The Difference in Vitamin D Status between Urban and Rural Elderly Women of Khon Kaen Province, Thailand

Background : Our study in the year 2000 concluded that the level of calcidiol at  35 ng/ml indicated a vitamin D deficiency, making the deficiency prevalence among the elderly in Khon Kaen municipality to be about 66.3%Objectives : To compare 104 urban elderlies with 130 rural elderlies in:\  1) Verified calcidiol and PTH levels; 2) Re-determine the level associated with vitamin D deficiency; and, 3) Compare the bone mineral density (BMD) of femoral neck, lumbar vertebrae and distal radius.Design : Cross-sectional, descriptive study.Setting :\ Urban and rural Khon Kaen, Thailand.Measures\ Serum calcidiol and PTH levels, and the proximal femur, lumbar spine and distal radius BMD.Results:\ The rural elderly were older (p \< 0.004), but their weight, BMI and alkaline phosphatase were lower (p = 0.007, p \< 0.001 and p \< 0.001, respectively) than their urban counterparts.\  The correlation coefficient for calcidiol and PTH of the pooled data (n = 234) was -0.35 (p \< 0.001).\  The quantity of calcidiol at  35 ng/ml was associated with a significant increase in PTH (one-way ANOVA, Tamhane post hoc test p  0.007).\  The prevalence of vitamin D deficiency, and the mean (SD) calcidiol and PTH levels in the rural vs. urban elderly were 17 vs. 65% (p\<0.001), 45 (11) ng/ml vs. 33 (7) ng/ml and 18 (15) pg/ml vs. 32 (18) pg/ml (p \< 0.001), respectively.\  The BMD of the ultradiatal\  and distal one-third of the radius (not the femoral neck or lumbar spine) were significantly higher in the rural vs. urban elderly (p \< 0.001).Conclusion : The higher calcidiol levels and bone strength in the rural population suggest that lifestyle and activity levels are important factors.\  Further study is needed to confirm this.Keywords : vitamin D status, calcidiol, rural, urban, elderly

Vitamin D Deficiency and the Risk of Osteoporosis in Elderly Women

Backgroud : Vitamin D deficiency lead to elevations in parathyroid hormone levels, resulting in increased bone resorption and reduced  BMD, especially cortical bone, and caused skeletal osteoporosis.  Up  to now there are very few studies to show the effect of vitamin D deficiency on bone mineral density.  The level of vitamin D deficiency vary considerably with latitude, also the variability in the different vitamin D assays, that varies from 10 – 40 ng/ml. From our previous study about prevalence of vitamin D deficiency, it being found that the level of calcidiol \< 35 ng/ml was th level of vitamin D deficiency.Objective : To determine the risk of osteoporosis in lumbar spine, proximal femur and the distal radius, between the elderly women with and without vitamin D deficiency. Design : Cross – sectional descriptive study.Setting : Municipality  of Khon Kaen province, Thailand.Outcome Measurements : Serum calcidiol and PTH  levels and  bone mineral density of lumbar spine, proximal femur and distal forearm.Results : No any significant difference in age, weight, height, BMI  and  the  alkaline  phosphatase  level  between  both  groups.  There  was  only  PTH  level  that  showed  significant  difference  between  both  groups.  A  calcudiol  level  of 

The Prevalence and the Calcidiol Levels of Vitamin D Deficiency in the Elderly Thai Women in municipality of Khon Kaen Province, Thailand

Background:\ Secondary hyperparathyroidism usually occurs when patients are vitamin D deficient, which in turn is the main cause of femoral osteoporosis.\  The skin is the organ of ultraviolet stimulated vitamin D production and studies have shown that elderly women with inadequate exposure to sunlight are vitamin D deficient.\  The prevalence of vitamin D deficiency in the West is 38 to 57%.\  Thai doctors do not believe Thais, whether elderly or osteoporotic, require vitamin D supplements because Thailand is located in the tropics.Objectives:\ Primary: to determine the prevalence and the calcidiol level of vitamin D deficiency in elderly Thai women.\ \ \ \ \ \ \ \ \ \ \ \ \ \  Secondary:\  to estimate the prevalence of osteoporosis and the correlation to serum calcidiol and serum PTH levels in elderly Thai women.Design:\ \ Cross-sectional descriptive study.Setting:\ Municipality of Khon Kaen, Khon Kaen province, Thailand.Outcome Measurements: Serum calcidiol and PTH levels and bone mineral density of the femoral neck.Results:\ The mean (SD) of age, BMI, serum calcidiol and PTH in the elderly Thai women were:\  69.26 (6.58) years, 24.18 (6.7) kg/m2, 33.24 (7.12) ng/mL, 32.34 (18.04) pg/mL, respectively.\  The prevalence of osteoporosis was 38.8%. There was significant inverted linear relationship between the serum calcidiol and PTH levels (r=-0.421, p\<0.001). The serum calcidiol level of vitamin D deficiency was  35 ng/mL, prevalence 66.3%. Conclusion:\ The belief\  that Thais are not vitamin D deficient should be\  reconsidered, especially in elderly women. And the multicenter study to find out the prevalence of vitamin D deficiency in Thai population should be performed.\  Vitamin D supplements are necessary for elderly women especially with osteoporosis.Keywords : Prevalence, vitamin D deficiency, calcidiol level, elderly women.\ 

Diagnostic Reliability of the Singh index: Femoral Neck Osteoporosis

Background : The incidence of osteoporotic hip fracture increases annually, the key to successful treatment of osteoporosis is early diagnosis and treatment before fracture. The Singh index was a popular tool for diagnosis of osteoporosis in the past, but its reliability is debated.Objective : To evaluate the intra- and inter-personal reliability of Singh grading among elderly Thai  women between two radiologists at Srinagarind hospital, Khon Kaen University, Thailand.Design : Cross-sectional descriptive studySetting : Thai elderly women in Khon Kane province, Thailand.Outcome Measurements: Singh grading, intra- and inter-observer reliability by kappa (k) and weighted-kResults :We registered  130 elderly Thai women in the study. The age of participants averaged 71.6 years (range 61-86 years). The first and second intra-observer (and their weighted) reliability k was 0.15 (95%CI: 0.04-0.26) (and 0.27), and 0.29 (95%CI: 0.15-0.42) (and 0.35), respectively. The inter-observer (and weighted) reliability  kwas 0.10 (95%CI: 0.00-0.20) and 0.26. Conclusion : The intra- and inter-person reliability of the Singh index is poor; therefore, the index needs to be simplified to establish its reliability as a screening tool for osteoporosis. Key word : Singh index, Kappa (k), Reliability, Osteoporosis

Prevalence of Vitamin D Deficiency among Postmenopausal Women at Srinagarind Hospital, Khon Kaen Province, Thailand.

Background :Vitamin D is essential for bone strength and development. It enhances intestinal absorption of calcium and its apposition to bone. It also increases muscle strength. In vitamin D deficiency condition, blood calcium is depressed, parathyroid hormone production is stimulated resulting in secondary hyperparathyroidism which promotes bone turnover. Cortical bone is the primary site affected, particularly at the femoral neck.In previous studies, we documented an average calcidiol level of £  35 ng/ml as vitamin D deficiency. A very high (\> 60%) prevalence of vitamin D deficiency was found among urban elderly women in Khon Kaen, in contrast to less than 20% among their rural counterparts. Until now, only limited data has been available on the average level of calcidiol and prevalence of vitamin D deficiency among postmenopausal women in Thailand.ObjectivesPrimary: Ascertain the prevalence of vitamin D deficiency among postmenopausal womenSecondary: 1. Find out the average vitamin D (calcidiol) level in postmenopausal women                   2. Find out the correlation between calcidiol and PTH in the pooled data                 3. Find out the calcidiol level which indicates the level of vitamin D deficiency in the pooled dataDesign : Cross-sectional, descriptive studySetting : Postmenopausal Clinic, Srinagarind Hospital, Khon Kaen, ThailandOutcome measurement Serum calcidiol, PTH, and alkaline phosphataseResults: The pooled data set comprised 332 cases including 98 cases of postmenopausal women, 104 cases of previously cited urban elderly women, and 130 cases of rural elderly women. The mean (SD) calcidiol level among the postmenopausal women was 32.58 (8.93) ng/ml, and calcidiol and PTH had reverse relation with the correlation coefficient (r) = -0.265 (p-value \< 0.001). Calcidiol at £  35 ng/ml was associated with a significant increase in PTH, which indicated the level of vitamin D deficiency. The prevalence of vitamin D deficiency in postmenopausal women was 60.2 percent.Conclusion :The high prevalence of vitamin D deficiency with low average level of calcidiol among postmenopausal women suggests a risk for developing osteoporosis. Outdoor exercise with sunlight exposure, high vitamin D diet intake, or, if necessary, supplementation with vitamin D is advised. 

The Reliability of Calcaneal Quantitative Ultrasound in the Measurement of Bone Mineral Density

Background: Dual-energy X-ray absorptiometry (DXA) is regarded in other countries as the reference method for bone density assessment because of its high reliability and precision. It is an expensive and thus with limited availability in developing countries. Quantitative ultrasound (QUS) has been introduced as an alternative technology to bone densitometry. Advantages of this method for evaluating patients at risk of osteoporosis over X-ray-based techniques include its low cost, portability and no ionizing radiation. Until now, there has been no study in Thailand about the reliability of QUS for its use in diagnosis of osteoporosis.Objectives: To study both the intra- and inter-observer reliability of stiffness index (SI) of QUS in measuring bone mineral density of the calcaneus Study design: Cross-sectional descriptive study Setting: Subject for bone density measurement were 100 Thai elderly women 60-89 years old (average age of 69.97 years), living in urban areas of Khon Kaen province, ThailandOutcome measurement: Stiffness index (SI) of the calcaneus in elderly women measured by two observers twice each.Results: This study was part of the study of “the combination of OSTA index and QUS in diagnosing osteoporosis”. The average weight of the subjects was 49.24 (30-81) Kg. The respective correlation coefficient (r) for SI between the 1st and 2nd measurements of the 1st and 2nd observers and between the 1st and 2nd observer was 0.973, 0.976 and 0.925 (p