Effect of vitamin D supplementation on vitamin D status and bone turnover markers in young adults

Objective: To assess the vitamin D status of healthy young people living in Northern Ireland and the effect of vitamin D supplementation on vitamin D status and bone turnover.

Design: Double-blinded randomised controlled intervention study.

Setting: University of Ulster, Coleraine, Northern Ireland.

Subjects: In total, 30 apparently healthy students (15 male and 15 female subjects), aged 18–27 years, were recruited from the university, with 27 completing the intervention.

Interventions: Subjects were randomly assigned, to receive either 15 mug (600 IU) vitamin D3 and 1500 mg calcium/day (vitamin D group), or 1500 mg calcium/day (control group) for 8 weeks between January and March. Vitamin D status, bone turnover markers, serum calcium and parathyroid hormone concentrations were measured at baseline and post intervention.

Results: At baseline, vitamin D status was low in both the vitamin D group (47.9 (s.d. 16.0)) and the control group (55.5 (s.d. 18.6) nmol/l 25(OH)D). Post intervention vitamin D status was significantly higher in the vitamin D-treated group (86.5 (s.d. 24.5)) compared to the control group (48.3 (s.d. 16.8) nmol/l) (P<0.0001). There was no significant effect of supplementation on bone turnover markers or PTH concentrations.

Conclusions: This study suggests that young adults in Northern Ireland do not consume an adequate daily dietary intake of vitamin D to maintain plasma vitamin D concentrations in the wintertime. A daily supplement of 15 mug vitamin D3 significantly increased vitamin D status in these individuals to levels of sufficiency. Achievement of an optimum vitamin D status among young adults may have future positive health implications.

Tissue donation and the attitudes of health care professionals

Since the first corneal transplant in 1905, improved surgical techniques and the development of immunosuppressive drugs have led to excellent success rates for organ and tissue transplantation procedures. This Chapter ,"'ill focus on the cadaveric donation of tissue and the attitudes towards it of health professionals, because they are key players in the donation- transplantation process.

The chapter begins with an overview of cadaveric tissue donation, including what can currently be transplanted. It will then present what is known about health professionals' attitudes to and knowledge of tissue donation and the impact that these have on donation rates. Attitudes, their components and their effect upon behaviour are explored using theories arising from social psychology to explain how these influence actual or intended behaviours associated with the discussion of donation wishes with relatives of the potential donor. Since some tissues, such as blood and bone marrow, can only normally be donated during life, these will be excluded since the behaviours associated with blood donation differ significantly from those associated with cadaveric tissue donation.

Improving health with nutritional interventions in residential aged care

In a group of Australian aged care residents, dietary energy and nutrient intakes were generally inadequate, despite sufficient energy being served. Six months of multivitamin supplementation improved nutritional status and bone quality; and six months of fortified milk consumption improved serum 25(OH)D and folate levels, and increased vitamin D and folate intakes.

Interactive effects of exercise plus calcium-vitamin D3 on bone strength in older men

The findings from this 18-month, community-based study revealed that an exercise program involving strength training and jumping activities was feasible and effective for improving bone density, muscle mass and strength in older men. There were no additional skeletal benefits derived from consuming a high calcium-vitamin D milk drink.

Association between changes in habitual physical activity and changes in bone density, muscle strength, and functional performance in elderly men and women

OBJECTIVES: To investigate the long-term effects of habitual physical activity on changes in musculoskeletal health, functional performance, and fracture risk in elderly men and women.

DESIGN: Ten-year prospective population-based study.

SETTING: Malmö-Sjöbo Prospective Study, Sweden.

PARTICIPANTS: Participants were 152 men and 206 women aged 50, 60, 70, and 80 who were followed for 10 years.

MEASUREMENTS: Distal radius bone mineral density (BMD) (single photon absorptiometry), upper limb muscle (grip) strength, balance, gait velocity, occupational and leisure-time activity, and fractures (interview-administered questionnaire) were reassessed after 10 years. Annual changes for all measures were compared between participants with varying habitual physical activity histories at baseline and follow-up: inactive–inactive (n=202), active–inactive (n=47), inactive–active (n=49), and active–active (n=60). Data for men and women were pooled, because there were no sex-by-activity group interactions. To detect possible differences in fracture incidence between the varying habitual activity groups, participants were classified into two activity groups based on their activity classification at baseline and follow-up: inactive:less active versus active:more active.

RESULTS: The annual rate of bone loss was 0.6% per year less in individuals classified as active at both time points than in those classified as inactive at both time points (P<.01). Similar results were observed for balance, but there was no effect of varying habitual activity on changes in muscle strength or gait velocity. There were also no differences in fracture incidence between individuals categorized as active:more active and those categorized as inactive:less active during the follow-up (adjusted hazard ratio=0.90, 95% confidence interval (CI)=0.42–1.90).

CONCLUSION: This study showed that elderly men and women who maintained a habitually active lifestyle over 10 years had lower bone loss and retained better balance than those who remained habitually inactive.

Socioeconomic status and bone mineral density in a population-based sample of men

Overall, socioeconomic status (SES) is inversely associated with poorer health outcomes. However, current literature provides conflicting data of the relationship between SES and bone mineral density (BMD) in men. In an age-stratified population-based randomly selected cross-sectional study of men (n = 1467) we assessed the association between SES and lifestyle exposures in relation to BMD. SES was determined by matching the residential address for each subject with Australian Bureau of Statistics 2006 census data for the study region. BMD was measured at the spine and femoral neck by dual energy X-ray absorptiometry. Lifestyle variables were collected by self-report. Regression models were age-stratified into younger and older groups and adjusted for age, weight, dietary calcium, physical activity, and medications known to affect bone. Subjects with spinal abnormalities were excluded from analyses of BMD at the spine. In younger men, BMD was highest at the spine in the mid quintiles of SES, where differences were observed compared to quintile 1 (1–7%, p < 0.05). In older men, the pattern of BMD across SES quintiles was reversed, and subjects from mid quintiles had the lowest BMD, with differences observed compared to quintile 5 (1–7%, p < 0.05). Differences in BMD at the spine across SES quintiles represent a potential 1.5-fold increase in fracture risk for those with the lowest BMD. There were no differences in BMD at the femoral neck. Further research is warranted which examines the mechanisms that may underpin differences in BMD across SES quintiles and to address the current paucity of data in this field of enquiry.

Bone mineral density reference ranges for Australian men : Geelong Osteoporosis Study

Summary : A large population-based random sample of Australian white men was used to provide normative bone mineral density (BMD) data at multiple anatomical sites. The femoral neck BMD data are very similar to those obtained in USA non-Hispanic white males participating in the National Health and Nutrition Examination Survey III (NHANES III). The reference ranges will be suitable for similar populations.

Introduction : To provide normative BMD data for Australian men derived from a large population-based random sample.

Methods : An age-stratified random sample of men was recruited from the Australian electoral rolls (n = 1,467 aged 20–97 years). BMD was quantified at multiple sites using Lunar densitometers.

Results : Age-related differences in BMD were best predicted by linear relationships at the spine and hip and by quadratic functions at the whole body and forearm. At the spine, a small age-related increase in mean BMD was observed. Although in the subset with no spinal abnormalities, there was a decrease of 0.003 g/cm² per year from age 20. At the hip sites, mean BMD decreased at 0.001–0.006 g/cm² per year from age 20. At the forearm and whole body, BMD peaked at 41–47 years. Apart from a small difference in men greater than or equal to 80 years, the Australian femoral neck BMD data are not different to those obtained in USA non-Hispanic white males participating in NHANES III and were generally similar to those of large studies from Canada (CaMos) and Spain.

Conclusions : These data supply BMD reference ranges at multiple anatomical sites that will be applicable to white Australian men and similar populations such as USA non-Hispanic white men.

Geelong Osteoporosis Study Health Database

The database contains the following clinical, questionnaire and socio-demographic data suitable for cross-sectional and longitudinal analyses:
-Body composition: dual-energy x-ray absorptiometry (DXA) measures of the lumbar spine (posterior-anterior projection), proximal femur, whole body and forearm (ultradistal forearm and distal 33%)
-Other clinical assessments: body weight, height, arm span, waist and hip circumferences, blood pressure, visual acuity, muscle strength, functional reach test and timed ‘up-&-go’ test.
-Mental health: Major axis psychiatric disorders diagnosed using a Structured Clinical Interview.
-Blood and urine collections: blood and urine collected after an overnight fast.
-Questionnaires: exposure to disease, use of medications and supplements, diet, mobility, physical activity, sleep, sun exposure, falls and fractures, alcohol and tobacco use, reproductive history, family history of fractures and disease, quality of life, pain, anxiety and depression.
-Socio-demographics: Country of birth, ethnicity, marital status, education, housing and employment status, occupation, socioeconomic Index for Areas (SEIFA) scores.

Forearm bone mineral density and incidence of hip fractures in Swedish urban and rural men 1987-2002

Background: It is not known whether the recently described break in the trend in hip fracture incidence in many settings applies in both women and men, depends on changes in bone mineral density (BMD) or changes in other risk factors, or whether it is apparent in both urban and rural settings. Methods: We evaluated changes in annual hip fracture incidence from 1987 to 2002 in Swedish men aged ≥60 years in one urban (n=25,491) and one rural population (n=16,432) and also secular differences in BMD, measured by single-photon absorptiometry at the distal radius and multiple other risk factors for hip fracture in a population-based sub-sample of the urban and the rural men aged 60–80 years in 1988/89 (n=202 vs. 121) and in 1998/99 (n=79 vs. 69). Results: No statistically significant changes in the annual age-adjusted hip fracture incidence per 10,000 were apparent from 1987 to 2002 in urban (0.38 per year, 95% CI-0.12 to 0.88) or rural men (-0.05 per year, 95% CI -0.63 to 0.53). BMD was similar in 1988/89 and 1998/99 when examining both urban (-19.6 mg/cm², 95% CI -42.6 to 3.5) and rural (-23.0 mg/cm², 95% CI -52.1 to 6.1) men. Conclusions: Since no secular change in age-adjusted hip fracture incidence was found during the study period, a levelling off in hip fracture incidence is present also in Swedish men. Because BMD on a group level was similar in 1988/89 and 1998/99, changes in other risk factors ought to be either of minor importance or counteracted by changes in different risk factors.

Chronic disease and impairment among Alaska native elders : the Alaska Education and Research Towards Health (EARTH) study

Background: Chronic diseases and impairments are prevalent among older Americans. However, prevalence data for Alaska Native (AN) elders are limited, with estimates usually extrapolated from national studies in which AN elders may not be well-represented. The aim of this study was to describe the prevalence of selected chronic diseases, impairments, and measured medical risk factors among a large community sample of AN elders.

Methods: Design, setting, and participants. A community-based cross-sectional study of baseline information from 656 AN elders aged 55 years or over who participated in the Alaska Education and Research Towards Health (EARTH) Study, March 2004 to August 2006. Measurements. Self-reported lifetime prevalence of 17 doctor-diagnosed chronic diseases, and point prevalence of vision, hearing, oral, and general health impairment were estimated from data collected using audio computer-assisted self-administered questionnaires. In addition, height, weight, blood pressure, fasting blood lipids, and fasting blood glucose levels were measured.

Results: The four most prevalent chronic diseases among AN elders were high blood pressure (55%), arthritis (49%), high cholesterol (42%), and adult bone fracture/break (35%). The median number of chronic diseases reported was three (inter-quartile range, 2 to 5). The prevalence of self-reported vision impairment was 15%, hearing impairment 18%, and having had all natural teeth removed 25%. Almost 50% were obese. High blood pressure (systolic ≥ 140 mm Hg and/or diastolic ≥ 90 mm Hg) was measured in 23%, high low density lipoprotein (LDL) cholesterol (≥ 130 mg/dL) in 39%, and high fasting plasma glucose (> 125 mg/dL) in 9%. Obesity was more prevalent among women than men. There were also significant regional differences in rates of obesity and high LDL cholesterol.

Conclusion: These data may be useful in public health programs and health services planning.

Osteopaenia - a marker of low bone mass and fracture risk

Areal bone mineral density is commonly categorised into normal bone mineral density, osteopaenia and osteoporosis on the basis of nominal thresholds recommended by the World Health Organization. However, bone mineral density is a continuous variable and there is a strong association between lower bone mineral density and greater risk for fracture. Fracture risk is not negligible in persons with moderate deficits in bone mineral density. Although absolute fracture risk is greatest for individuals with osteoporosis, more than half of the fractures arise from those with osteopaenia, and even normal bone mineral density, a probable consequence of greater numbers of individuals at risk in these categories. However, areal bone mineral density measurements used commonly in clinical practice do not detect differences in bone tissue properties, geometry and microarchitecture, which contribute to bone strength. Newer technologies such as high-resolution peripheral computed tomography have the advantage of assessing trabecular and cortical components of bone separately, in addition to geometric characteristics of the skeleton. Quantifying these parameters and considering clinical risk factors that affect fracture risk independent of bone quantity and quality, may better discriminate between high- and low-risk individuals. This would improve the decision-making for targeting appropriate interventions, either lifestyle or medication, to reduce thepublic health burden of fractures.

Examining the impact of reimbursement on referral to bone density testing for older adults: 8 years of data from the Barwon Statistical Division, Australia

Summary
In 2007, Medicare Australia revised reimbursement guidelines for dual energy X-ray absorptiometry (DXA) for Australians aged ≥70 years; we examined whether these changes increased DXA referrals in older adults. Proportions of DXA referrals doubled for men and tripled for women from 2003 to 2010; however, rates of utilization remained low.

Introduction
On April 1, 2007 Medicare Australia revised reimbursement guidelines for DXA for Australians aged ≥70 year; changes that were intended to increase the proportion of older adults being tested. We examined whether changes to reimbursement increased DXA referrals in older adults, and whether any sex differences in referrals were observed in the Barwon Statistical Division.

Methods
Proportions of DXA referrals 2003–2010 based on the population at risk ascertained from Australian Census data and annual referral rates and rate ratios stratified by sex, year of DXA, and 5-year age groups. Persons aged ≥70 years referred to the major public health service provider for DXA clinical purposes (n = 6,096; 21 % men).

Results
DXA referrals. Proportions of DXA referrals for men doubled from 0.8 % (2003) to 1.8 % (2010) and tripled from 2.0 to 6.3 % for women (all p < 0.001). For 2003–2006, referral ratios of men/women ranged between 1:1.9 and 1:3.0 and for 2007–2010 were 1:2.3 to 1:3.4. Referral ratios <2007:≥2007 were 1:1.7 for men aged 70–79 years (p < 0.001), 1:1.2 for men aged 80–84 years (p = 0.06), and 1:1.3 for men 85+ years (p = 0.16). For women, the ratios <2007:≥2007 were 1:2.1 (70–79 years), 1.1.5 (80–84 years), and 1:1.4 (85+ years) (all p < 0.001).

Conclusions
DXA referral ratios were 1:1.6 (men) and 1:1.8 (women) for 2007–2010 vs. 2003–2006; proportions of referrals doubled for men and tripled for women from 2003 to 2010. Overall, rates of DXA utilization remained low. Policy changes may have had minimal influence on referral; thus, ongoing evaluation over time is warranted.

The association between use of antidepressants and bone quality using quantitative heel ultrasound.

Osteoporosis and depression are major public health problems worldwide. Studies have reported an association between antidepressant use, mainly selective serotonin reuptake inhibitors (SSRIs), and bone mineral density (BMD), but the issue remains unclear.