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Original Studies |
Department of Endocrinology, Academic Hospital Vrije Universiteit (P.L., A.O.), 1007 M.B. Amsterdam, The Netherlands; Preventive Sciences Group, University of California (T.D., D.B., S.C.), San Francisco, California 94105; and Lilly Research Laboratories (D.C., T.N.), Indianapolis, Indiana 46285
Address all correspondence and requests for reprints to: Paul Lips, M.D., Department of Endocrinology, Academic Hospital Vrije Universiteit, P.O. Box 7057, 1007 M.B. Amsterdam, The Netherlands. E-mail: p.lips{at}azvu.nl
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Abstract |
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 Top Abstract IntroductionSubjects and MethodsResultsDiscussionReferences |
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For this study, baseline data were available from 7564 postmenopausal women from 25 countries on 5 continents. All women had osteoporosis, i.e. bone mineral density (BMD) at femoral neck or lumbar spine was lower than t-score -2.5, or they had 2 vertebral fractures. Serum 25OHD was measured by RIA, and serum PTH was measured by immunoradiometric assay. BMD was measured by dual x-ray absorptiometry. The mean (±SD) serum 25OHD was 70.8 ± 30.9 nmol/L. A low serum 25OHD (<25 nmol/L) was observed in 4.1% of all women in the Multiple Outcomes of Raloxifene Evaluation study, ranging from 0% in south east Asia (very few patients) to 8.3% in southern Europe. Serum 25OHD was between 25–50 nmol/L in 24.3% of the women. Serum 25OHD showed a significant seasonal relationship, with lower values in all regions in winter. Serum PTH correlated negatively with serum 25OHD (r = -0.25; P < 0.001). This significant negative correlation was observed in all regions. When serum 25OHD was less than 25, 25–50, or more than 50 nmol/L, respectively, mean serum PTH levels were 4.8, 4.1, and 3.5 pmol/L, respectively (by ANOVA, P < 0.001). Similarly, mean alkaline phosphatase levels were 83.7, 79.1, and 75.7 U/L (P < 0.001), respectively, with increasing serum 25OHD. The effect of serum 25OHD on BMD was only significant for the BMD of the trochanter where a serum 25OHD level less than 25 nmol/L was associated with a 4% lower BMD. After 6 months of treatment with vitamin D3 (400–600 IU/day) and calcium (500 mg/day), serum 25OHD increased from 70.8 ± 29.8 to 92.3 ± 28.6 nmol/L. Serum PTH decreased significantly after 6 months of treatment, and this decrease depended on baseline serum 25OHD. When baseline serum 25OHD was less than 25, 25–50, or more than 50 nmol/L, respectively, serum PTH decreased by 0.8, 0.5, or 0.2 pmol/L, respectively (P < 0.001).
In conclusion, serum 25OHD was less than 25 nmol/L in 4% of the women, and this was associated with a 30% higher serum PTH. In 24% of the women serum 25OHD was between 25–50 nmol/L, associated with a 15% higher level of serum PTH compared with women with a serum 25OHD greater than 50 nmol/L. A low serum 25OHD level was also associated with higher serum alkaline phosphatase and lower BMD of the trochanter. Treatment with vitamin D3 and calcium increased serum 25OHD and decreased serum PTH significantly; the effect was greater for lower baseline serum 25OHD.
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Introduction |
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TopAbstractIntroductionSubjects and MethodsResultsDiscussionReferences |
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Vitamin D status depends on latitude, as vitamin D3 is synthesized in the skin under the influence of UV irradiation from the sun mainly during spring and summer (13, 14). The diet, especially fatty fish, also contains vitamin D3, and some foods, mainly dairy products, are fortified with vitamin D. Elderly people do not often go out into the sunshine, and the diet cannot adequately compensate for this. Vitamin D deficiency is common in elderly people, and the incidence may vary from 5–25% in independent elderly to 60–80% in institutionalized elderly depending on latitude, nutrition, supplementation, and definition (4, 8, 15, 16). Opinions with regard to the definition of vitamin D deficiency and adequate vitamin D status vary widely (6, 7, 8, 14, 17, 18, 19, 20).
Recently, vitamin D status has been defined as adequate when the serum PTH concentration is not elevated and when vitamin D supplementation does not decrease serum PTH (7, 17). This has led to the conclusion that serum 25OHD should be higher than estimated previously, and that the vitamin D requirement in the elderly may be 400–800 IU/day or even more (20, 21). Precise definitions and consensus are hampered by the fact that there are large interlaboratory differences in assays for serum 25OHD (22). Several studies have compared vitamin D status in different populations and geographical regions (15, 23, 24, 25). These comparisons are complicated by differences in assays, except in one European study with a central laboratory (25). Another confounder is the dietary calcium intake, which influences serum PTH. The increase in serum PTH in the case of low serum 25OHD may be less prominent when calcium intake is high (26).
The international Multiple Outcomes of Raloxifene Evaluation (MORE) study, a large prospective intervention trial of women with postmenopausal osteoporosis, offers the opportunity to compare vitamin D status and parathyroid function in postmenopausal women throughout many countries throughout the world, as biochemical measurements were performed in a central laboratory facility. This may help to define more precisely the borderline between vitamin D deficiency and a vitamin D-replete state.
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Subjects and Methods |
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TopAbstractIntroductionSubjects and MethodsResultsDiscussionReferences |
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The BMDs of the lumbar spine, femoral neck, and trochanter were measured by dual energy x-ray absorptiometry as previously reported (28). A control reading facility provided correction factors to adjust for intersite differences, longitudinal drifts, and manufacturer differences.
For statistical analysis, t tests were used to compare mean
values of serum 25OHD, PTH, and alkaline phosphatase by season. In the
northern hemisphere, winter was defined as October through March, and
summer as April through September, whereas in the southern hemisphere,
it was the reverse. A one-way ANOVA was performed to compare the mean
values of serum PTH, alkaline phosphatase, and BMD according to
different 25OHD levels. Pairwise comparisons with adjustment for
multiple comparisons (Bonferroni) were also made if the one-way ANOVA
was significant. Fisher’s exact test and the
2 test of association were used to determine
whether significant associations between vitamin D deficiency and other
factors, such as substudy, hemisphere, and season, existed. Pearson
correlation coefficients were calculated between serum 25OHD and PTH as
well as other biochemical markers. Changes in serum 25OHD and PTH
according to baseline serum 25OHD were tested with the Kruskal-Wallis
test.
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Results |
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TopAbstractIntroductionSubjects and MethodsResultsDiscussionReferences |
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shows the mean serum
25OHD concentration classified according to country, region, and level
(<25, 25–50, and >50 nmol/L) among osteoporotic women participating
in the MORE study. It should be noted that the prevalence of serum
25OHD below 25 nmol/L differed widely by country and region
(P < 0.01), being more common in Southern Europe and
some countries of Central Europe (Poland, Slovakia, and Slovenia). The
country differences are not explained by seasonal and/or age
differences in recruitment of the participants. The season- and
age-adjusted mean values for different regions are significantly
different (P < 0.01). The prevalence of low serum
25OHD (<25 nmol/L) and the mean serum 25OHD concentration according to
region are shown in Fig. 1, A and B.
Serum 25OHD did not show a significant correlation with latitude on a
global scale. However, within Europe there was an unexpected
significant positive correlation between serum 25OHD and latitude (Fig. 2). The distribution of serum 25OHD
levels (<25, 25–50, or >50 nmol/L) was not different in patients
with or without vertebral fractures.
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. Serum 25OHD was higher in summer than
in winter in most countries. A low serum 25OHD level (<25 nmol/L) was
observed in 3% of participants in summer and 5.1% of participants in
winter (P < 0.001) Serum PTH showed a less consistent
picture, with few differences between summer and winter. BMD of the
femoral neck, trochanter, and lumbar spine did not show significant
seasonal differences (data not shown).
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. It is apparent that
higher serum concentrations of PTH and alkaline phosphatase were
associated with lower serum 25OHD concentrations, especially when serum
25OHD was lower than 25 nmol/L. The effect of vitamin D deficiency on
BMD was small and not significant, except for BMD of the trochanter,
where a serum 25OHD level below 25 nmol/L was associated with a 4%
lower BMD. A low, but very significant, negative correlation existed
between serum 25OHD and serum PTH (r = -0.25; P
< 0.001). This correlation was significant in all regions, even in
countries near the equator (Singapore; r = -0.39;
P < 0.01).
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The increase in serum 25OHD and the decrease in serum PTH after
treatment were greater when baseline serum 25OHD was lower
(P < 0.001).
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Discussion |
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TopAbstractIntroductionSubjects and MethodsResultsDiscussionReferences |
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The prevalence of low serum 25OHD levels observed in this study cohort was generally lower than that reported in healthy adult and elderly subjects in previous studies (4, 7, 8, 15). In contrast to the 5% prevalence of serum 25OHD levels less than 25 nmol/L observed globally during the winter months in the present study, 25–50% of the healthy elderly in the U.S. and Europe, respectively, are reported to have these low levels during the winter months (4, 5, 7, 8, 15, 25). The women enrolled in this clinical trial were fairly healthy and free of diseases other than osteoporosis. In addition, volunteers for clinical trials may be more conscious about their health than the general population. Both of these factors may have contributed to the lower overall prevalence of vitamin D deficiency observed in this study compared with previous studies.
Consistent with previous assessments of vitamin D in various countries, the prevalence of low serum 25OHD levels was lower in countries of North America and northern Europe than in those of central and southern Europe (15, 25). The often practiced fortification of dairy products with vitamin D (400 IU/quart) in North American countries is probably responsible for much of this difference (16). The widespread consumption of fatty fish provides an excellent source of dietary vitamin D for residents of northern Europe (31) and may explain the lower prevalence of vitamin D deficiency in this region compared with central and southern Europe.
Serum 25OHD levels exhibit a marked seasonal variation in different regions of the world, being lowest during the winter months and peaking in late summer (32, 33, 34, 35). Consistent with these data, the global prevalence of low serum 25OHD was higher during the winter than during the summer months in the present study.
Given that sunshine exposure is the most important source of vitamin D, one should expect that vitamin D status depends upon geographic location relative to the equator, with vitamin D status being better in residents closer to the equator compared with those living at higher latitudes. Such a relationship was reported for the general adult urban population living in various regions of France (7). However, when considering all countries represented in this study, there was no apparent relationship between either serum 25OHD levels or the prevalence of low levels (<25 nmol/L) and latitude of the country of origin. In contrary to what should be expected, a positive relationship was observed between northern latitude and serum 25OHD levels in Europe, i.e. the prevalence of low serum 25OHD levels tended to decrease with increasing northern latitude. Similar results were reported for women participating in the SENECA study, a nutrition study in elderly men and women from 11 European countries in which low serum 25OHD was most prevalent in Italy and Spain, followed by Hungary, Switzerland, and France and was least prevalent in Denmark and Norway (25). These data suggest that although the influence of sunlight exposure is detectable when comparing vitamin D status within countries between the winter and summer months, these differences in vitamin D status may be overwhelmed by the influences of vitamin D fortification policies, dietary habits, and the use of vitamin D supplements. Inhabitants of southern Europe stay out of direct sunlight (25). In addition, time spent outdoors, clothing habits, and skin type and pigmentation may influence differences in vitamin D status between countries (13, 14).
Vitamin D deficiency is associated with secondary hyperparathyroidism.
A negative correlation between serum PTH and serum 25OHD levels has
been reported by many investigators (5, 7, 8). A negative
correlation was observed in all global regions in our study. As shown
in Table 3
, the mean serum PTH level was 30% higher in women with low
serum 25OHD (<25 nmol/L) than in women with higher serum 25OHD (>50
nmol/L). This confirms previous observations in elderly people in Lyon,
Amsterdam, and Boston (10, 11, 12). Serum PTH shows an inverse
seasonal variation, with maximal values at the end of winter and a
nadir at the end of summer, when serum 25OHD is at its maximum
(34). In this study a seasonal variation in serum PTH was
not observed in most regions, which may be explained by the fact that
most samples were obtained between January and July.
Secondary hyperparathyroidism is associated with increased bone turnover and bone loss, which is mainly cortical, but also may be trabecular (1, 3, 35, 36, 37). In an earlier study in Amsterdam, a positive correlation was observed between serum 25OHD and BMD of the femoral neck in elderly women, compatible with a bone deficit of 5–10% when the serum 25OHD level was 20 or 10 nmol/L, respectively (5). In the present study, BMD of the hip was similar in women with low or high serum 25OHD levels. There was evidence for high bone turnover in women with low serum 25OHD levels, as alkaline phosphatase was higher with low serum 25OHD than with high serum 25OHD. The differences in BMD according to vitamin D status were small and only significant for the trochanter, compatible with a bone deficit of 4% in women with low serum 25OHD levels (<25 nmol/L) compared with the other groups (serum 25OHD, >25 nmol/L).
Last decades, several attempts have been made to define vitamin D deficiency. A definition based on the lower reference limit in healthy adults is not satisfactory because it depends on sunshine exposure, clothing habits, skin pigmentation, use of sunblocks, and diet (13, 14, 38). The existence of secondary hyperparathyroidism could be another way to define vitamin D deficiency (5, 7, 17, 39), but the increase in serum PTH usually is small and in the normal range in mild degrees of vitamin D deficiency, also called vitamin D insufficiency (6). In elderly people in Amsterdam, the negative relationship between serum PTH and serum 25OHD only was significant when serum 25OHD was lower than 30 nmol/L (5). In normal French adults, serum PTH started to increase when serum 25OHD was lower than 78 nmol/L (7). In Boston, the seasonal variation in serum PTH disappeared when serum 25OHD was higher than 90 nmol/L (40). These different borderlines may be partly explained by interlaboratory differences in assays for serum 25OHD (22). Another modifying factor of the relationship between serum PTH and serum 25OHD is the calcium intake. The 24-h pattern of PTH secretion decreases markedly after an increase in calcium intake (41). Calcium intake is relatively low in France (7, 11) and high in The Netherlands (4, 5), and this may influence the serum 25OHD level at which serum PTH starts to increase (26). According to a recent study from the U.S., 8 weeks of treatment with vitamin D (50,000 IU/week) and calcium (1000–1500 mg/day) caused a significant decrease in serum PTH when baseline serum 25OHD was lower than 50 nmol/L, but serum PTH did not decrease with higher serum 25OHD levels (17). This limit for vitamin D insufficiency was used in our classification. However, arguments may exist to set this limit higher (7, 18, 19, 20, 40).
What are the therapeutic implications of vitamin D deficiency in postmenopausal women? Treatment with vitamin D3 (400–800 IU/day) in institutionalized elderly adequately increases serum 25OHD and suppresses serum PTH about 15–30% (8, 42). In elderly women in Amsterdam, a vitamin D3 supplement of 400 IU/day decreased serum PTH by 15% and increased BMD of the femoral neck by 2.2% after 2 yr (10). However, in that study vitamin D supplementation had no effect on the incidence of hip and other osteoporotic fractures (43). A greater suppression of serum PTH (up to 50%) and a larger increase in BMD of the hip (up to 6%) have been observed in elderly women during combined treatment with vitamin D3 and calcium, and this caused a significant decrease of the incidence of hip and other peripheral fractures in elderly French women in nursing homes (11). Similar results were reported from elderly women in Boston (12).
In this study serum 25OHD increased, on the average, 21 nmol/L after supplementation with vitamin D3 and calcium. The increase was much more when the baseline serum 25OHD level was lower than 25 nmol/L and, on the contrary, was rather small when the baseline serum 25OHD level was higher than 50 nmol/L. A similar observation was made in the vitamin D supplementation study in Amsterdam (10), where the increase in serum 25OHD showed a negative correlation with baseline serum 25OHD (r = -0.47; P < 0.001; Ooms, M. E., personal communication). It is uncertain how many women in this study would profit from vitamin D treatment. The higher serum PTH in the groups with serum 25OHD levels below 25 and 25–50 nmol/L and the greater decrease in serum PTH in these groups after treatment suggest that at least these groups might profit from vitamin D supplementation.
The MORE trial was not designed to investigate the consequences of vitamin D deficiency and secondary hyperparathyroidism and the effects of vitamin D supplementation. We used a serum 25OHD level of 50 nmol/L as the limit for sufficiency in our classification based on one high dose supplementation study (17). Other investigators have advocated higher desired serum 25OHD levels up to 100 nmol/L (18, 19, 20) with potential benefits for the prevention of osteoporosis, osteoarthritis, some cancers, multiple sclerosis, and hypertension (18, 19, 20). Large scale trials are needed to explore possible preventive effects of various doses of vitamin D supplementation on osteoporosis and other chronic diseases in the elderly.
In conclusion, serum 25OHD was lower than 50 nmol/L in 28.4% of the postmenopausal women participating in the MORE trial, and this was associated with a relatively higher serum PTH. Low levels of serum 25OHD (<25 nmol/L) were most frequent in some countries of central and southern Europe. Treatment with vitamin D3 and calcium increased serum 25OHD and decreased serum PTH significantly, and the effect was greater for lower baseline serum 25OHD.
Investigators for the Multiple Outcomes of Raloxifene Evaluation (MORE) trial
Argentina: Carlos Mautalen, M.D., Centro De Osteopatias Medicas, and Jose R. Zanchetta, M.D., Instituto de Investigaciones Metabolicas and USAL University School of Medicine, Buenos Aires. Australia: Michael J. Hooper, M.B., B.S., F.R.A.C.P., University of Sydney and Concord Repatriation General Hospital, Sydney; Geoffrey Nicholson, M.B.B.S., Ph.D., M.R.C.P., F.R.A.C.P., The Geelong Hospital, Geelong, Kong; Wah Ng, F.R.A.C.P., M.D., and Ego Seeman, B.Sc., M.B.B.S., F.R.A.C.P., M.D., Austin and Repatriation Medical Center, University of Melboure, Melbourne; Richard L. Prince, M.D., F.R.A.C.P., University of Western Australia, Nedlands; and Sir Charles Gairdner Hospital; Anthony P. Roberts, M.D., Ashford Specialist Center, Ashford Hospital, Ashford; Margaret M. Williamson, M.B.Ch.B., M.R.C.P., F.R.A.C.P., Princess Alexandra Hospital, Brisbane. Austria: Ewald Boschitsch, M.D., Ambulatorium Klimax; and Georg Leb, M.D., Graz Universitatskliniken. Belgium: Thierry Appelboom, M.D., Hopital Universitaire Erasme; Jean J. Body. M.D., Institut Jules Bordet, Anne Peretz, M.D., Hopital Universitaire Brugmann; and Jean P. Devogelaer, M.D., Cliniques Universitaires Saint Luc, Brussels; Jan Dequeker, M.D., Universitaire Ziekenhuis Pellenberg Lubbeek; Piet Geusens, M.D., Limburgs Universitair Centrum Diepenbeek; Jean-Marc Kaufman, M.D., Universitair Ziekenhuis, Gent; and Jean-Yves Reginster, M.D., Polycliniques Universitaires L. Brull, Liege. Canada: David A. Hanley, M.D., F.R.C.P., University of Calgary, Endocrinology and Metabolism Health Sciences Center, Alberta; John P. Wade, M.D., The Arthritis Center, Vancouver; William Leslie, M.D., M.Sc., F.R.C.P.C, St. Boniface General Hospital, University of Manitoba, Winnipeg; Carol A. Joyce, M.D., Memorial University of Newfoundland, St John’s; Roger S. Rittmaster, M.D., Center for Clinical Research, and Jack R. Wall, M.D., Ph.D., Dalhousie University, Halifax; Angela M. Cheung, M.D., Ph.D., F.R.C.P., University Health Network and Mount Sinai Hospital, University of Toronto; Gillian A. Hawker, M.D., F.R.C.P.C., Womens College Hospital, and William C. Sturtridge, M.D., Toronto Hospital General Division; Anthony B.Hodsman, M.D., University of Western Ontario, London; and Theodore C.Monchesky, M.D., Oshawa General Hospital, Oshawa. Jonathan R. Adachi, M.D., Charlton Medical Center, Charlton; and William G. Bensen, M.D., F.R.C.P.C., St. Joseph’s Hospital, Alfred A. Cividino, B.A.Sc., M.D., F.R.C.P., McMaster University, Hamilton; Jacques P. Brown, M.D., F.R.C.P.C., Centre Hospitalier Universitaire de Quebec-Pavillon Chul; and Alan Tenenhouse, M.D., Clinical Research Consultant Group, Quebec; and Wojciech P. Olszynski, M.D., Ph.D., F.R.C.P., University of Saskatchewan, Saskatoon; and Kerry G. Siminoski, M.D., Endocrine Center of Edmonton and Medical Imaging Consultants, Edmonton. Czech Republic: Jan J. Stepan, M.D., D.Sc., University Karlovy. Denmark: Claus Christiansen, M.D., and Henrik Lawaetz, M.D., Center for Clinical and Basic Research, Ballerup; Erik F. Eriksen, M.D., Aarhus Amtssygehus; Lars Hyldstrup, M.D., Hvidovre Hospital; and Ole H. Sorensen, M.D., Kommunehospitalet I Koebenhavn, Copenhagen. Finland: Esko Alhava, M.D., Kuopion Yliopistollinen Keskussairaalal; Martti Kormano, M.D., Ph.D., Laakariasema Vagus, Turku; Pasi Salmela, M.D., Oulun Yliopistollinen Sairaala; Jorma Salmi, M.D., Ph.D., Koskiklinikka, Tampere; and Matti Valimaki, M.D., Ph.D., Helsinki University Central Hospital. France: Christian Alexandre, M.D., CHU de St. Etienne Hopital Bellevue; Maurice Audran, M.D., CHU d’Angers; Daniel Briancon, M.D., Hopital Reine Hortense; Pierre Delmas, M.D., Ph.D., INSERM, Lyon; Marie C. DeVernejoul, M.D., Hopital Lariboisiere, Paris; Patrice Fardellone, M.D., CHU d’Amiens Hopital Sud; D. Kuntz, Jacques LeClerc, M.D., CHU De Nancy Hopital d’Adultes De Brabois; and Claude Ribot, M.D., CHU de Toulouse Hopital de Rangueil. Germany: J. Beyer, H. Franck, Claus C. Gluer, M.D., Department of Diagnostic Radiology Christian Albrechts Universitat, Kiel; Elmar Keck, M.D., Landesarztekammer Hessen, Wiesbaden; Peter Maier, M.D., Staedt. Kurbetriebe Bad Waldsee; Gerhard Scholz, M.D., Universitat Leipzig; and J. Semler and Christian Wuester, M.D., Universitat Heidelberg. Hungary: Geza Balint, M.D., Orszagos Reumatologiai Es Fizioterapias Intezet, and Janos Szuecs, M.D., Semmelweis Medical University, Budapest; Adam Balogh, M.D., Debreceni Orvostudomanyi Egyetem, Debrecen; and Jonas Julesz, M.D., Ph.D., Szent-Gyorgyi Albert Owostudomanyi Egyetem. Israel: Avraham Karasik, M.D., and Iris Vered, M.D., Sheba Medical Center, Tel-Hashomer; Uri Liberman, M.D., Ph.D., Rabin Medical Center, Petah Tiqva, Italy: Maria Luisa Brandi, M.D., Ph.D., Department of Clinical Physiopathology, University of Florence; Antonio Del Puente, M.D., and Pasquale Oriente, M.D., Universita Federico II, Naples; Carmelo Fiore, M.D., Universita Di Catania; Andrea R. Genazzani, M.D., Ospedale Santa Chiara Di Pisa; Carlo Gennari, M.D., Institute of Internal Medicine, University of Siena; Giancarlo Isaia, M.D., University of Torino; Gianfranco Mazzuoli, M.D., Universita La Sapienza, Rome; Gian B. Melis, M.D., Universita Di Cagliari; Torquato Nencioni, M.D., Istituto Mangiagalli Milano; Mario Passeri, M.D., Universita Di Parma; and Leonardo Sartori, M.D., Ph.D., Universita Di Padova. Mexico: Ricardo Correa-Rotter, M.D., Instituto Nacional De La Nutricion, and Alfonso Murillo-Uribe, M.D., Instituto Nacional de Perinatologia, Mexico City. The Netherlands: Paul Lips, M.D., Ph.D., Academic Hospital Vrije Universiteit, Amsterdam; Henk Mulder, M.D., Medisch Onderzoekscentrum GCP, and Huibert A. Pols, M.D., Ph.D., Erasmus University Medical Center, Rotterdam. New Zealand: Nigel Gilchrist, M.D., Canterbury Geriatric Medical Research Trust, The Princess Margaret Hospital, Christchurch. Norway: Johan Halse, M.D., Ph.D., Betanien Medial Lab, Oslo; Rolf Jorde, M.D., Regionsykehuset I Tromsoe; and Jacob A. Stakkestad, M.D., Ph.D., CECOR AS, Center for Clinical Osteoporosis, Haugesund. Poland: Janusz Badurski, M.D., Center of Osteoporosis and Osteoarticular Diseases, Bialystok; Krzysztof Hoszowski, M.D., Szpital Kolejowy, Warszawa; and Jaroslaw Ogonowski, M.D., Pomorska Akademia Medyczna, Szczecin. Singapore: Kamat Bose, M.B.B.S., M.S., National University Hospital. Slovak Republic: Rastislav Dzurik, M.D., Ph.D., D.Sc., Institute of Preventive and Clinical Medicine, Bratislava. Slovenia: Andreja Kocijancic, M.D., University Clinical Center, Ljubljana. Spain: Juan J. Garcia Borras, M.D., Ph.D., Hospital Universitario La Fe, Valencia; Jorge B. Cannata, M.D., Ph.D., Hospital General de Asturias, Oviedo; Fernando Escobar, M.D., Ph.D., and Manuel Munoz, M.D., Endocrine Unit Hospital Universitatio S. Cecilia, Granada; Jardi Farrerons, M.D., Ph.D., Hospital De La Santa Creu I Sant Pau, and Adolfo Diez-Perez, M.D., Ph.D., Hospital Del Mar, Barcelona; and Federico Hawkins, M.D., Ph.D., Hospital 12 de Octubre, Madrid. Sweden: Sverker Ljunghall, M.D., and Karin Larsson, M.D., Academic Hospital Uppsala; Dan Mellstrom, M.D., Ph.D., Uppsala University, Goteborg; Britt-Marie Nyhall-Wahlin, M.D., and Mats Palmer M.D., Uppsala University Orebro; Goran Toss, M.D., Uppsala Univesity, Linkoping. United Kingdom: Richard Eastell, B.Sc., M.B., Ch.B., The Osteoporosis Center, University of Sheffield; Ignac Fogelman, B.Sc., M.D., Guy’s Hospital, London; Robert Landray, M.C., C.H.B., Synexus Ltd.; David W. Purdie, M.B., Ch.B., M.D., University of Hull, Center for Metabolic Bone Disease; David M. Reid, M.B., Ch.B., M.D., University of Aberdeen; Ian Smith, B.M.S., M.B., Ch.B., National Health Service Trust Royal Preston Hospital, Lancashire; Michael D. Stone, B.A., M.B., B.S., Llandough Hospital, South Glamorgan. United States: Cora Lewis, M.D., M.S.P.H., University of Alabama; and William J. Shergy, M.D., Clinical Research Rheumatology Associates, Birmingham, AL; Robert C. Biesbroeck, M.D., Valley Endocrine Associates, P.C., Mesa; and Michael J. Maricic, M.D., University of Arizona Health Sciences Center, Tucson, AZ; Thomas T. Aoki, M.D., Aoki Diabetes Research Institute, Sacramento; Claude D. Arnaud, M.D., and Steven T. Harris, M.D., University of California, San Francisco; Elizabeth Barrett- Connor, M.D., University of California, San Diego; David J. Baylink, M.D., Musculoskeletal Disease Center, Loma Linda University and Pettis Veterans Affairs Medical Center, Loma Linda; Bruce Ettinger, M.D., Division of Research, Kaiser Permanente, Oakland; Richard O. Kamrath, M.D., John Muir Health Network/The Osteoporosis Center; Robert Marcus, M.D., Department of Veterans Affairs Medical Center, Palo Alto; Sidney Rosenblatt, M.D., The Irvine Clinical Researh Center, Irvine; Charles F. Sharp, Jr., M.D., Huntington Memorial Hospital; Stuart L. Silverman, M.D., University of Califomia, Los Angeles; West Los Angeles-Veterans Affairs Medical Center, Osteoporosis Medical Center; Frederick Singer, M.D., John Wayne Cancer Institute at St. John’s Health Center, Santa Monica; and Stuart R. Weiss, M.D., San Diego Endocrine and Medical Clinic, San Diego, CA; David A. Podlecki, M.D., Longmont Clinic, Longmont, CO; Robert Lang, M.D., Osteoporosis Evaluation Center, Hamden, CT; Mark P. Ettinger, M.D., Clinical Research Center of South Florida, Marvin A. Heuer, M.D., Florida Medical and Research Institute, and Silvina Levis, M.D., University of Miami, Miami, FL; Nelson B. Watts, M.D., Emory University, Atlanta, GA; Richard D. Wasnich, M.D., Hawaii Osteoporosis Center, Honolulu, HI; Sheldon Berger, M.D., Chicago Center for Clinical Research; and Murray J. Favus, M.D., University of Chicago Medical Center, Chicago; and Robert G. Trapp, M.D., The Arthritis Center, Springfield, IL; M. Rashid Khairi, M.D., Physicians Research Group; and Randall R. Stoltz, M.D., GFI Research Center, Indianapolis, IN; Barbara P. Lukert, M.D., University of Kansas, Kansas City, KS; Christine L. Cook, M.D., University of Louisville, Louisville, KY; Alan Burshell, M.D., Alton Ochsner Clinic, New Orleans, LA; Clifford J. Rosen, M.D., Maine Center for Osteoporosis Research and Education, St Joseph’s Hospital, Bangor, ME; Michael A. Bolognese, M.D., Osteoporosis Analysis Center, Norman S. Koval, M.D., Center for Rheumatology and Bone Research, Philip Levin, M.D., Greater Baltimore Medical Center, Baltimore; and Nathan Wei, M.D., Arthritis and Osteoporosis Center of Maryland, Frederick, MD; Robert M. Neer, M.D., Massachusetts General Hospital, Boston, MA; Kristine E. Ensrud, M.D., Veterans Affairs Medical Center, University of Minnesota, Minneapolis, MN; Louis V. Avioli, M.D., Washington University School of Medicine, St. Louis, MO; Robert R. Recker, M.D., Creighton University, Omaha, NE; Keith S. Usiskin, M.D., Morristown Memorial Hospital, Morristown, NJ; Arnold M. Moses, M.D., State University of New York Health Science Center, Louis L. Shane, M.D., Physician’s Clinical Research Service, White Plains; Ethel Siris, M.D., Irvine Center to Clinical Research, Irvine; and Stuart Weinerman, M.D., North Shore University Hospital, Great Neck, NY; Michelle Hooper, M.D., University Hospitals of Cleveland, James H. Lui, M.D., University of Cincinnati; David Bacha, M.D., Crystal Arthritis Center, Akron, OH; William C. Orr, Ph.D., Lynn Health Science Institute, Oklahoma City, OK; Jane A. Cauley, M.D., Dr.P.H., University of Pittsburgh; Solomon Epstein, M.D., Allegheny University of the Health Sciences, Allegheny; and Susan B. Ward, M.D., Jefferson Osteoporosis Center, Jefferson, PA; Joseph Tucci, M.D., Roger Williams Medical Center, Providence, RI; Norman H. Bell, M.D., Medical University of South Carolina, Charleston, SC; William Applegate, M.D., and Suzanne Satterfield, M.D., Dr.P.H., University of Tennessee, Memphis, TN; M. Cedars and Stanley B. Cohen, M.D., Metroplex Clinical Research Center, Dallas, TX; Clark McKeever, M.D., Research for Health/Health Advance; Veronica K. Piziak, M.D., Ph.D., Scott and White Clinic; Julio Rosenstock, M.D., Dallas Diabetes Endocrine Center; and Sherwyn L. Schwartz, M.D., Diabetes and Glandular Disease Clinic, Dallas, TX; C. Deal and Robert Downs, M.D., Virginia Commonwealth University, Richmond, VA; Barbara Drinkwater, Ph.D., Pacific Medical Center, Seattle, WA; and Noel Binkley, M.D., University of Wisconsin Hospital and Clinics, Madison, WI.
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Acknowledgments |
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Received December 30, 1999.
Revised July 27, 2000.
Revised November 3, 2000.
Accepted November 6, 2000.
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|
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|
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|
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 H. J. Heller and K. Sakhaee Anticonvulsant-Induced Bone Disease: A Plea for Monitoring and Treatment Arch Neurol, September 1, 2001; 58(9): 1352 - 1353. [Full Text] [PDF]
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 P. Lips Vitamin D Deficiency and Secondary Hyperparathyroidism in the Elderly: Consequences for Bone Loss and Fractures and Therapeutic Implications Endocr. Rev., August 1, 2001; 22(4): 477 - 501. [Abstract] [Full Text] [PDF]
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