Association of glucocorticoid use and low 25-hydroxyvitamin D levels

Results from the National Health and Nutrition Examination Survey (NHANES): 2001-2006

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65 Citations (Scopus)

Abstract

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.

Original languageEnglish (US)
Pages (from-to)3838-3845
Number of pages8
JournalJournal of Clinical Endocrinology and Metabolism
Volume96
Issue number12
DOIs
StatePublished - Dec 2011

Fingerprint

Nutrition Surveys
Nutrition
Glucocorticoids
Steroids
Health
Odds Ratio
Confidence Intervals
25-hydroxyvitamin D
Serum
Population
Vitamin D
Bone Density
Minerals
Screening
Bone
Cross-Sectional Studies
Outcome Assessment (Health Care)

ASJC Scopus subject areas

  • Biochemistry
  • Clinical Biochemistry
  • Endocrinology
  • Biochemistry, medical
  • Endocrinology, Diabetes and Metabolism

Cite this

@article{52ea8136c5ec4e70b50764a904bdb2ae,
title = "Association of glucocorticoid use and low 25-hydroxyvitamin D levels: Results from the National Health and Nutrition Examination Survey (NHANES): 2001-2006",
abstract = "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.",
author = "Skversky, {Amy L.} and Juhi Kumar and Abramowitz, {Matthew K.} and Kaskel, {Frederick J.} and Melamed, {Michal L.}",
year = "2011",
month = "12",
doi = "10.1210/jc.2011-1600",
language = "English (US)",
volume = "96",
pages = "3838--3845",
journal = "Journal of Clinical Endocrinology and Metabolism",
issn = "0021-972X",
publisher = "The Endocrine Society",
number = "12",

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T1 - Association of glucocorticoid use and low 25-hydroxyvitamin D levels

T2 - Results from the National Health and Nutrition Examination Survey (NHANES): 2001-2006

AU - Skversky, Amy L.

AU - Kumar, Juhi

AU - Abramowitz, Matthew K.

AU - Kaskel, Frederick J.

AU - Melamed, Michal L.

PY - 2011/12

Y1 - 2011/12

N2 - 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.

AB - 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.

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