And: Those younger than 18 were 14X more likely to have less than 10 ng
Association of Glucocorticoid Use and Low 25-Hydroxyvitamin D Levels: Results from the National Health and Nutrition Examination Survey (NHANES): 2001–2006
The Journal of Clinical Endocrinology & Metabolism September 28, 2011 jc.2011-1600
Amy L. Skversky, skversal at gmail.com
Matthew K. Abramowitz,
Frederick J. Kaskel and
Michal L. Melamed
Division of Pediatric Nephrology (A.L.S., F.J.K.), Albert Einstein College of Medicine, The Children's Hospital at Montefiore, Bronx, New York 10467; Division of Pediatric Nephrology (J.K.), Weill Cornell Medical Center, New York, New York 10021; and Department of Medicine, Division of Nephrology (M.K.A., M.L.M.), Albert Einstein College of Medicine, Bronx, New York 10467
Context: 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.
Design: Cross-sectional analysis was performed using NHANES 2001–2006.
Setting: We analyzed a nationally representative sample of U.S. children and adults.
Participants: 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.
Main Outcome Measure: 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).
Conclusion: 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.
Received May 26, 2011; Accepted September 6, 2011.
September 28, 2011 - (BRONX, NY) - People taking oral steroids are twice as likely as the general population to have severe vitamin D deficiency, according to a study of more than 31,000 children and adults by scientists at Albert Einstein College of Medicine of Yeshiva University. Their findings, in the September 28 online edition of The Journal of Clinical Endocrinology and Metabolism, suggest that physicians should more diligently monitor vitamin D levels in patients being treated with oral steroids.
"When doctors write that prescription for steroids and they're sending the patients for lab tests, they should also get the vitamin D level measured," said study lead author Amy Skversky, M.D., M.S., assistant professor of pediatrics at Einstein and Montefiore Medical Center, the University Hospital for Einstein.
The severe vitamin D deficiency assessed in this study (defined as levels below 10 nanograms per milliliter of blood) is known to be associated with osteomalacia (softening of the bones), rickets (softening of bones in children) and clinical myopathy (muscle weakness). While there is much debate on the issue, vitamin D levels between 20 and 50 ng/ml are generally considered adequate for bone and overall health in healthy individuals. Steroids have been shown to cause vitamin D deficiency, possibly by increasing levels of an enzyme that inactivates the vitamin.
Smaller studies involving people often prescribed steroids (i.e., children with asthma and patients with Crohn's disease and lupus) have found significantly reduced vitamin D levels in these patients. To further assess this association between steroid use and vitamin D levels, the Einstein researchers carried out the first-ever study of a large, nationally representative sample of people.
The researchers examined data collected from participants who had participated in the National Health and Nutrition Examination Survey 2001-2006. About one percent of the participants answered "yes" when asked if they had used oral steroids during the previous 30 days.
Eleven percent_ of the self-reported steroid users had severely low vitamin D levels compared with a severe vitamin D deficiency of 5 percent for people not taking steroids – a two-fold increased risk for severe vitamin D deficiency. The risk was particularly pronounced for steroid users under 18, who were 14 times more likely to have a severe vitamin D deficiency compared with young non-steroid users. (Participants who reported using inhaled steroids were not included in the steroid-user group.)__
The paper is titled "Association of Glucocorticoid Use and Low 25-Hydroxyvitamin D Levels: Results from the National Health and Nutrition Examination Survey (NHANES): 2001?." Co-authors include senior author Michal Melamed, M.D., M.H.S., Matthew Abramowitz, M.D., M.S., and Frederick Kaskel, M.D., Ph.D., all at Einstein; and Juhi Kumar, M.D., M.P.H. at Weill Cornell Medical Center. This research was funded by the National Institute of Diabetes and Digestive and Kidney Diseases and the National Institutes of Health and National Center for Research Resources, both part of the National Institutes of Health.
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