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Published in: Osteoporosis International 2/2012

01-02-2012 | Original Article

High prevalence of vitamin D deficiency among healthy Saudi Arabian men: relationship to bone mineral density, parathyroid hormone, bone turnover markers, and lifestyle factors

Authors: M.-S. M. Ardawi, A. M. Sibiany, T. M. Bakhsh, M. H. Qari, A. A. Maimani

Published in: Osteoporosis International | Issue 2/2012

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Abstract

Summary

In this cross-sectional study, the prevalence of vitamin D deficiency [serum 25-hydroxyvitamin D (25(OH)D) <50 nmol/L] was 87.8% among Saudi Arabian men. There was a linear inverse relationship between serum 25(OH)D and intact parathyroid hormone (PTH) levels, but without a threshold of 25(OH)D at which intact PTH values plateaued.

Introduction

Vitamin D insufficiency and/or deficiency has now reached epidemic proportions and has been linked to low bone mineral density (BMD), some lifestyle factors, and obesity in adults. This relationship is not well documented in Saudi Arabian men. This study examines the relationship between vitamin D status, intact parathyroid hormone (intact PTH), and lifestyle factors among Saudi Arabian men.

Methods

This cross-sectional study involved 834 men aged 20–74 years living in Jeddah area who were randomly selected and medically examined. Men had their BMD (lumbar spine (L1–L4) and neck femur), 25(OH)D, intact PTH, and other parameters measured according to detailed inclusion criteria.

Results

Deficiency (25(OH)D<50 nmol/L) and insufficiency (≥50–75 nmol/L) were present in 87.8% and 9.7%, respectively. Deficiency was common among older and obese men with no education and sedentary lifestyle sampled during summer and spring. Serum 25(OH)D showed an inverse linear relationship with intact PTH, but there was no threshold of serum 25(OH)D at which PTH levels plateaued. There was a positive correlation between BMD values at both lumbar spine (L1–L4) (P < 0.023) and neck femur (P < 0.036) and serum 25(OH)D levels, respectively.

Conclusions

Functionally significant vitamin D deficiency affects BMD and bone turnover markers among Saudi Arabian men and is largely attributed to older age, obesity, sedentary lifestyle, no education, poor exposure to sunlight, smoking, and poor dietary vitamin D supplementation. The data suggest that an increase in PTH cannot be used as a marker for vitamin D deficiency.
Literature
1.
go back to reference Holick MF (2004) Sunlight and vitamin D for bone health and prevention of autoimmune diseases, cancers, and cardiovascular disease. Am J Clin Nutr 80:1678S–1688SPubMed Holick MF (2004) Sunlight and vitamin D for bone health and prevention of autoimmune diseases, cancers, and cardiovascular disease. Am J Clin Nutr 80:1678S–1688SPubMed
2.
go back to reference Holick MF (2009) Vitamin D status: measurement, interpretation and clinical application. Am Epidemiol 19:73–78CrossRef Holick MF (2009) Vitamin D status: measurement, interpretation and clinical application. Am Epidemiol 19:73–78CrossRef
3.
go back to reference DeLuca HF (2004) Overview of general physiologic features and functions of vitamin D. Am J Clin Nutr 80:1689S–1696SPubMed DeLuca HF (2004) Overview of general physiologic features and functions of vitamin D. Am J Clin Nutr 80:1689S–1696SPubMed
4.
go back to reference Holick MF, Chen TC (2008) Vitamin D deficiency: a worldwide problem with health consequences. Am J Clin Nutr 87:1080S–1086SPubMed Holick MF, Chen TC (2008) Vitamin D deficiency: a worldwide problem with health consequences. Am J Clin Nutr 87:1080S–1086SPubMed
5.
go back to reference Lappe JM, Travers-Gustafson D, Davies KM, Recker RR, Heaney RP (2007) Vitamin D and calcium supplementation reduces cancer risk: results of a randomized trial. Am J Clin Nutr 85:1586–1591PubMed Lappe JM, Travers-Gustafson D, Davies KM, Recker RR, Heaney RP (2007) Vitamin D and calcium supplementation reduces cancer risk: results of a randomized trial. Am J Clin Nutr 85:1586–1591PubMed
6.
go back to reference Garnero P, Munoz F, Sornay-Rendu E, Delmas PD (2007) Associations of vitamin D status with bone mineral density, bone turnover, bone loss and fracture risk in healthy postmenopausal women. The OFELY Study. Bone 40:716–722PubMedCrossRef Garnero P, Munoz F, Sornay-Rendu E, Delmas PD (2007) Associations of vitamin D status with bone mineral density, bone turnover, bone loss and fracture risk in healthy postmenopausal women. The OFELY Study. Bone 40:716–722PubMedCrossRef
7.
go back to reference Autier P, Gandini S (2007) Vitamin D supplementation and total mortality: a meta-analysis of randomized controlled trials. Arch Intern Med S 167:1730–1737CrossRef Autier P, Gandini S (2007) Vitamin D supplementation and total mortality: a meta-analysis of randomized controlled trials. Arch Intern Med S 167:1730–1737CrossRef
8.
go back to reference Lips P (2004) Which circulating level of 25-hydroxyvitamin D is appropriate? J Steroid Biochem Mol Biol 89–90:611–614PubMedCrossRef Lips P (2004) Which circulating level of 25-hydroxyvitamin D is appropriate? J Steroid Biochem Mol Biol 89–90:611–614PubMedCrossRef
10.
go back to reference Ardawi MSM, Qari MH, Rouzi AA, Maimani AA, Raddadi RM (2010) Vitamin D status in relation to obesity, bone mineral density, bone turnover markers and vitamin D receptor genotypes in healthy Saudi pre- and postmenopausal women. Osteoporos Int 22:463–475PubMedCrossRef Ardawi MSM, Qari MH, Rouzi AA, Maimani AA, Raddadi RM (2010) Vitamin D status in relation to obesity, bone mineral density, bone turnover markers and vitamin D receptor genotypes in healthy Saudi pre- and postmenopausal women. Osteoporos Int 22:463–475PubMedCrossRef
11.
go back to reference Ardawi MSM, Miamani AA, Bahksh TM, Rouzi AA, Qari MH, Raddadi RM (2010) Reference intervals of biochemical bone turnover markers for Saudi Arabian women: a cross-sectional study. Bone 47:804–814PubMedCrossRef Ardawi MSM, Miamani AA, Bahksh TM, Rouzi AA, Qari MH, Raddadi RM (2010) Reference intervals of biochemical bone turnover markers for Saudi Arabian women: a cross-sectional study. Bone 47:804–814PubMedCrossRef
12.
go back to reference O’Neill TW, Cooper C, Cannata JB, Loper JB, Hoszowski K, Johnell O, Lorenc RS, Nilsson B, Raspe H, Stewart O, Silman AJ (1994) Reproducibility of a questionnaire on risk factors for osteoporosis in multicenter prevalence survey: the European Vertebral Osteoporosis Study. Int J Epidemiol 23:559–565PubMedCrossRef O’Neill TW, Cooper C, Cannata JB, Loper JB, Hoszowski K, Johnell O, Lorenc RS, Nilsson B, Raspe H, Stewart O, Silman AJ (1994) Reproducibility of a questionnaire on risk factors for osteoporosis in multicenter prevalence survey: the European Vertebral Osteoporosis Study. Int J Epidemiol 23:559–565PubMedCrossRef
13.
go back to reference Barger-Lux MJ, Heaney RP (2002) Effects of above average summer sun exposure on serum 25-hydroxyvitamin D and calcium absorption. J Clin Endocrinol Metab 87:4952–4956PubMedCrossRef Barger-Lux MJ, Heaney RP (2002) Effects of above average summer sun exposure on serum 25-hydroxyvitamin D and calcium absorption. J Clin Endocrinol Metab 87:4952–4956PubMedCrossRef
14.
go back to reference Spiegelman D, Hertzmark E (2005) Easy SAS calculations for risk or prevalence ratios and differences. Am J Epidemiol 162:199–200PubMedCrossRef Spiegelman D, Hertzmark E (2005) Easy SAS calculations for risk or prevalence ratios and differences. Am J Epidemiol 162:199–200PubMedCrossRef
15.
go back to reference Deddens JA, Petersen MR (2008) Approaches for estimating prevalence ratios. Occup Environ Med 65(48):501–506CrossRef Deddens JA, Petersen MR (2008) Approaches for estimating prevalence ratios. Occup Environ Med 65(48):501–506CrossRef
17.
go back to reference Lips P, Duong T, Oleksik A, Black D, Cumming S, Cox D, Nickelsen T (2001) A global study of vitamin D status and parathyroid function in postmenopausal women with osteoporosis: baseline data from the multiple outcomes of raloxifene evaluation clinical trial. J Clin Endocrinol Metab 86:1212–1221PubMedCrossRef Lips P, Duong T, Oleksik A, Black D, Cumming S, Cox D, Nickelsen T (2001) A global study of vitamin D status and parathyroid function in postmenopausal women with osteoporosis: baseline data from the multiple outcomes of raloxifene evaluation clinical trial. J Clin Endocrinol Metab 86:1212–1221PubMedCrossRef
18.
go back to reference Lamberg-Allardt CJ, Outila TA, Karkkainen MU, Rita HJ, Valsta MA (2001) Vitamin D deficiency and bone health in healthy adults in Finland: could this be a concern in other parts of Europe? J Bone Miner Res 16:2066–2073PubMedCrossRef Lamberg-Allardt CJ, Outila TA, Karkkainen MU, Rita HJ, Valsta MA (2001) Vitamin D deficiency and bone health in healthy adults in Finland: could this be a concern in other parts of Europe? J Bone Miner Res 16:2066–2073PubMedCrossRef
19.
go back to reference Kudlacek S, Schneider B, Peterlik M, Leb G, Klaushofer K, Weber K, Woloszczuk W, Willvonseder R (2003) Assessment of vitamin D and calcium status in healthy adult Austrians. Eur J Clin Invest 33:323–331PubMedCrossRef Kudlacek S, Schneider B, Peterlik M, Leb G, Klaushofer K, Weber K, Woloszczuk W, Willvonseder R (2003) Assessment of vitamin D and calcium status in healthy adult Austrians. Eur J Clin Invest 33:323–331PubMedCrossRef
20.
go back to reference Saquib N, von Muhlen D, Garland CF, Barrett-Connor E (2006) Serum 25-hydroxyvitamin D, parathyroid hormone, and bone mineral density in men: the Rancho Bernardo study. Osteoporos Int 17:1734–1741PubMedCrossRef Saquib N, von Muhlen D, Garland CF, Barrett-Connor E (2006) Serum 25-hydroxyvitamin D, parathyroid hormone, and bone mineral density in men: the Rancho Bernardo study. Osteoporos Int 17:1734–1741PubMedCrossRef
21.
go back to reference Yan L, Prentice A, Zhang H, Wang X, Stirling DM, Golden MM (2000) Vitamin D status and parathyroid hormone concentrations in Chinese women and men from the north-east of the People’s Republic of China. Eur J Clin Nutr 54:68–72PubMedCrossRef Yan L, Prentice A, Zhang H, Wang X, Stirling DM, Golden MM (2000) Vitamin D status and parathyroid hormone concentrations in Chinese women and men from the north-east of the People’s Republic of China. Eur J Clin Nutr 54:68–72PubMedCrossRef
22.
go back to reference Nakamura K (2006) Vitamin D insufficiency in Japanese populations: from the viewpoint for the prevention of osteoporosis. J Bone Miner Metab 24:1–6PubMedCrossRef Nakamura K (2006) Vitamin D insufficiency in Japanese populations: from the viewpoint for the prevention of osteoporosis. J Bone Miner Metab 24:1–6PubMedCrossRef
23.
go back to reference Wat WZ, Leung JY, Tam S, Kung AW (2007) Prevalence and impact of vitamin D insufficiency in southern Chinese adults. Ann Nutr Metab 51:59–64PubMedCrossRef Wat WZ, Leung JY, Tam S, Kung AW (2007) Prevalence and impact of vitamin D insufficiency in southern Chinese adults. Ann Nutr Metab 51:59–64PubMedCrossRef
24.
go back to reference Hawkins RC (2009) 25-OH vitamin D3 concentrations in Chinese, Malays and Indians. Clin Chem 55:1749–1751PubMedCrossRef Hawkins RC (2009) 25-OH vitamin D3 concentrations in Chinese, Malays and Indians. Clin Chem 55:1749–1751PubMedCrossRef
25.
go back to reference Ho-Pham LT, Nguyen ND, Lai TG, Eisman JA, Nguyen TV (2011) Vitamin D status and parathyroid hormone in a urban population in Vietnam. Osteoporos Int 22:241–248PubMedCrossRef Ho-Pham LT, Nguyen ND, Lai TG, Eisman JA, Nguyen TV (2011) Vitamin D status and parathyroid hormone in a urban population in Vietnam. Osteoporos Int 22:241–248PubMedCrossRef
26.
go back to reference Hannan MT, Litman HJ, Araujo AB, McLennan CE, McLean RR, McKinlay JB, Chen TC, Holick MF (2008) Serum 25-hydroxyvitamin D and bone mineral density in a racially and ethnically diverse group of men. J Clin Endocrinol Metab 93:40–46PubMedCrossRef Hannan MT, Litman HJ, Araujo AB, McLennan CE, McLean RR, McKinlay JB, Chen TC, Holick MF (2008) Serum 25-hydroxyvitamin D and bone mineral density in a racially and ethnically diverse group of men. J Clin Endocrinol Metab 93:40–46PubMedCrossRef
27.
go back to reference Mithal A, Wahl DA, Bonjour JP, Burckhardt P, Dawson-Hughes B, Eisman JA, El-Hajj Fuleihan G, Josse RG, Lips P, Morales-Torres J (2009) Global vitamin D status and determinants of hypovitaminosis D. Osteoporos Int 20:1807–1821PubMedCrossRef Mithal A, Wahl DA, Bonjour JP, Burckhardt P, Dawson-Hughes B, Eisman JA, El-Hajj Fuleihan G, Josse RG, Lips P, Morales-Torres J (2009) Global vitamin D status and determinants of hypovitaminosis D. Osteoporos Int 20:1807–1821PubMedCrossRef
28.
go back to reference Saadi HF, Nagelkerke N, Benedict S, Qazaq HS, Zilahi E, Mohamadiyeh MK, Al-Suhaili AI (2006) Predictors relationships of serum 25-hydroxyvitamin D concentrations with bone turnover markers, bone mineral density and vitamin D receptor genotypes in Emirati women. Bone 39:1136–1143PubMedCrossRef Saadi HF, Nagelkerke N, Benedict S, Qazaq HS, Zilahi E, Mohamadiyeh MK, Al-Suhaili AI (2006) Predictors relationships of serum 25-hydroxyvitamin D concentrations with bone turnover markers, bone mineral density and vitamin D receptor genotypes in Emirati women. Bone 39:1136–1143PubMedCrossRef
29.
go back to reference Clemens TL, Adms JS, Henderson SL, Holick MF (1982) Increased skin pigment reduces the capacity of the skin to synthesize vitamin D. Lancet 1:74–76PubMedCrossRef Clemens TL, Adms JS, Henderson SL, Holick MF (1982) Increased skin pigment reduces the capacity of the skin to synthesize vitamin D. Lancet 1:74–76PubMedCrossRef
30.
go back to reference Souberbielle JC, Cormier C, Kindermans C, Gao P, Cantor T, Forette F, Baulie E-E (2001) Vitamin D status and redefining serum parathyroid hormone reference range in the elderly. J Clin Endocrinol Metab 86:3086–3090PubMedCrossRef Souberbielle JC, Cormier C, Kindermans C, Gao P, Cantor T, Forette F, Baulie E-E (2001) Vitamin D status and redefining serum parathyroid hormone reference range in the elderly. J Clin Endocrinol Metab 86:3086–3090PubMedCrossRef
31.
go back to reference Vieth R, Ladak Y, Walfish PG (2003) Age-related changes in the 25-hydroxyvitamin D versus parathyroid hormone relationship suggest a different reason why older adults require more vitamin D. J Clin Endocrinol Metab 88:185–191PubMedCrossRef Vieth R, Ladak Y, Walfish PG (2003) Age-related changes in the 25-hydroxyvitamin D versus parathyroid hormone relationship suggest a different reason why older adults require more vitamin D. J Clin Endocrinol Metab 88:185–191PubMedCrossRef
32.
go back to reference Need AG, O’Loughlin PD, Morris HA, Horowitz M, Nordin BEC (2004) The effects of age and other variables on serum parathyroid hormone in postmenopausal women attending an osteoporosis center. J Clin Endocrinol Metab 89:1646–1649PubMedCrossRef Need AG, O’Loughlin PD, Morris HA, Horowitz M, Nordin BEC (2004) The effects of age and other variables on serum parathyroid hormone in postmenopausal women attending an osteoporosis center. J Clin Endocrinol Metab 89:1646–1649PubMedCrossRef
33.
go back to reference Peppe J, Romagnoli E, Nofroni I, Pacitti MT, De Geronimo D, Letizia C, Tonnarini G, Scarpiello A, D’Erasmo E, Minisola S (2005) Vitamin D status as the major factor determining circulating levels of parathyroid hormone: a study in normal subjects. Osteoporos Int 16:805–812CrossRef Peppe J, Romagnoli E, Nofroni I, Pacitti MT, De Geronimo D, Letizia C, Tonnarini G, Scarpiello A, D’Erasmo E, Minisola S (2005) Vitamin D status as the major factor determining circulating levels of parathyroid hormone: a study in normal subjects. Osteoporos Int 16:805–812CrossRef
34.
go back to reference Chapuy MC, Preziozi P, Maamer M, Arnaud S, Galan P, Hercberg S, Meunier PJ (1997) Prevalence of vitamin D insufficiency in an adult normal population. Osteoporos Int 7:439–443PubMedCrossRef Chapuy MC, Preziozi P, Maamer M, Arnaud S, Galan P, Hercberg S, Meunier PJ (1997) Prevalence of vitamin D insufficiency in an adult normal population. Osteoporos Int 7:439–443PubMedCrossRef
35.
go back to reference Lips P, Chapuy MC, Dawson-Hughes B, Pols AP, Holick MF (1999) An international comparison of serum 25-hydroxyvitamin D measurements. Osteoporos Int 9:394–397PubMedCrossRef Lips P, Chapuy MC, Dawson-Hughes B, Pols AP, Holick MF (1999) An international comparison of serum 25-hydroxyvitamin D measurements. Osteoporos Int 9:394–397PubMedCrossRef
36.
go back to reference Binkley N, Krueger D, Cowgill CS, Plum L, Lake E, Hansen KD, De Luca HF, Drezner MK (2004) Assay variation confounds the diagnosis of hypovitaminosis D. A call for standardization. J Clin Endocrinol Metab 89:3152–3157PubMedCrossRef Binkley N, Krueger D, Cowgill CS, Plum L, Lake E, Hansen KD, De Luca HF, Drezner MK (2004) Assay variation confounds the diagnosis of hypovitaminosis D. A call for standardization. J Clin Endocrinol Metab 89:3152–3157PubMedCrossRef
37.
go back to reference Martinez ME, del Campo MT, Sanchez-Cabezudo MJ, Garcia JA, Sanchez Calvin MT, Torrijos A, Coya J, Munuera L (1994) Relations between calcidiol serum levels and bone mineral density in postmenopausal women with low density. Calcif Tissue Int 55:253–256PubMedCrossRef Martinez ME, del Campo MT, Sanchez-Cabezudo MJ, Garcia JA, Sanchez Calvin MT, Torrijos A, Coya J, Munuera L (1994) Relations between calcidiol serum levels and bone mineral density in postmenopausal women with low density. Calcif Tissue Int 55:253–256PubMedCrossRef
38.
go back to reference Ooms ME, Lips P, Roos JC, van der Vijgh WJ, Popp-Snijders C, Bezemer PD, Bouter LM (1995) Vitamin D status and sex hormone binding globulin: determinants of bone turnover and bone mineral density in elderly women. J Bone Miner Res 10:1177–1184PubMedCrossRef Ooms ME, Lips P, Roos JC, van der Vijgh WJ, Popp-Snijders C, Bezemer PD, Bouter LM (1995) Vitamin D status and sex hormone binding globulin: determinants of bone turnover and bone mineral density in elderly women. J Bone Miner Res 10:1177–1184PubMedCrossRef
39.
go back to reference Melin AL, Wilske J, Ringertz H, Saaf M (1999) Vitamin D status, parathyroid function and femoral bone density in an elderly Swedish population living at home. Aging (Milano) 11:200–207 Melin AL, Wilske J, Ringertz H, Saaf M (1999) Vitamin D status, parathyroid function and femoral bone density in an elderly Swedish population living at home. Aging (Milano) 11:200–207
40.
go back to reference Mezquita-Raya P, Munoz-Torres M, Luna JD, Luna V, Lopez-Rodriguez F, Torres-Vela E, Escobar-Jimenez F (2001) Relation between vitamin D insufficiency, bone density and bone metabolism in healthy postmenopausal women. J Bone Miner Res 16:1408–1415PubMedCrossRef Mezquita-Raya P, Munoz-Torres M, Luna JD, Luna V, Lopez-Rodriguez F, Torres-Vela E, Escobar-Jimenez F (2001) Relation between vitamin D insufficiency, bone density and bone metabolism in healthy postmenopausal women. J Bone Miner Res 16:1408–1415PubMedCrossRef
41.
go back to reference Bischoff-Ferrari HA, Dietrich T, Orav EJ, Dawson-Hughes B (2004) Positive association between 25-hydroxy vitamin D levels and bone mineral density: a population-based study of younger and older adults. Am J Med 116(9):634–639PubMedCrossRef Bischoff-Ferrari HA, Dietrich T, Orav EJ, Dawson-Hughes B (2004) Positive association between 25-hydroxy vitamin D levels and bone mineral density: a population-based study of younger and older adults. Am J Med 116(9):634–639PubMedCrossRef
42.
go back to reference Webb AR, Pilbeam C, Hanafin N, Holick MF (1990) An evaluation of the relative contributions of 25-hydroxyvitamin D in an elderly nursing home population in Boston. Am J Clin Nutr 51:1075–1081PubMed Webb AR, Pilbeam C, Hanafin N, Holick MF (1990) An evaluation of the relative contributions of 25-hydroxyvitamin D in an elderly nursing home population in Boston. Am J Clin Nutr 51:1075–1081PubMed
43.
go back to reference Need AG, Morris HA, Horrowitz M, Nordin BEC (1993) Effects of skin thickness, age, body fat and sunlight on serum 25-hydroxyvitamin D. Am J Clin Nutr 58:882–885PubMed Need AG, Morris HA, Horrowitz M, Nordin BEC (1993) Effects of skin thickness, age, body fat and sunlight on serum 25-hydroxyvitamin D. Am J Clin Nutr 58:882–885PubMed
44.
go back to reference Wortsman J, Matsuoko CY, Chen TC, Lu Z, Holick MF (2000) Decreased bioavailability of vitamin D in obesity. Am J Clin Nutr 72(3):690–693PubMed Wortsman J, Matsuoko CY, Chen TC, Lu Z, Holick MF (2000) Decreased bioavailability of vitamin D in obesity. Am J Clin Nutr 72(3):690–693PubMed
45.
go back to reference Murphy S, Khaw KT, Prentice A, Compston JE (1993) Relationships between parathyroid hormone, 25-hydroxyvitamin D, and bone mineral density in elderly men. Age Ageing 22:198–204PubMedCrossRef Murphy S, Khaw KT, Prentice A, Compston JE (1993) Relationships between parathyroid hormone, 25-hydroxyvitamin D, and bone mineral density in elderly men. Age Ageing 22:198–204PubMedCrossRef
46.
go back to reference Hyponen E, Laara E, Reunanen A, Jarvelin MR, Virtanen SM (2001) Intake of vitamin D and risk of type 1 diabetes: a birth-cohort study. Lancet 358:1500–1503CrossRef Hyponen E, Laara E, Reunanen A, Jarvelin MR, Virtanen SM (2001) Intake of vitamin D and risk of type 1 diabetes: a birth-cohort study. Lancet 358:1500–1503CrossRef
47.
go back to reference Heaney RP (2004) Functional indices of vitamin D status and ramifications of vitamin D deficiency. Am J Clin Nutr 80:1706S–1709SPubMed Heaney RP (2004) Functional indices of vitamin D status and ramifications of vitamin D deficiency. Am J Clin Nutr 80:1706S–1709SPubMed
48.
go back to reference Holick MF (2006) Vitamin D: its role in cancer prevention and treatment. Prog Biophys Mol Biol 92:49–59PubMedCrossRef Holick MF (2006) Vitamin D: its role in cancer prevention and treatment. Prog Biophys Mol Biol 92:49–59PubMedCrossRef
50.
go back to reference Melamed ML, Michos ED, Post W, Astor B (2008) 25-hydroxyvitamin D levels and the risk of mortality in the general population. Arch Intern Med 168:1629–1637PubMedCrossRef Melamed ML, Michos ED, Post W, Astor B (2008) 25-hydroxyvitamin D levels and the risk of mortality in the general population. Arch Intern Med 168:1629–1637PubMedCrossRef
Metadata
Title
High prevalence of vitamin D deficiency among healthy Saudi Arabian men: relationship to bone mineral density, parathyroid hormone, bone turnover markers, and lifestyle factors
Authors
M.-S. M. Ardawi
A. M. Sibiany
T. M. Bakhsh
M. H. Qari
A. A. Maimani
Publication date
01-02-2012
Publisher
Springer-Verlag
Published in
Osteoporosis International / Issue 2/2012
Print ISSN: 0937-941X
Electronic ISSN: 1433-2965
DOI
https://doi.org/10.1007/s00198-011-1606-1

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