Assessing the effect of dietary calcium intake and 25 OHD status on bone turnover in women in Pakistan

Khan, Aysha Habib; Naureen, Ghazala; Iqbal, Romaina; Dar, Farhan Javed

doi:10.1007/s11657-013-0151-2

Cited by 14 publications

(12 citation statements)

References 20 publications

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“…Our finding of very high prevalence of inadequate vitamin D status is in keeping with those of other investigators, who have reported a low prevalence of optimal vitamin D status among women in Karachi, Pakistan, where one study has reported that 84 % of participants had serum 25(OH)D concentrations <75 nmol/L [ 12 ]; another has reported that 91 % of participants had serum concentrations <50 nmol/L [ 1 ]. Studies conducted elsewhere in Asia have reported similarly high rates of vitamin D deficiency among women [ 13 – 15 ].…”

Section: Discussionsupporting

confidence: 91%

“…Despite its sub-tropical location and sunny climate, vitamin D deficiency has been reported to be very common in Pakistan, especially among women: a recent study reported that 90 % of pre-menopausal females had serum 25-hydroxyvitamin D (25[OH] D) concentrations <50 nmol/L (20 ng/mL) [ 1 ]. A growing literature points to the importance of adequate maternal vitamin D status in protecting against a wide range of adverse obstetric and neonatal outcomes, including pre-term birth, fetal neurodevelopment and neonatal infection [ 2 , 3 ].…”

Section: Introductionmentioning

confidence: 99%

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High prevalence of vitamin D deficiency among women of child-bearing age in Lahore Pakistan, associating with lack of sun exposure and illiteracy

et al. 2015

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BackgroundVitamin D status is a key determinant of maternal and neonatal health. Deficiency has been reported to be common in Pakistani women, but information regarding environmental and genetic determinants of vitamin D status is lacking in this population.MethodsWe conducted a cross-sectional study among three groups of healthy women living in Lahore, Pakistan: university students, students or employees of Medrasas or Islamic Institutes, and employees working in office, hospital or domestic settings. Multivariate analysis was performed to identify environmental and genetic determinants of vitamin D status: polymorphisms in genes encoding the vitamin D receptor, vitamin D 25-hydroxylase enzyme CYP2R1 and vitamin D binding protein [DBP] were investigated. We also conducted analyses to identify determinants of body ache and bone pain in this population, and to determine the sensitivity and specificity of testing for hypocalcaemia and raised serum alkaline phosphatase to screen for vitamin D deficiency.ResultsOf 215 participants, 156 (73 %) were vitamin D deficient (serum 25[OH]D <50 nmol/L). Risk of vitamin D deficiency was independently associated with illiteracy (adjusted OR 4.0, 95 % CI 1.03–15.52, P = 0.04), <30 min sun exposure per day (adjusted OR 2.13, 95 % CI 1.08–4.19, P = 0.02), sampling in January to March (adjusted OR 2.38, 95 % CI 1.20–4.70), P = 0.01) and lack of regular intake of multivitamins (adjusted OR 2.61, 95 % CI 1.32–5.16, p = 0.005). Participants with the GG genotype of the rs4588 polymorphism in the gene encoding vitamin D binding protein tended to have lower 25(OH)D concentrations than those with GT/TT genotypes (95 % CI for difference 22.7 to −0.13 nmol/L, P = 0.053). Vitamin D deficiency was independently associated with increased risk of body ache or bone pain (adjusted OR 4.43, 95 % CI 2.07 to 9.49, P = 0.001). Hypocalcaemia (serum calcium concentration ≤9.5 mg/dL) and raised alkaline phosphatase concentration (≥280 IU/L) had low sensitivity and very low specificity for identification of vitamin D deficiency.ConclusionVitamin D deficiency is common among healthy women of child-bearing age in Lahore, Pakistan: illiteracy, decreased sun exposure and lack of multivitamin intake are risk factors.

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Section: Discussionsupporting

confidence: 91%

Section: Introductionmentioning

confidence: 99%

High prevalence of vitamin D deficiency among women of child-bearing age in Lahore Pakistan, associating with lack of sun exposure and illiteracy

et al. 2015

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“…In our study, we found a vast majority of pregnant women (96.3%) were de cient in vitamin D at enrolment. The prevalence of vitamin D de ciency observed is alarming and the ndings in our study are similar to other studies conducted in Karachi, Pakistan, which reported de ciency in over 90% females (Anwar et al, 2016;A. Khan et al, 2013).…”

Section: Discussionsupporting

confidence: 91%

“…Similarly, a trial from Pakistan reported vitamin D de ciency in 90.5% women (A. Khan, Naureen, Iqbal, & Dar, 2013). The most recent National Nutrition Survey (NNS) 2018 reported a prevalence of vitamin D de ciency in 79.7% Women of Reproductive Age (WRA), which has increased by 11-13% since the previous NNS (2011) (Government of Pakistan, 2013; Government of Pakistan & UNICEF, 2019).…”

Section: Introductionmentioning

confidence: 99%

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Vitamin D Supplementation during Pregnancy- A Double Blinded Randomized, Controlled, Dose-Comparison, Trial in Pakistan

Nausheen¹,

Shaikh²,

Habib³

et al. 2020

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Vitamin D deficiency during pregnancy is a public health problem in Pakistan, and prevalent among most women of reproductive age in the country. Vitamin D supplementation during pregnancy is suggested to prevent adverse pregnancy outcomes and prevent vitamin D deficiency in both the mother and her newborn. However, there remains uncertainty surrounding the appropriate and safe dose for vitamin D supplementation in pregnant women who experience deficiency. We conducted a double-blinded, randomized, controlled, dose-comparison trial aimed to evaluate the relationship between different doses of vitamin D supplementation during pregnancy and pregnancy outcomes among women in a maternity hospital of the Aga Khan University (AKU) in Karachi, Pakistan. Pregnant women (n=350) in their first trimester were recruited and randomized to three treatment groups of vitamin D supplementation: 4,000 IU/day (Group A; n=120), 2,000 IU/day (Group B; n=115), or 400 IU/day (Group C – control; n=115). Deficiency in serum vitamin D (serum 25OHD <20ng/mL) at baseline was prevalent in more than 95% of women in each group. Participants in group A had the lowest vitamin D deficiency at endline and in newborns (endline: 75.9%; neonatal: 64.9%), followed by group B (endline: 84.9%; neonatal: 73.7%) and then the control group (endline: 90.2%; neonatal: 91.8%). Vitamin D deficiency was significantly lower in group A than group C (p=0.006) for women at endline, and lower in both group A and group B than the control group (p=0.001) in neonates. There were no adverse events attributable to vitamin D supplementation in all groups. Our study concluded that vitamin D supplementation with 4000 IU/day is safe and effective in reducing the risk of maternal and neonatal vitamin D deficiency.

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Clinical characteristics and outcomes of patients presenting with hip fractures at a tertiary care hospital in Pakistan

et al. 2021

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Osteoporosis remains under-recognized and sub-optimally managed in Pakistan, with a lack of awareness that minimal impact hip fracture is a manifestation of low bone mineral density (BMD). Purpose Hip fracture is often the first clinical presentation of osteoporosis and an opportunity to intervene and reduce future fracture risk. Our aim was to understand the current practices in Pakistan related to bone health in patients presenting with a hip fracture. Methods This is a retrospective study at a tertiary care center in Pakistan of patients admitted with a hip fracture. Data collected includes previous fracture history, known preceding diagnosis of low BMD medication details, comorbidities, and DXA results. Results Two hundred ten patients were studied. The mean age of patients was 73.1 years, with 112 (53.3%) women. Most (195 (92.9%)) had presented with a low-impact hip fracture, with 17 (8.1%) reporting previous history of fracture. None had been treated with osteoporosis medications prior to fracture. Nineteen (9%) were on calcium and vitamin D supplements prior to fracture; of the minority who were screened, all were vitamin D deficient and subsequently discharged on vitamin D supplements. No one was prescribed medications to reduce fracture risk at discharge. Conclusion This study reveals that patients admitted with minimal impact hip fractures in Pakistan are rarely evaluated for low BMD and not started on osteoporosis medications even after presenting with a typical osteoporosis-related fracture. This underscores the need for health provider education about osteoporosis as a major cause for hip fractures and the need to intervene for future fracture risk reduction.

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Assessing the effect of dietary calcium intake and 25 OHD status on bone turnover in women in Pakistan

Cited by 14 publications

References 20 publications

High prevalence of vitamin D deficiency among women of child-bearing age in Lahore Pakistan, associating with lack of sun exposure and illiteracy

High prevalence of vitamin D deficiency among women of child-bearing age in Lahore Pakistan, associating with lack of sun exposure and illiteracy

Vitamin D Supplementation during Pregnancy- A Double Blinded Randomized, Controlled, Dose-Comparison, Trial in Pakistan

Clinical characteristics and outcomes of patients presenting with hip fractures at a tertiary care hospital in Pakistan

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