Article
Cover
RNJPH Journal Cover Page

RGUHS Nat. J. Pub. Heal. Sci Vol No: 9  Issue No: 3 eISSN: 2584-0460

Article Submission Guidelines

Dear Authors,
We invite you to watch this comprehensive video guide on the process of submitting your article online. This video will provide you with step-by-step instructions to ensure a smooth and successful submission.
Thank you for your attention and cooperation.

Original Article

Madan S1 , Manjunatha S N2

1: Resident in Surgery, JIPMER, 2: Associate professor, Department of Community Medicine, MMCRI

Address for correspondence:

Dr. Manjunatha S N

Associate Professor, Department of Community Medicine Mysore Medical College and Research Institute

E-mail ID : drmanju.mmcri@gmail.com

Date of Received: 11/07/2020                                                                              Date of Acceptance:29/08/2020

Year: 2018, Volume: 3, Issue: 2, Page no. 24-32,
Views: 875, Downloads: 8
Licensing Information:
CC BY NC 4.0 ICON
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0.
Abstract

Background: Vitamin D deficiency prevails in epidemic proportions all over the Indian subcontinent, with a prevalence of 70%–100% in the general population. Hence it is important to estimate its burden in doctors and other health care providers.

Objectives: 1. To test Bone Mineral Density (BMD) values using Dual Energy X-Ray Absorptiometry (DEXA) scan among the study population. 2. To correlate values of Bone Mineral Density with serum 25-(OH) cholecalciferol, serum calcium, weight, height, body mass index (BMI), sun exposure, physical activity and diet. 3. To document known co-morbidities among study population.

Methodology: The study is a prospective cross sectional study.50 medical practitioners adhering to the inclusion and exclusion criteria of the study were invited for participation with voluntary consent. Their Bone Mineral Density values were calibrated by using an Ultrasound based Bone mineral densitometer having a 1 MHz transducer probe. Serum Vitamin D values were estimated by radioimmunoassay method and were expressed in nmol/L. Serum Calcium values were estimated by semiauto-analyzer.

Results: 58% of study population had normal bone mineral density. Only 12% had normal serum vitamin D. There was no significant association between bone mineral density and serum VitaminD.

Conclusion: The Bone Mineral Density (BMD) values in the study population are on an average in the osteopenic range with low serum vitamin D levels.

<p><strong>Background:</strong> Vitamin D deficiency prevails in epidemic proportions all over the Indian subcontinent, with a prevalence of 70%&ndash;100% in the general population. Hence it is important to estimate its burden in doctors and other health care providers.</p> <p><strong>Objectives:</strong> 1. To test Bone Mineral Density (BMD) values using Dual Energy X-Ray Absorptiometry (DEXA) scan among the study population. 2. To correlate values of Bone Mineral Density with serum 25-(OH) cholecalciferol, serum calcium, weight, height, body mass index (BMI), sun exposure, physical activity and diet. 3. To document known co-morbidities among study population.</p> <p><strong>Methodology: </strong>The study is a prospective cross sectional study.50 medical practitioners adhering to the inclusion and exclusion criteria of the study were invited for participation with voluntary consent. Their Bone Mineral Density values were calibrated by using an Ultrasound based Bone mineral densitometer having a 1 MHz transducer probe. Serum Vitamin D values were estimated by radioimmunoassay method and were expressed in nmol/L. Serum Calcium values were estimated by semiauto-analyzer.</p> <p><strong>Results:</strong> 58% of study population had normal bone mineral density. Only 12% had normal serum vitamin D. There was no significant association between bone mineral density and serum VitaminD.</p> <p><strong> Conclusion: </strong>The Bone Mineral Density (BMD) values in the study population are on an average in the osteopenic range with low serum vitamin D levels.</p>
Keywords
Bone mineral density, Serum Vitamin D, Serum Calcium, BMI
Downloads
  • 1
    FullTextPDF
Article

Introduction

Medical practitioners are a set of people having erratic lifestyles, irregular dietary patterns, poor physical activity and poor exposure to sunlight1. Hence, they form a vulnerable population for reduced Bone Mineral Density (BMD). Peak bone mass, a major determinant of osteoporosis is influenced by genetic, nutritional, lifestyle and hormonal factors2 . Vitamin D deficiency prevails in epidemic proportions all over the Indian subcontinent, with a prevalence of 70%–100% in the general population3 . The Indian population appears particularly vulnerable to the problem of osteoporosis and hip fractures and develop these conditions almost a decade earlier than their Caucasian counterparts4 . Bone Mineral Density is further compromised by conditions like Type 2 Diabtes Mellitus whose incidence is on the rise5 . Pure vegetarian diet and higher melanin content among the study population may also contribute to decreased serum Calcium and Vitamin D levels respectively6 . The best way to prevent deterioration of Bone Mineral Density and its possible complications like osteoporosis is to screen the population for BMD values at regular intervals. Hence we carried out this study in our hospital set up by which we have obtained a picture of the prevailing bone health and its determinants among medical practitioners in the study setting. Estimation of BMD values and their correlation with serum levels of Calcium, vitamin D and other factors like physical activity, diet and sun exposure can go a long way in documenting and treating subjects at risk for complications and morbidity. It can play a significant role in keeping the healthcare system healthy. Hence the present study was aim to test Bone Mineral Density (BMD) values using Dual Energy X-Ray Absorptimetry (DEXA) scan among the study population and to correlate values of Bone Mineral Density with serum 25-(OH) cholecalciferol, serum calcium, weight, height, body mass index (BMI), sun exposure, physical activity and diet and also to document known co-morbidities among study population.

Materials and methods

The study is a prospective cross sectional study. It was conducted between July 1st to August 31st,2017. 50 medical practitioners adhering to the inclusion and exclusion criteria of the study were invited for participation with voluntary consent. Their Bone Mineral Density values were calibrated by using an Ultrasound based Bone mineral densitometer having a 1 MHz transducer probe. The values were calibrated by probing ‘tibia’ bone and have been expressed in terms of T scores (corresponds to standard deviation). The values were also graded into 3 categories – normal (0 to -1.0), osteopenic (-1.1 to -2.5) and osteoporotic (-2.6 to -4.0) according to WHO guidelines. DEXA scan could not be used for the study due to constraints in availability and funding of the process. Ultrasound based values are closely comparable to values obtained by DEXA scan and hence the study objective has been adhered to in the best possible manner.

Subsequently the blood samples of the participants were collected at the same venue. 3 ml syringes were used with all necessary aseptic precautions. Tributaries of the cephalic vein were selected for withdrawal of blood. The samples were transferred immediately into sterile vacutainer tubes and were labeled. No anticoagulant was used. They were transported to the biochemical laboratory within a time of 2 hours of collection. Serum Vitamin D (25-OH Cholecalciferol) values were estimated by radioimmunoassay method and were expressed in nmol/L. The values were graded as normal (>50), normal/high bone turnover (25-50), high bone turnover (12.5-25) and incipient osteomalacia (<12.5).

Serum Calcium values were estimated by semiautoanalyser and were expressed in mg/ dl. The values were graded as normal (>8.9) and hypocalcemic (<8.9).

Body Mass Index values of all the study subjects were compiled after measuring their heights and weights at the venue using the formula

BMI= weight (kg) / (Height (m) 2 . The values were graded as normal (18.5-23.9), underweight (<18.5), overweight (24-29.99) and obese (>30).

Sun exposure was calculated by calculating ‘Sun Index’ which is expressed as the product of hours of sun exposure per day and the percentage of body surface area exposed per day.

Physical activity was expressed as moderate (3-6 MET) or severe (>6 MET) physical activity based on responses to a questionnaire on the same.

Results

50 study subjects (25 males and 25 females) were invited to participate in the study. Average age of the study population was 40.2. The age distribution is illustrated below-

Bone Mineral Density (BMD) values computed using bone densitometer showed an average BMD value of -1.156 (T score) which falls in ‘osteopenic’ range. The distribution of BMD values in the study population is illustrated below-

Serum Vitamin D (25-OH cholecalciferol) values estimated by semiautoanalyser were computed and 88% of the study population was found to be vitamin D deficient (<50 nmol/L). 58% of subjects had values between 25-50 nmol/L and 30% had values between 12.5-25 nmol/L. The distribution of vitamin D values in the study population is illustrated below-

Serum Calcium values estimated by radioimmunoassay method were compiled and they showed an average value of 9.35 mg/dl which falls within the normal range. The distribution of serum calcium values in the study population is illustrated below

Comparison of serum Vitamin D and BMD values was made. We found that there was no significant association between the two parameters. In other words, low values of serum Vitamin D do not directly correlate with low BMD values in the study population.

Comparison of serum calcium values and BMD was made. There was no significant association between the two parameters. Low serum Calcium values did not directly correlate with low BMD values.

A comparison between serum calcium and serum vitamin D levels was made. There was no significant association between the two parameters and hence serum vitamin D and calcium values do not seem to influence each other.

Gender predisposition of low Vitamin D and low BMD values was examined. Slight female preponderance was found among the subjects having low values of serum Vitamin D and BMD. The results are illustrated below

A comparison was made between Body Mass Index (BMI) and BMD values. It was found that 62.5 % of subjects above the normal upper limit BMI of 24 had low Bone Mineral Density values. Hence it is clear that low BMI values are more likely to be associated with healthier BMD values.

A comparison was made between Sun Exposure and BMD values. In both the groups with sun index greater than and lesser than 20, the proportion of people with normal BMD was greater- 60% of subjects with sun index > 20 and 53.3% of subjects with sun index < 20 had normal BMD. The results are illustrated below-

A comparison was made between skin type and Bone Mineral Density. 40 out of the 50 participants (80%) had skin type 3-6. 57.5% of people with skin type 3-6 had normal BMD and 42.5% had low BMD. 60% of subjects having skin types 1 and 2 had normal BMD and 40% had low BMD. The results are illustrated below-

Discussion

Our study was started with the aim of estimating Bone Mineral Density (BMD) values among medical practitioners of a tertiary care government hospital and correlating it with serum parameters like vitamin D, calcium and other parameters like Body Mass Index, Sun exposure and Physical activity. We chose an equal number of male and female participants for the study (25 participants each). Mean age of the participants of the study was 40.2 years.

Bone Mineral Density (BMD) estimation showed an average T score of -1.156 which falls in the osteopenic range. 42% of study subjects were found to be osteopenic. In the study by Multani S K et al 1131 out of 214 study subjects (61.2%) who were also medical practitioners were osteopenic. In the study conducted by Sunil Kota et al8 around 43.1% of participants were osteopenic. None of the subjects in our study was found to be osteoporotic which may have to do with the lower mean age of participants. BMD values are expected to decrease in the mid thirties and the decrease is expected to accelerate around menopause in women 4 .

Serum vitamin D estimation among the study population showed the following – 88% of our study population had low values of vitamin D (< 50 nmol/L) and 12% had values in the normal range. Vitamin D deficiency is believed to be prevalent to the extent of 70-100% among Indian population3 . In the study conducted by Sunil kota et al8 . 84.3% of subjects had vitamin D deficiency. When we correlated Vitamin D and BMD values, we found that there was no significant association between the two – P(0.05) was 1.703 which is insignificant. The above mentioned study by Sunil Kota et al. also came to the conclusion that there was no significant association between vitamin D and BMD values. The study by VasundharaKamineni et al9 also concluded that there was no correlation between Vitamin D and BMD values.

Serum Calcium estimation showed that 90% of study subjects had values in the normal range (8.9- 10.3 mg/dl). 6% of the population had low serum calcium level. Correlation between serum calcium and BMD values was made. We found that the association between the two was insignificant – P(0.05) was 0.797 which was insignificant. The studies mentioned in the ‘references’ section also broadly coincide with the conclusion that there is no correlation between serum calcium and BMD.

Body Mass Index (BMI) values were computed among the study population and it showed that 48% of the study population had BMI in excess of 24. Among this group 62.5 % of people had low BMD and 37.5% had normal BMD values. Among the population with BMD < 24, 70% had normal BMD and 30% had low BMD values. Hence lower values of BMI were found to be associated with healthier values of BMD. This conclusion was also made by a study conducted by Mohammad Reza Salamat et al12and in another one conducted by RexhepHoxha et al.13

Sun exposure among the study population was computed using the Sun Index. The population was divided into 2 groups based on an arbitrary cut off value of 20 and it was found that in people with sun index < 20, 53.3% of people had normal BMD values and 46.7% of people had low BMD values. Among the subjects with sun index > 20, 60% had normal BMD and 40% had low BMD. Though the BMD values in subjects with higher sun exposure are slightly better than the ones with lesser exposures, data does not suggest significantly better BMD values in subjects with higher exposure to sunlight. A study conducted by Weaver S P et.al also concluded that there was no significant improvement in vitamin D levels in their study subjects even after 6-8 weeks of sun exposure14.

Conclusion

The Bone Mineral Density (BMD) values in the study population are on an average in the osteopenic range. Low serum vitamin D levels (in 88% of the subjects), higher values of Body Mass Index (in 48% of subjects), lesser exposure to sunlight and darker skin types seem to be determining factors for BMD as suggested in some of the references, but in our study we did not find significant association between BMD values and serum parameters such as Vitamin D and Calcium. Although low BMI and higher exposure to sunlight correlate with higher BMD values, the association is again not significant. The cause for lower values of BMD and vitamin D seems to be multifactorial and not strongly associated with any one parameter.

Supporting File
References

1. Multani S K, Sarathi V, Shivane V, Bandgar T R, Menon P S, Shah N S; Study of bone mineral density in resident doctors working at a teaching hospital; J Postgrad Med 2010; 56:65-70.

2. Raman K. Marwaha, SeemaPuri, Nikhil Tandon, Sakshi Dhir, NehaAgarwal, Kuntal Bhadra, Namita Saini; Effects of sports training & nutrition on bone mineral density in young Indian healthy females; Indian J Med Res. 2011 Sep; 134(3): 307–313.

3. Ritu G, Ajay Gupta; Vitamin D Deficiency in India: Prevalence, Causalities and Interventions; Nutrients. 2014 Feb; 6(2): 729–775

4. Malhotra N, Mithal A. Osteoporosis in Indians. Indian J Med Res 2008;127:263-8.

5. Sadishkumar Kamalanathan, VimalNambiar, Vyankatesh Shivane, Tushar Bandgar, Padmavathy Menon, Nalini Shah; Bone mineral density and factors influencing it in Asian Indian population with type 2 diabetes mellitus; Indian J Endocrinol Metab. 2014 Nov-Dec; 18(6): 831– 837.

6. Weaver CM, Proulx WR, Heaney RP. Choices for achieving adequate dietary calcium with a vegetarian diet. Am J ClinNutr 1999; 72:S543-8.

7. Mir Sadat-Ali,a Abdulmohsen H. Al Elq,b Haifa A. Al-Turki,c Fathma A. Al-Mulhim,d and Amein K. Al-Alie; Influence of vitamin D levels on bone mineral density and osteoporosis; Ann Saudi Med. 2011 Nov-Dec; 31(6): 602–608

8. Sunil Kota, Sruti Jammula,1 Siva Kota,2 Lalit Meher,3 and Kirtikumar Modi; Correlation of vitamin D, bone mineral density and parathyroid hormone levels in adults with low bone density; Indian J Orthop. 2013 Jul-Aug; 47(4): 402–407.

9. VasundharaKamineni, Akkenapally Prasanna Latha, and K. Ramathulasi; Association between serum 25-hydroxyvitamin D levels and bone mineral density in normal postmenopausal women; J Midlife Health. 2016 Oct-Dec; 7(4): 163–168.

10. Chon SJ1, Koh YK2, Heo JY2, Lee J3, Kim MK2, Yun BH2, Lee BS2, Seo SK2; Effects of vitamin D deficiency and daily calcium intake on bone mineral density and osteoporosis in Korean postmenopausal woman; ObstetGynecol Sci. 2017 Jan;60(1):53-62. doi: 10.5468/ ogs.2017.60.1.53. Epub 2017 Jan 19

11. Cranney A, Horsley T, O'Donnell S, Weiler H, Puil L, Ooi D, Atkinson S, Ward L, Moher D, Hanley D, Fang M, Yazdi F, Garritty C, Sampson M, Barrowman N, Tsertsvadze A, Mamaladze V; Effectiveness and safety of vitamin D in relation to bone health; Evid Rep Technol Assess (Full Rep). 2007 Aug;(158):1- 235.

12. Mohammad Reza Salamat,1 Amir Hossein Salamat,2 Iraj Abedi,1 and Mohsen Janghorbani; Relationship between Weight, Body Mass Index, and Bone Mineral Density in Men Referred for Dual-Energy X-Ray Absorptiometry Scan in Isfahan, Iran; Journal of Osteoporosis, Volume 2013 (2013), Article ID 205963.

13. Rexhep Hoxha,1Hilmi Islami,1 Hasime QorrajBytyqi,1 Shpetim Thaçi,2 and Elton Bahtiri1; Relationship of Weight and Body Mass Index with Bone Mineral Density in Adult Men from Kosovo; Mater Sociomed. 2014 Oct; 26(5): 306– 308.Published online 2014 Oct 29.

14. Weaver SP1, Passmore C, Collins B, Fung E; Vitamin D, sunlight exposure, and bone density in elderly African American females of low socioeconomic status; Fam Med. 2010 Jan;42(1):47-51

HealthMinds Logo
RGUHS Logo

© 2024 HealthMinds Consulting Pvt. Ltd. This copyright specifically applies to the website design, unless otherwise stated.

We use and utilize cookies and other similar technologies necessary to understand, optimize, and improve visitor's experience in our site. By continuing to use our site you agree to our Cookies, Privacy and Terms of Use Policies.