Association of Glucocorticoid Use and Low 25-Hydroxyvitamin D Levels: Results from the National Health and Nutrition Examination Survey (NHANES): 2001-2006

Division of Pediatric Nephrology, Albert Einstein College of Medicine, The Children's Hospital at Montefiore, Bronx, New York 10467, USA.
The Journal of Clinical Endocrinology and Metabolism (Impact Factor: 6.21). 09/2011; 96(12):3838-45. DOI: 10.1210/jc.2011-1600
Source: PubMed


In many disorders requiring steroid therapy, there is substantial decrease in bone mineral density. The association between steroid use and 25-hydroxyvitamin D [25(OH)D] deficiency has not been confirmed in large population-based studies, and currently there are no specific vitamin D recommendations for steroid users.
The aim of the study was to evaluate the association of serum 25(OH)D deficiency [defined as 25(OH)D <10 ng/ml] with oral steroid use.
Cross-sectional analysis was performed using NHANES 2001-2006.
We analyzed a nationally representative sample of U.S. children and adults.
The study sample consisted of children, adolescents, and adults from NHANES 2001-2006 (n = 22,650), representative of 286 million U.S. residents, with serum 25(OH)D levels and data on other potential confounders.
We measured serum 25(OH)D levels below 10 ng/ml.
A total of 181 individuals (0.9% of the population) used steroids within the past 30 d. Overall, 5% of the population had 25(OH)D levels below 10 ng/ml. Among steroid users, 11% had 25(OH)D levels below 10 ng/ml, compared to 5% among steroid nonusers (P = 0.009). The odds of having 25(OH)D deficiency were 2-fold higher in those who reported steroid use compared to those without steroid use [odds ratio (OR), 2.36; 95% confidence interval (CI), 1.25, 4.45]. This association remained after multivariable adjustment (OR, 2.21; 95% CI, 1.01, 4.85) and in a multivariable model using NHANES III data (OR, 1.88; 95% CI, 1.01, 3.48).
Steroid use is independently associated with 25(OH)D deficiency in this nationally representative cohort limited by cross-sectional data. It suggests the need for screening and repletion in patients on chronic steroids.

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    • "Our previous study revealed that femoral neck BMD was negatively related to percent LBM in postmenopausal women with glucocorticoid treatment, although the influence of body composition on vertebral fracture risk seemed to differ depending on age.[36] Moreover, glucocorticoid use was independently related to 25(OH)D deficiency in a large, nationally representative sample of children and adults,[37] although vitamin D deficiency affects both muscle and bone. "
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    02/2014; 21(1):29-40. DOI:10.11005/jbm.2014.21.1.29
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    • "Neither was there an effect due to treatment with antipsychotics observed. No patients were treated with corticosteroids at the time of the study, which can also be associated with vitamin D deficiency (Skversky et al., 2011). There are difficulties inherent to the measurement and interpretation of vitamin D levels (Harvey and Cooper, 2012; Rosen, 2011) with a lack of unanimity on the best tests or range of tests to use. "
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    Schizophrenia Research 09/2013; 150(2-3). DOI:10.1016/j.schres.2013.08.036 · 3.92 Impact Factor
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    • "Haglin et al. [52] hypothesize that the mechanism that cause hypophosphatemia in relation to obesity is an overconsumption of a diet with low nutrient density or phosphate depletion due to low protein intake and in animal experiments, hypophosphatemia is associated with glucose uptake [47] and hypophosphatemia is related to reduced glucose tolerance [53]. Lastly, we did not find any association between phosphate levels and steroid use, in contrast with the study by Skversky et al., which found an inverse association between steroid use and vitamin D levels [54]. "
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    BMC Nephrology 08/2013; 14(1):178. DOI:10.1186/1471-2369-14-178 · 1.69 Impact Factor
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