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: 6.31). 09/2011; 96(12):3838-45. DOI: 10.1210/jc.2011-1600
Source: PubMed

ABSTRACT 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.

  • [Show abstract] [Hide abstract]
    ABSTRACT: To determine the prevalence of and risk factors for decreased bone mineral density (BMD) and vitamin D deficiency in children and adolescents with congenital adrenal hyperplasia (CAH). This study was conducted on 30 girls and 22 boys with CAH (age range = 5-20 years) with median age of 12.0 years. BMD values of lumbar vertebras (L1-L4), which were determined by dual-energy X-ray absorptiometry, were used to calculate z-scores according to chronological age. A serum 25-hydroxyvitamin D level of <15 ng/mL was considered as indicative of vitamin D deficiency. Mean vitamin D level was 14.8 ng/mL in the whole group. Twenty-seven (51.9%) children had vitamin D deficiency and it was more prevalent during pubertal ages. Vitamin D levels were found to be significantly lower in pubertal females. BMD z-score was below -1 standard deviation in 40.1% of cases with significantly higher mean age and lower vitamin D levels. Decreased BMD z-score and vitamin D deficiency were common in these children with CAH. Vitamin D levels were significantly lower in girls and pubertal children. Decreased BMD z-score was related to older age and lower levels of vitamin D. Periodical controls of vitamin D status and vitamin D supplementation were recommended in these cases, whenever required.
    Turkish Journal of Medical Sciences 01/2014; 44(1):109-114. DOI:10.3906/sag-1301-114 · 0.84 Impact Factor
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Increased bone resorption and enhanced risk of osteoporotic fractures are often reported in patients with diseases having immune system involvement, mainly inflammatory rheumatic diseases, for which glucocorticoids are more often prescribed because of their powerful antinflammatory effects. Among secondary osteoporosis, glucocorticoid-induced osteoporosis is the most common and severe form, and up to now prolonged glucocorticoid therapy has been considered the most important osteoporotic risk factor in rheumatic patients.However, it is now clear that the pathogenesis of osteoporosis in inflammatory rheumatic diseases is mediated by several factors. In particular, new discoveries within osteoimmunology concerning the complex relationship between bone and immunity, suggest that inflammation itself, through proinflammatory and osteoclastogenic cytokine overexpression, promotes bone resorption leading to increased skeletal fragility. Therefore, by controlling systemic inflammation, it is also possible to reduce the loss of bone mass which accompanies rheumatic diseases.From this point of view, we critically revisit the effects of glucocorticoids on bone in rheumatic diseases, in which they should be seen not just as an enemy of the bone health but eventually as a potential therapeutic tool capable of reducing the risk of osteoporosis by controlling disease activity and inflammation.
    Current Medicinal Chemistry 11/2014; · 3.72 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: Background: Mental stressYinduced (MSIMI) or physical stressYinduced (PSIMI) myocardial ischemia portends a worse prognosis in patients with coronary artery disease (CAD). Vitamin D insufficiency is associated with adverse cardiovascular outcomes, but its relationship to myocardial ischemia remains unclear. We hypothesized that vitamin D insufficiency will be associated with a higher prevalence of myocardial ischemia in patients with CAD. Methods: In 255 patients with stable CAD, myocardial perfusion imaging was performed to assess ischemia in response to mental and physical stress protocols. Vitamin D insufficiency was defined as serum 25-hydroxyvitamin D [25(OH) D] levels below 30 ng/ml, collected on the day of stress testing. Results: Mean (standard deviation) 25(OH) D level was 30.8 (12.8) ng/ml, and 139 (55%) patients had vitamin D insufficiency. MSIMI occurred in 30 (12%) patients and PSIMI in 67 (27%). Individuals with MSIMI had significantly lower levels of 25(OH) D as compared with those without MSIMI (24.0 [8.6] versus 31.7 [12.9], p = .002). The prevalence of MSIMI was higher in those with as compared with those without vitamin D insufficiency (17% versus 6%, p = .009). Moreover, low 25(OH) D levels remained independently associated with MSIMI after adjusting for potential confounders. Conversely, 25(OH) D levels were similar between those with or without PSIMI (29.8 [13.0] versus 31.4 [12.7], p = .37), as was the prevalence of PSIMI in those with or without vitamin D insufficiency (29% versus 24%, p = .42). Conclusions: Vitamin D insufficiency is associated with a higher prevalence of MSIMI but not PSIMI among stable patients with CAD. Whether this association serves as a potential mechanism linking low vitamin D status to adverse cardiovascular outcomes warrants further investigation.
    Psychosomatic Medicine 09/2014; 76(7):569-575. DOI:10.1097/PSY.0000000000000088 · 4.09 Impact Factor