Associations between serum calcium, 25(OH)D level and bone mineral density in adolescents

Pan, Kaiyu; Tu, Rongliang; Yao, Xiaocong; Zhu, Zhongxin

doi:10.1186/s42358-021-00174-8

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Research • Adv. rheumatol. 61 • 2021 • https://doi.org/10.1186/s42358-021-00174-8 copy

Associations between serum calcium, 25(OH)D level and bone mineral density in adolescents

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstract

Backgrounds:

It is important to improve our understanding of the roles of calcium and vitamin D in bone health for preventing osteoporosis. We aimed at exploring the associations between serum calcium, vitamin D level, and bone mineral density (BMD) in adolescents included in the National Health and Nutrition Examination Survey (NHANES) 2001 – 2006.

Methods:

Weighted multivariate linear regression models were used to estimate the associations of serum calcium, 25(OH)D level with total BMD. Smooth curve fitting was used to explore the potential non-linear relationship.

Results:

A total of 5990 individuals aged between 12 and 19 years were included in this study. The fully-adjusted model showed serum calcium positively correlated with total BMD. However, an inverted U-shaped relationship was found when we performed the smooth curve fitting method, and the inflection point was calculated at 9.6 mg/dL using the two-piecewise linear regression model. In contrast, there was a positive correlation between serum 25(OH)D and total BMD after adjusting for potential confounders.

Conclusions:

The present study revealed a positive correlation between serum 25(OH)D level and total BMD, and an inverted U-shaped relationship between serum calcium and total BMD.

Keywords:
Calcium; Vitamin D; Bone health; Adolescent; NHANES

Characteristic		Boys (n = 3086)	Girls (n = 2904)	P value
Age, mean ± SD (years)		15.46 ± 2.26	15.35 ±2.23	0.0551
Race/Ethnicity (%)				0.9754
	Non-Hispanic White	62.87	63.15
	Non-Hispanic Black	14.47	14.48
	Mexican American	11.50	11.13
	Other race/ethnicity	11.16	11.25
BMI, mean ± SD (kg/m²)		23.31 ± 5.50	23.55 ± 5.78	0.1073
Income to poverty ratio, mean ±SD		2.64 ± 1.62	2.57 ± 1.62	0.0912
Physical activity (%)				< 0.0001
	Sedentary	2.95	4.85
	Low	7.72	11.63
	Moderate	6.51	8.47
	High	22.05	16.20
	Not recorded	60.77	58.85
Calcium supplementation (%)				< 0.0001
	Not use	87.21	83.80
	< 0.4 g/d	10.94	12.99
	≥ 0.4 g/d	1.84	3.21
Serum calcium, mean ± SD (mg/dL)		9.80 ± 0.30	9.64 ±0.30	< 0.0001
Serum vitamin D, mean ± SD (ng/mL)		24.23 ±8.63	23.32 ± 10.02	0.0002
Total BMD, mean ± SD (g/cm²)		1.10 ± 0.14	1.06 ± 0.10	< 0.0001

		Model 1 β (95% CI)	Model 2 β (95% CI)	Model 3 β (95% CI)
Serum calcium		−0.0157 (−0.0257, −0.0058)	−0.0003 (− 0.0083, 0.0077)	0.0084 (0.0007, 0.0160)
Serum calcium (quartile)
	Q1	Reference	Reference	Reference
	Q2	-0.0065 (- 0.0163, 0.0033)	0.0072 (- 0.0003, 0.0148)	0.0088 (0.0017, 0.0160)
	Q3	0.0008 (-0.0087, 0.0103)	0.0136 (0.0062, 0.0211)	0.0141 (0.0070,0.0212)
	Q4	-0.0144 (- 0.0233, - 0.0055)	0.0032 (- 0.0040, 0.0103)	0.0098 (0.0030, 0.0166)
P for trend		0.004	0.484	0.008
Serum 25(OH)D		-0.0005 (- 0.0009, - 0.0002)	0.0001 (- 0.0003, 0.0003)	0.0006 (0.0003, 0.0008)
Serum 25(OH)D (quartile)
	Q1	Reference	Reference	Reference
	Q2	-0.0415 (- 0.0532, - 0.0298)	-0.0051 (- 0.0145, 0.0044)	0.0050 (- 0.0040, 0.0139)
	Q3	-0.0475 (- 0.0581, - 0.0369)	0.0046 (- 0.0046, 0.0138)	0.0166 (0.0079, 0.0254)
	Q4	-0.0384 (- 0.0483, - 0.0284)	0.0030 (- 0.0062, 0.0122)	0.0202 (0.0113, 0.0291)
P for trend		<0.001	0.181	<0.001

Quartiles of serum calcium		White	Black	Mexican American	Other race
Quartiles of serum calcium		Total BMD g/cm² (95% Confidence Interval)		Mexican American	Other race
12 to 15 years
	Lowest quartile	1.012 (0.994, 1.029)	1.069 (1.055, 1.083)	1.015 (1.000, 1.031)	1.015 (0.983, 1.047)
	2nd	1.011 (0.996, 1.026)	1.068 (1.055, 1.081)	1.008 (0.995, 1.021)	1.024 (1.000, 1.048)
	3rd	1.011 (0.998, 1.025)	1.065 (1.052, 1.077)	1.010 (0.998, 1.023)	1.027 (1.002, 1.052)
	Highest quartile	1.006 (0.995, 1.017)	1.062 (1.052, 1.072)	0.994 (0.983, 1.005)	0.998 (0.978, 1.018)
P for trend		0.540	0.383	0.031	0.200
16 to 19years
	Lowest quartile	1.132 (1.118, 1.146)	1.207 (1.195, 1.220)	1.120 (1.109, 1.131)	1.139 (1.116, 1.162)
	2nd	1.137 (1.124, 1.151)	1.203 (1.190, 1.216)	1.117 (1.105, 1.128)	1.164 (1.139, 1.189)
	3rd	1.140 (1.127, 1.152)	1.214 (1.202, 1.225)	1.117 (1.105, 1.129)	1.132 (1.108, 1.156)
	Highest quartile	1.137 (1.126, 1.148)	1.207 (1.196, 1.219)	1.113 (1.102, 1.125)	1.152 (1.127, 1.176)
P for trend		0.598	0.722	0.485	0.883

			Adjusted ß (95% CI), p-value
Serum calcium
	Total
		Fitting by standard linear model	0.0084 (0.0007, 0.0160) 0.0317
		Fitting by two-piecewise linear model
		Inflection point	9.6
		Serum calcium < 9.6 (mg/dL)	0.0348 (0.0165, 0.0530) 0.0002
		Serum calcium > 9.6 (mg/dL)	-0.0051 (- 0.0164,0.0063) 0.3824
		Log likelihood ratio	0.002
	Boy
		Fitting by standard linear model	0.0034 (-0.0076, 0.0143) 0.5446
		Fitting by two-piecewise linear model
		Inflection point	9.6
		Serum calcium < 9.6 (mg/dL)	0.0447 (0.0128, 0.0765) 0.0060
		Serum calcium > 9.6 (mg/dL)	-0.0109 (- 0.0260, 0.0042) 0.1564
		Log likelihood ratio	0.007
	White
		Fitting by standard linear model	0.0129 (-0.0017, 0.0276) 0.0843
		Fitting by two-piecewise linear model
		Inflection point	9.6
		Serum calcium < 9.6 (mg/dL)	0.0465 (0.0091, 0.0839) 0.0148
		Serum calcium > 9.6 (mg/dL)	-0.0025 (- 0.0240, 0.0191) 0.8218
		Log likelihood ratio	0.055
	Black
		Fitting by standard linear model	0.0053 (-0.0080, 0.0187) 0.4353
		Fitting by two-piecewise linear model
		Inflection point	9.2
		Serum calcium <9.2 (mg/dL)	0.1074(0.0200, 0.1949) 0.0161
		Serum calcium > 9.2 (mg/dL)	-0.0011 (- 0.0155, 0.0133) 0.8780
		Log likelihood ratio	0.020
Serum 25(OH)D
	Boy
		Fitting by standard linear model	0.0013 (0.0009, 0.0018) < 0.0001
		Fitting by two-piecewise linear model
		Inflection point	24
		Serum 25(OH)D < 24(ng/mL)	0.0024 (0.0015, 0.0034) < 0.0001
		Serum 25(OH)D > 24(ng/mL)	0.0007 (0.0000, 0.0014) 0.0400
		Log likelihood ratio	0.008
	Girl
		Fitting by standard linear model	0.0003 (-0.0000, 0.0007) 0.0565
		Fitting by two-piecewise linear model
		Inflection point	26
		Serum 25(OH)D < 26(ng/mL)	0.0011 (0.0005,0.0018) 0.0006
		Serum 25(OH)D > 26(ng/mL)	-0.0003 (- 0.0008, 0.0003) 0.3218
		Log likelihood ratio	0.004
	White
		Fitting by standard linear model	0.0003 (-0.0002, 0.0009) 0.1945
		Fitting by two-piecewise linear model
		Inflection point	23
		Serum 25(OH)D < 23(ng/mL)	0.0035 (0.0018, 0.0052) <0.0001
		Serum 25(OH)D > 23(ng/mL)	-0.0005 (- 0.0011,0.0002) 0.1629
		Log likelihood ratio	< 0.001

Quartiles of 25(OH)D level		White	Black	Mexican American	Other race
Quartiles of 25(OH)D level		Total BMD g/cm² (95% Confidence Interval)		Mexican American	Other race
12 to 15 years
	Lowest quartile	0.975 (0.929, 1.022)	1.064 (1.054, 1.074)	0.996 (0.979, 1.013)	1.027 (0.996, 1.058)
	2nd	0.994(0.973, 1.015)	1.068 (1.056, 1.079)	0.994 (0.982, 1.007)	0.993 (0.970, 1.016)
	3rd	1.013 (1.001, 1.025)	1.061 (1.048, 1.075)	1.012 (1.002, 1.023)	1.000 (0.981, 1.020)
	Highest quartile	1.011 (1.002, 1.020)	1.071 (1.052, 1.090)	1.014 (1.000, 1.027)	1.050 (1.026, 1.074)
	P for trend	0.134	0.780	0.024	0.079
16 to 19years
	Lowest quartile	1.106 (1.073, 1.139)	1.212 (1.204, 1.220)	1.107 (1.094, 1.120)	1.135 (1.107, 1.162)
	2nd	1.126 (1.106, 1.146)	1.203 (1.191, 1.215)	1.109 (1.098, 1.119)	1.153 (1.128, 1.178)
	3rd	1.127(1.115, 1.140)	1.198 (1.182, 1.215)	1.115 (1.104, 1.125)	1.136 (1.115, 1.157)
	Highest quartile	1.144(1.136, 1.152)	1.210 (1.188, 1.232)	1.140 (1.128, 1.152)	1.160 (1.136, 1.185)
	P for trend	0.003	0.262	<0.001	0.347

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