title: Calcium and vitamin D supplementation failed to improve bone mineral density in Indo-Asians suffering from hypovitaminosis D and secondary hyperparathyroidism.
abstract: BACKGROUND
  The association of low bone mineral density (BMD) in Asians with hypovitaminosis D (HD) and when complicated with secondary hyperparathyroidism (HD-SHPT) has been shown previously.
  
  
  OBJECTIVE
  Our aim was to study the effectiveness of calcium and vitamin D therapy in Indo-Asians with HD and HD-SHPT.
  
  
  METHODS
  One hundred forty-three patients attending our rheumatology clinic, including 97 (68%) with HD aged 48.9+/-11.6 years (86% female) and 46 (32%) with HD-SHPT aged 55.9+/-12.6 years (85% female), were recruited. Baseline investigations included routine biochemistry and 25-hydroxy vitamin D [25(OH)D], and parathyroid hormone (PTH) assays. Bone mineral densities (BMDs) of femoral neck, lumbar spine (LS), and distal radius (DR) were measured by dual energy X-ray absorptiometry. Patients were commenced on 1.0-1.25 g of calcium plus 400 IU of vitamin D. Blood tests were repeated at 6 and 12 months. Thirty-six patients with t scores of <-1 had their BMDs remeasured at 2 years. Unpaired t- and Mann-Whitney U tests were used in statistics. Results were considered significant at P< or =0.05.
  
  
  RESULTS
  Femur t and z scores failed to improve in either group. The reduction in LS t scores but not z scores was significant in both groups. Significant reductions in DR t and z scores occurred in the HD group only. Calcium and 25(OH)D increased significantly in both groups. Alkaline phosphatase and PTH were suppressed significantly only in HD-SHPT.
  
  
  CONCLUSIONS
  The failure of BMD to improve could be due to lack of compliance with medication between years 1 and 2, when most patients were under the supervision of primary care. To overcome this, we recommend continuance of blood monitoring at least once a year.
authors.affiliation: Department of Rheumatology, New Cross Hospital, Wolverhampton WV10 0QP, UK. e.serhan@btinternet.com
authors.forename: Ergin
authors.initials: E
authors.lastname: Serhan
authors.forename: Martin R
authors.initials: MR
authors.lastname: Holland
mesh_terms: D044466:Asian People; D015519:Bone Density / Q000187:drug effects*; D002118:Calcium / Q000008:administration & dosage*; D019587:Dietary Supplements; D004359:Drug Therapy, Combination; D005260:Female; D006801:Humans; D006962:Hyperparathyroidism, Secondary / Q000097:blood / Q000178:diet therapy* / Q000473:pathology; D008297:Male; D008875:Middle Aged; D010281:Parathyroid Hormone / Q000097:blood; D016896:Treatment Outcome; D014807:Vitamin D / Q000008:administration & dosage* / Q000031:analogs & derivatives / Q000097:blood; D014808:Vitamin D Deficiency / Q000097:blood / Q000178:diet therapy* / Q000473:pathology
chemical_list: D010281:Parathyroid Hormone; D014807:Vitamin D; C104450:25-hydroxyvitamin D; D002118:Calcium