title: Adverse interaction of low-calcium diet and low 25(OH)D levels on lumbar spine mineralization in late-pubertal girls.
abstract: No consensus has been reached on the serum 25-hydroxyvitamin D [25(OH)D] levels required to ensure optimal bone health around menarche. We searched for a possible interaction of 25(OH)D levels and calcium intake on lumbar spine mineralization and on biologic features of bone metabolism in healthy late-pubertal girls. Lumbar spine parameters (ie, area, mineral content, and density) and calcium intake were evaluated in 211 healthy white adolescent girls at pubertal stages IV-V (11 to 16.9 years), together with biologic markers of calcium and bone metabolism and with International External Quality Assessment Scheme for Vitamin D Metabolite (DEQAS)-validated serum 25(OH)D levels. A high prevalence of 25(OH)D levels ≤ 30 nmol/L (41%), ≤ 40 nmol/L (61%), and ≤ 50 nmol/L (70%) was found during winter-spring. Parathyroid hormone (PTH) levels were inversely associated with 25(OH)D levels (p = .0021). In contrast, lumbar spine mineral content and density were not associated with 25(OH)D, excepted when calcium intake was below 600 mg/day (p = .0081). Girls with such low calcium intake and 25(OH)D levels of 40 nmol/L or less (9% of the cohort) had a 0.4 to 0.7 SD lower mean areal bone mineral density Z-score than girls with higher calcium intake and/or higher 25(OH)D status. The adverse association between lumbar spine mineralization and combined calcium deficiency-low 25(OH)D levels remained significant in the 91 girls who could be followed over 4 years after their initial evaluation. We conclude that low 25(OH)D levels (≤40 nmol/L) are observed frequently during winter-spring in late-pubertal European girls, which may exacerbate the negative impact of calcium deficiency on lumbar spine mineralization.
authors.affiliation: INSERM U986, Hôpital St Vincent de Paul, Paris, France. laure.esterle@inserm.fr
authors.forename: Laure
authors.initials: L
authors.lastname: Esterle
authors.forename: Minh
authors.initials: M
authors.lastname: Nguyen
authors.forename: Odile
authors.initials: O
authors.lastname: Walrant-Debray
authors.forename: Jean-Pierre
authors.initials: JP
authors.lastname: Sabatier
authors.forename: Michèle
authors.initials: M
authors.lastname: Garabedian
mesh_terms: D000293:Adolescent; D000886:Anthropometry; D015415:Biomarkers / Q000097:blood; D015519:Bone Density / Q000502:physiology; D002113:Calcification, Physiologic / Q000502:physiology*; D002118:Calcium / Q000378:metabolism; D002136:Calcium, Dietary / Q000008:administration & dosage / Q000378:metabolism*; D002648:Child; D015331:Cohort Studies; D004032:Diet; D005260:Female; D005602:France; D006801:Humans; D016014:Linear Models; D008159:Lumbar Vertebrae / Q000033:anatomy & histology / Q000502:physiology*; D015999:Multivariate Analysis; D009929:Organ Size / Q000502:physiology; D010281:Parathyroid Hormone / Q000097:blood; D011627:Puberty / Q000502:physiology*; D012621:Seasons; D014807:Vitamin D / Q000031:analogs & derivatives* / Q000097:blood
chemical_list: D015415:Biomarkers; D002136:Calcium, Dietary; D010281:Parathyroid Hormone; D014807:Vitamin D; C104450:25-hydroxyvitamin D; D002118:Calcium