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CIA 41335 Calcium and Vitamin D Intake by Postmenopausal Women With Os 061513
CIA 41335 Calcium and Vitamin D Intake by Postmenopausal Women With Os 061513
CIA 41335 Calcium and Vitamin D Intake by Postmenopausal Women With Os 061513
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O riginal R esearch
Tao Fan 1
Gonzalo Nocea 2
Ankita Modi 3
Leah Stokes 1
Shuvayu S Sen 1
Global Outcomes Research, Merck &
Company, Whitehouse Station,
NJ, USA; 2Department of Outcomes
Research, Merck, Sharp and Dohme
Spain, Madrid, Spain; 3Global Human
Health, Outcomes Research, Merck &
Company, Whitehouse Station,
NJ, USA
1
Background
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http://dx.doi.org./10.2147/CIA.S41335
Osteoporotic fractures are common in women aged $50 years but are potentially
preventable. The lifetime risk of fracture is .50% for women at age 50 and is .20%
for men of the same age,1 with such fractures estimated to affect 20million Europeans.2,3
Osteoporotic fractures are associated with serious complications and contribute to an
increase in mortality rates of up to 20% in the elderly.4
Osteoporosis presents a considerable health burden for individual European countries.
In Spain, postmenopausal women experience a lifetime fracture risk of 50.4%;5 the
prevalence of osteoporotic hip fracture is about 7.20 per 1000 people aged $60 years,
with 74% of sufferers being women and 26% being men.6 The total annual direct cost
of hospitalization for hip fractures in Spain was about 216 million Euros in 1996.7
Clinical Interventions in Aging 2013:8 689696
2013 Fan etal, publisher and licensee Dove Medical Press Ltd. This is an Open Access article
which permits unrestricted noncommercial use, provided the original work is properly cited.
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Methods
Study participants
Spanish physicians (107) were identified using national stratified physician lists purchased from national councils and the
local national health system. The physicians were contacted
and those willing to participate in the study were asked to
refer their qualifying patients with osteoporosis who were
subsequently contacted by telephone. Patients interested in
participating in the study were asked to phone a toll-free number for additional information and to determine whether they
qualified. Inclusion criteria included being a female aged $
50 years diagnosed with postmenopausal osteoporosis, and
whose residence was in Spain. The study design and question-
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Survey questions
The survey was conducted by trained, native Spanishspeaking interviewers; an average of 15minutes was given
to participants for survey completion. Questions were drafted
in English and translated into Spanish. Subsequently, the
questions were translated back into English to ensure that
the questions had been accurately translated.
Survey responses provided information on prescribed
osteoporosis medications, calcium, and vitamin D intake
from the diet and supplements. Participants were asked, Are
you currently taking prescription medication(s) for your bone
health? If their answer was affirmative, they were asked, What
prescription medication(s) are you currently taking for bone
health? Participants were also asked to describe the frequency
with which they consumed certain foods, using the Supplementation en Vitamines et Mineraux Antioxydants (SU.VI.MAX)
food-frequency questionnaire;24 a list of the most common
foods consumed was broken down by type. Participants were
also asked eight questions about their use of vitamin and mineral
supplements, including calcium or calcium-containing antacids.
They were asked if they took multivitamins regularly and, if so,
how often (possible responses: every day, 46days per week,
13days per week, 13days per month, and ,1day per month).
Participants were asked if the calcium products contained vitamin D and were prompted to look at the package label to report
the calcium dosage (,500 mg, 500599 mg, 600999 mg,
$1000 mg). Participants were also asked, During the past
month, have you sunbathed or travelled to a sunny climate or
region? and During the past month, on average, how many
hours per week did you spend outside without and with sun
protection (sunscreen or protective clothing)? Of the twelve
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Statistical analysis
Mean daily calcium and vitamin D intake were computed.
A one-sample t-test was performed to estimate whether
Results
Patient characteristics
Of the 207 women who participated, 62.8% were aged
5064 years, 20.8% were aged 6574 years, and 16.4% were
aged $75 years.
Supplemental vitamin D
and multivitamin use
Of those participants who derived 200400 IU/day of
vitamin D from their diets, 68% reported taking a multivitamin with vitamin D and 54% reported taking supplemental
vitamin D alone (Figure 1). Use of a multivitamin with
vitamin D and supplemental vitamin D alone by groups
Mean (SD)
,200 IU
200400 IU
.400 IU
207
167 (87)
23%
45%
32%
93
70
29
186 (92)
156 (64)
148 (85)
60%
74%
76%
38%
26%
21%
2%
0%
3%
130
43
34
177 (77)
176 (115)
120 (65)
64%
67%
82%
35%
26%
18%
1%
7%
0%
Pa
0.114
0.034
Notes: aP values are based on Fishers exact test; bnine participants reported having taken medication but did not know what it was.
Abbreviation: SD, standard deviation.
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80%
70%
% reporting use
60%
50%
<200 IU (n = 140)
40%
200400 IU (n = 63)
>400 IU (n = 4)
30%
20%
10%
0%
Supplemental vitamin D
Multivitamin
Figure 1 Supplemental vitamin D and multivitamin use by daily dietary vitamin D intake.
obtaining ,200 IU/day and .400 IU/day from their diet was
notably lower, as shown in Figure1. When considered by
age group, women aged $75 years reported a significantly
lower mean daily intake of vitamin D from food (12065
IU/day versus 177 77 IU/day for the 5064 years age
group and 176115 IU/day for the 6574 years age group;
P=0.034) (Table1).
more participants taking milk every day than the other major
sources of calcium (Table3). The proportion of participants
eating a portion each day of all major calcium sources was
higher for those with a daily calcium intake of more than
800mg.
The mean (SD) calcium intake from food was 1239 (457)
mg/day (Table2), which was notably higher than the recommended daily dose of 800mg/day. Daily calcium intake was
also significantly lower (P=0.037) in patients not taking prescription medications for bone health (1054336mg/day) compared with those taking bisphosphonates (1365 448mg/day)
or non-bisphosphonates (1167432mg/day).
The predominant sources of dietary calcium were dairy
products (mean 477.4mg) and vegetables (371.3mg), with
Mean (SD)
,800 mg
8001200 mg
.1200 mg
207
1239 (457)
28%
53%
19.3%
93
70
29
1365 (448)
1167 (432)
1054 (336)
10%
19%
28%
28%
37%
34%
62%
44%
38%
130
43
34
1314 (461)
1209 (460)
988 (346)
11%
19%
41%
29%
42%
32%
60%
40%
26%
Pa
0.037
,0.0001
Notes: aP values are based on Fishers exact test; bnine participants reported having taken medication but did not know what it was.
Abbreviation: SD, standard deviation.
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Dairy
Skim milk
Semi-cured cheese
Vegetables
Swiss chard, spinach
Endive, lettuce,
escarole
Fruit and nuts
Almonds, walnuts,
peanuts
Orange, grapefruit
,800 mg
(n = 171)
$800 mg
(n = 36)
72%
0%
90%
13%
0%
22%
30%
64%
160.7
27.7
36%
75%
38.6
3%
23%
477.4
90.9
85.1
371.3
100.4
80.9
Discussion
The results of this observational study in postmenopausal
Spanish women indicate a high prevalence of insufficient
vitamin D intake (mean 167 IU/day from food) in women
with osteoporosis, particularly in those aged $ 75 years.
Although the amount of vitamin D obtained from supplements
80%
70%
% reporting use
60%
50%
<800 mg (n = 36)
40%
8001200 mg (n = 67)
>1200 mg (n = 104)
30%
20%
10%
0%
Supplemental calcium
Multivitamin
Figure 2 Supplemental calcium and multivitamin use by daily dietary calcium intake.
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Methods of improving
vitamin D sufficiency
In our study, vitamin D intake from food was not notably
different in women who did or did not receive prescribed
medication for osteoporosis. This finding is somewhat surprising, given that women regularly taking such treatments
might be expected to be more aware of other methods of
optimizing their bone health. Vitamin D supplementation
could help to promote bone health in Spanish women with
osteoporosis.34,35
Study limitations
There are several limitations inherent in our study design. The
study was observational in its nature and, although likely to
be reflective of usual-care practice, may be subject to selection bias. Results may be biased by the use of a convenience
sample and by the selection of patients who consented to the
study and contacted the interviewers: these patients may be
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Conclusion
Inadequate vitamin D intake is common among postmenopausal women with osteoporosis in Spain. Further initiatives, including improved patient education, lifestyle, and
vitamin D supplementation or pharmacotherapy, are needed
to promote adequate vitamin D intake in elderly populations
to avoid serious adverse consequences for bone health.
Authors contributions
TF, SS, and GN conceived and designed the study. TF performed statistical analyses. AM and LS led data presentation
and report drafting. All authors contributed to the interpretation of study data, the intellectual content of the report, and
approval of the final manuscript.
Acknowledgments
Study funding was provided by Merck & Company, Inc. We
thank Melissa Stauffer, PhD, Lauren Weisenfluh, and Dimitra
Panagiotoglou, all in affiliation with SCRIBCO, for medical
writing assistance.
Disclosure
All the authors are employees of Merck & Company, Inc.
References
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