style, and a daily calcium intake less than 700 mg are the most important factors that influence hypovitaminosis D. We defined hypovitaminosis D as a circulating level of 25(OH)D below 30 ng/mL. The choice of 30 ng/mL as a cutoff value agrees with previous studies that demonstrated secondary hyperparathyroidism, increased bone

Acknowledgments

This work was supported by grants from the University Mohammed V, Souissi, Rabat-Morocco. The Laboratory of Royal Gendarmerie supported the Biochemical measures. We wish to express special thanks to its director, Dr. Saâd El Kabbaj.

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BoneHigh Prevalence of Hypovitaminosis D in Morocco: Relationship to Lifestyle, Physical Performance, Bone Markers, and Bone Mineral Density

Objectives

Methods

Results

Conclusions

Section snippets

Subjects

Clinical Characteristics

Discussion

Acknowledgments

Bone

Am J Med

J Nutr

Am J Clin Nutr

Am J Clin Nutr

Bone

Am J Clin Nutr

Severe myopathy associated with vitamin D deficiency in western New York

Arch Intern Med

Vitamin D and intact PTH status in patients with hip fracture

Osteoporos Int

Occult vitamin D deficiency in postmenopausal US women with hip fracture

JAMA

Calcium plus vitamin D supplementation and the risk of fractures

N Engl J Med

A randomized controlled trial of vitamin D supplementation on preventing postmenopausal bone loss and modifying bone metabolism using identical twin pairs

J Bone Miner Res

Vitamin D status of middle-aged women at 65-71 degrees N in relation to dietary intake and exposure to ultraviolet radiation

Public Health Nutr

Hypovitaminosis D in a sunny country: relation to lifestyle and bone markers

J Bone Miner Res

High bone turnover in Muslim women with vitamin D deficiency

Med J Aust

Sunlight exposure and vitamin D in Turkish women

J Endocrinol Invest

Vitamin D deficiency in Pakistani premenopausal women living in Norway is not associated with evidence of reduced skeletal strength

Scand J Clin Lab Invest

Prevalence of vitamin D insufficiency in postmenopausal south Indian women

Osteoporos Int

Bone mineral density of the spine and femur in healthy Saudi females: relation to vitamin D status, pregnancy, and lactation

Calcif Tissue Int

Vitamin D deficiency in a group of Tehran Population

Res Med

Vitamin D deficiency in veiled or dark-skinned pregnant women

Med J

The impact of clothing style on bone mineral density among post menopausal women in Morocco: a case-control study

BMC Public Health

Bone
High Prevalence of Hypovitaminosis D in Morocco: Relationship to Lifestyle, Physical Performance, Bone Markers, and Bone Mineral Density