Ultrasound bone mineral density of Os Calcis - its relationship with bone mineral markers and 25(OH) vitamin D in endemic fluorotic and non-fluorotic villages

Objectives: To study the relationship between the nutritional status, serum bone mineral markers, 25 hydroxy vitamin D [25(OH)D] levels and ultrasound bone mineral density (USBMD) of Os Calcis in subjects living in endemic fluorotic and non-fluorotic villages. Methods: Subjects from fluorotic (n=57) and non-fluorotic (n=79) villages were studied for their dietary habits, biochemical parameters of bone mineral markers, 25(OH)D levels and correlated with stiffness index (SI) measured using Achilles ultrasound bone densitometer. Results: Dietary calcium intake in both the villages is far below the recommended daily allowances (RDA) by Indian Council of Medical Research (ICMR), India for Indian population. The 25(OH)D correlated positively with energy intake (r=0.7; p<0.001); dietary calcium (r= 0.5; p<0.001); and negatively with phytate/calcium ratio (r=0.2; p<0.001), in subjects in fluorotic villages. No similar correlation was observed among subjects from non-fluorotic villages. For comparable levels of serum calcium, subjects in non-fluorotic villages were more osteopenic than the fluorotic counterparts. USBMD did not correlate with 25(OH)D in the fluorotic and non-fluorotic subjects. Conclusions: The dietary calcium intake among subjects from fluorotic and non-fluorotic villages is less than the RDA suggested by ICMR. The 25(OH)D levels of both these villages were in the vitamin D insufficiency range. USBMD does not correlate with the 25(OH)D status of an individual and it should not be used for screening osteoporosis in areas endemic for fluorosis

The effect of anti epileptic drug therapy on serum 25-hydroxyvitamin D and parameters of calcium and bone metabolism—A longitudinal study

AbstractBackgroundChronic antiepileptic drug use is associated with bone loss. We sought to assess the longitudinal effect of antiepileptic drug on serum 25-hydroxyvitamin D [25(OH)D] levels and bone mineral metabolism markers.MethodsPatients in the emergency services or those in neurology outpatient department with history of seizure were characterized and included in the study prospectively. Daily dietary intake of calories, calcium, phosphorus and phytates were characterized by dietary recall method. Base line bone mineral parameters – serum calcium, phosphorus, alkaline phosphatase (SAP), tartrate resistant acid phosphatase (TRACP), 25(OH)D levels, parathyroid hormone (PTH) and urinary calcium creatinine ratio (Ca.Cr), urinary calcium/kg/bodyweight (BW) and phosphate excretion index (PEI) were determined. Patients on AED therapy with normal 25(OH)D levels were followed up and were re-evaluated at the end of 6 months.ResultsThe daily dietary calcium intake of the subjects was lower than the RDA (Recommended Dietary Allowance) by ICMR (Indian Council of Medical Research). The diet was high in phytates. Two-thirds of the recruited subjects were vitamin D deficient. Subjects with normal 25(OH)D levels at base line showed a significant fall of 25(OH)D levels, urinary calcium, urinary calcium/kg/BW and TRACP levels at the end of 6 months irrespective of the AED used or the plasma level of AED.ConclusionsHypovitaminosis D is common in our population. Subjects with normal 25(OH)D levels, irrespective of the type of antiepileptic medications even at sub-therapeutic serum levels of the drug, went into 25(OH)D deficiency and insufficiency states. Theoretically it can be worthwhile to supplement calcium and vitamin D even before initiation of antiepileptic therapy