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LETTER TO THE EDITOR
Year : 2012  |  Volume : 16  |  Issue : 5  |  Page : 859-860

Rapid improvement in the bone mineral density with vitamin D supplementation in postmenopausal woman with vitamin D deficiency


Department of Endocrinology, Army Hospital (Research and Referral), Delhi Cantonment, New Delhi, India

Date of Web Publication6-Sep-2012

Correspondence Address:
M K Garg
Department of Endocrinology, Army Hospital (Research and Referral), Delhi Cantonment - 110 010, New Delhi
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/2230-8210.100689

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How to cite this article:
Garg M K, Brar K S, Kharb S. Rapid improvement in the bone mineral density with vitamin D supplementation in postmenopausal woman with vitamin D deficiency. Indian J Endocr Metab 2012;16:859-60

How to cite this URL:
Garg M K, Brar K S, Kharb S. Rapid improvement in the bone mineral density with vitamin D supplementation in postmenopausal woman with vitamin D deficiency. Indian J Endocr Metab [serial online] 2012 [cited 2021 Jan 27];16:859-60. Available from: https://www.ijem.in/text.asp?2012/16/5/859/100689

Sir,

A 50-year-old postmenopausal medical professional was detected with osteoporosis on a DXA scan and was advised bisphosphonate therapy [Table 1]. She reported to this hospital for advice. She was asymptomatic except feeling fatigued at the end of the day after work. Her clinical examination was unremarkable. Her biochemical investigations including hematological, liver, and renal functions were normal. Her serum calcium was 9.2 mg/ dl (9-11 mg/dl), inorganic phosphorus 3.4 mg/ dl (2.5-4.5 mg/dl), and serum alkaline phosphatase 200 IU/l (60- 250 IU/l). Hormonal parameters were TSH 1.08 mIU/l (0.5-6.5 mIU/l), vitamin D 10.3 ng/ml (>30 ng/ml), and PTH 76.9 ng/ml (12-72 ng/ml). She was started on oral vitamin D supplementation of 60,000 units weekly for 8 weeks, and then once monthly. After 1 year, vitamin D levels improved to 36.4 ng/ml and PTH was 43.6 ng/dl. Her repeat DXA scan showed marked improvement in the bone mineral density (BMD) in the range of osteopenia [Table 1].
Table 1: Change in bone mineral density after Vitamin D Supplementation: Change in bone mineral density after Vitamin D Supplementation


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This case though considered to be an anecdotal report highlights a pertinent question which is relevant to our context since >90% of our population above the age of 50 years is vitamin D deficient. [1] With the proliferation of DXA machines and increasing awareness about osteoporosis particularly in cities, many elderly subjects undergo testing for BMD. Most females are diagnosed postmenopausal osteoporosis cases without considering the secondary cause of vitamin D deficiency (VDD), which is the commonest. [2] In our patient, the Z-score of −2.3 at lumbar spine also suggested the possibility of a secondary cause, which was confirmed as VDD on hormonal evaluation. Most of patients with VDD do not have clinical or biochemical evidence of osteomalacia. [1] Grados et al.[3] reported significant improvement in BMD at lumbar spine (0.029 ± 0.057 g/cm 2 , P < 0.0001) and femoral neck (0.010 ± 0.036 g/cm 2 , P = 0.025) after 1 year of vitamin D supplementation in vitamin D insufficient postmenopausal women. Should all subjects with osteoporosis be treated with bisphosphonate or should a repeat BMD be done after a year of vitamin D supplementation? There is an urgent need for a larger study in India and other countries where the prevalence of VDD is very high, [4] as was done in Bangladesh, where a study reported improvement in BMD after 1 year of vitamin D supplementation in premenopausal women with hypovitaminosis D. [5]

 
   References Top

1.Marwaha R, Tandon N, Garg MK, Kanwar R, Narang A, Sastry A, et al. Vitamin D status in healthy Indians aged 50 years and above. J Assoc Physicians India 2011;59:706-9.  Back to cited text no. 1
    
2.Favus MJ. Postmenopausal osteoporosis and the detection of so-called secondary causes of low bone density. J Clin Endocrinol Metab 2005;90:3800-1.  Back to cited text no. 2
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3.Grados F, Brazier M, Kamel S, Mathieu M, Hurtebize N, Maamer M, et al. Prediction of bone mass density variation by bone remodeling markers in postmenopausal women with vitamin D insufficiency treated with calcium and vitamin D supplementation. J Clin Endocrinol Metab 2003;88:5175-9.  Back to cited text no. 3
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4.Mithal A, Wahl DA, Bonjour JP, Burckhardt P, Dawson-Hughes B, Eisman JA, et al.; IOF Committee of Scientific Advisors (CSA) Nutrition Working Group. Global vitamin D status and determinants of hypovitaminosis D. Osteoporos Int 2009;20:1807-20.  Back to cited text no. 4
    
5.Islam MZ, Shamim AA, Viljakainen HT, Akhtaruzzaman M, Jehan AH, Khan HU, et al. Effect of vitamin D, calcium and multiple micronutrient supplementation on vitamin D and bone status in Bangladeshi premenopausal garment factory workers with hypovitaminosis D: A double-blinded, randomised, placebo-controlled 1-year intervention. Br J Nutr 2010;104:241-7.  Back to cited text no. 5
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2 Is vitamin D deficiency being considered in the differential diagnosis of osteoporosis in routine practice?
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