title: Association of glucocorticoid use and low 25-hydroxyvitamin D levels: results from the National Health and Nutrition Examination Survey (NHANES): 2001-2006.
abstract: BACKGROUND
  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.
  
  
  OBJECTIVE
  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.
  
  
  METHODS
  Cross-sectional analysis was performed using NHANES 2001-2006.
  
  
  METHODS
  We analyzed a nationally representative sample of U.S. children and adults.
  
  
  METHODS
  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.
  
  
  METHODS
  We measured serum 25(OH)D levels below 10 ng/ml.
  
  
  RESULTS
  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).
  
  
  CONCLUSIONS
  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.
authors.affiliation: Division of Pediatric Nephrology, Albert Einstein College of Medicine, The Children's Hospital at Montefiore, Bronx, New York 10467, USA. skversal@gmail.com
authors.forename: Amy L
authors.initials: AL
authors.lastname: Skversky
authors.forename: Juhi
authors.initials: J
authors.lastname: Kumar
authors.forename: Matthew K
authors.initials: MK
authors.lastname: Abramowitz
authors.forename: Frederick J
authors.initials: FJ
authors.lastname: Kaskel
authors.forename: Michal L
authors.initials: ML
authors.lastname: Melamed
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002648:Child; D002675:Child, Preschool; D003430:Cross-Sectional Studies; D005260:Female; D005938:Glucocorticoids / Q000009:adverse effects* / Q000627:therapeutic use; D006801:Humans; D007223:Infant; D008297:Male; D008875:Middle Aged; D009749:Nutrition Surveys; D014807:Vitamin D / Q000031:analogs & derivatives* / Q000097:blood; D014808:Vitamin D Deficiency / Q000097:blood / Q000139:chemically induced*
chemical_list: D005938:Glucocorticoids; D014807:Vitamin D; C104450:25-hydroxyvitamin D