Impact of calcium and vitamin D insufficiencies on serum parathyroid hormone and bone mineral density: Analysis of the fourth and fifth Korea National Health and Nutrition Examination Survey (KNHANES IV-3, 2009 and KNHANES V-1, 2010)

Authors

  • Nam-Seok Joo,

    1. Jean Mayer–U.S. Department of Agriculture Human Nutrition Research Center on Aging, Tufts University, Boston, MA, USA
    2. Ajou University School of Medicine, Suwon, Republic of Korea
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  • Bess Dawson-Hughes,

    1. Jean Mayer–U.S. Department of Agriculture Human Nutrition Research Center on Aging, Tufts University, Boston, MA, USA
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  • Young-Sang Kim,

    1. CHA Bundang Medical Center, CHA University, Bundang, Republic of Korea
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  • Kyungwon Oh,

    1. Division of Health and Nutrition Survey, Korea Centers for Disease Control and Prevention, Chengwon, Republic of Korea
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  • Kyung-Jin Yeum

    Corresponding author
    1. Jean Mayer–U.S. Department of Agriculture Human Nutrition Research Center on Aging, Tufts University, Boston, MA, USA
    • Jean Mayer–USDA Human Nutrition Research Center on Aging at Tufts University, 711 Washington St., Boston, MA 02111, USA.
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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) ≥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/cm2; and lumbar spine BMD was 0.881 g/cm2. 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. © 2013 American Society for Bone and Mineral Research.

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