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The Asia-Pacific Regional Audit-Epidemiology, Costs, and Burden of Osteoporosis in India 2013: A report of International Osteoporosis Foundation

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      High prevalence of low dietary calcium, high phytate consumption, and vitamin D deficiency in healthy south Indians.

      Data on the vitamin D status of the population in a tropical country such as India have seldom been documented. Vitamin D deficiency is presumed to be rare. The objective was to document the dietary habits and concentrations of serum calcium, 25-hydroxyvitamin D [25(OH)D], and parathyroid hormone of Indian urban and rural populations. Healthy urban (n = 943) and rural (n = 205) subjects were studied for their dietary pattern and concentrations of serum calcium, phosphorus, alkaline phosphatase, 25(OH)D, and immunoreactive parathyroid hormone. The daily dietary calcium intake of both the urban and rural populations was low compared with the recommended dietary allowances issued by the Indian Council of Medical Research. Dietary calcium and phosphorous were significantly lower in rural adults than in urban adults (P 30 ng/mL) states were observed in 44%, 39.5%, and 16.5% of the men and 70%, 29%, and 1% of the women, respectively. In the urban subjects, 25(OH)D-deficient, -insufficient, and -sufficient states were observed in 62%, 26%, and 12% of the men and 75%, 19%, and 6% of the women, respectively. Low dietary calcium intake and 25(OH)D concentrations were associated with deleterious effects on bone mineral homeostasis. Prospective longitudinal studies are required to assess the effect on bone mineral density, a surrogate marker for fracture risk and fracture rates.
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        Osteoporosis in Indians.

         A Mithal,  N. Malhotra (2008)
        Osteoporosis is characterized by low bone mass with micro architectural deterioration of bone tissue leading to enhance bone fragility, thus increasing the susceptibility to fracture. Although exact numbers are not available, based on available data and clinical experience, on estimated 25 million Indians may be affected. Osteoporotic fractures in India occur commonly in both sexes, and may occur at a younger age than in the West. Recently published data have clearly demonstrated widespread vitamin D deficiency across India, at all ages and in both sexes, particularly in the urban areas. Poor sunlight exposure, skin pigmentation and a vitamin D-deficient diet are some obvious causes for this finding. Indians have low BMD as compared to the western Caucasians. This could be attributed to differences in skeletal size; however, the high prevalence of vitamin D deficiency is a major factor in the low BMD and poor bone health of Indians. Healthy lifestyle (diet, exercise and sunlight exposure) can have a major positive impact on the bone metabolism and bone health of Indians. These public health measures are recommended for the population at large as they are efficacious, safe and cost-effective. The peak bone mass of the population can be increased significantly by appropriate and timely intervention in children. Pharmacological interventions are expensive and should therefore be targeted to only those at high risk of fractures.
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          Bone status of Indian women from a low-income group and its relationship to the nutritional status.

          Indian women from low-income groups consume diets that have inadequate calcium coupled with too few calories, proteins and micronutrients. Hospital-based data suggest that these women have osteoporotic hip fractures at a much earlier age than Western women. Studies reporting bone parameters of the Indian population involving large sample sizes are not available. This study was therefore carried out with 289 women in the 30-60-year age group to estimate the prevalence of osteoporosis and measure the bone parameters by dual energy X-ray absorptiometry (DXA). Their mean (+/- SD) age was 41.0+/-8.60 years. Their mean (+/- SD) height, weight and body mass index (BMI) were 149.1+/-5.49 cm, 49.2+/-9.85 kg and 22.1+/-3.99, respectively. Dietary intake of calcium was estimated to be 270+/-57 mg/day. The prevalence of osteoporosis at the femoral neck was around 29%. Bone mineral density (BMD) and T scores at all the skeletal sites were much lower than the values reported from the developed countries and were indicative of a high prevalence of osteopenia and osteoporosis. BMD showed a decline after the age of 35 years in cases of the lumbar spine and femoral neck. This was largely due to a decrease of bone mineral content (BMC). The nutritional status of women appears to be an important determinant of bone parameters. BMD and BMC at all the skeletal sites and whole body increased significantly with increasing body weight and BMI of women (P<0.05). However, bone area (BA) did not change with an increase in BMI. In the multiple regression analysis, apart from body weight, age, menopause and calcium intake were the other important determinants of BMD (P<0.05). In addition to these, height was also an important determinant of WB-BMC. This study highlights the urgent need for measures to improve the nutritional status, dietary calcium intake and thus the bone health of this population.
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            Author and article information

            Affiliations
            Division of Endocrinology and Diabetes, Medanta, the Medicity, Gurgaon, India
            [1 ] International Osteoporosis Foundation IOF 9, rue Juste-Olivier, CH-1260 Nyon, Switzerland
            [2 ] Northwest Academic Center, University of Melbourne, Australia
            Author notes
            Corresponding Author: Dr. Ambrish Mithal, Chairman, Division of Endocrinology and Diabetes, Medanta, the Medicity, Sector 39, Gurgaon - 122 001, India. E-mail: ambrishmithal@ 123456hotmail.com
            Journal
            Indian J Endocrinol Metab
            Indian J Endocrinol Metab
            IJEM
            Indian Journal of Endocrinology and Metabolism
            Medknow Publications & Media Pvt Ltd (India )
            2230-8210
            2230-9500
            Jul-Aug 2014
            : 18
            : 4
            : 449-454
            4138897
            IJEM-18-449
            10.4103/2230-8210.137485
            Copyright: © Indian Journal of Endocrinology and Metabolism

            This is an open-access article distributed under the terms of the Creative Commons Attribution-Noncommercial-Share Alike 3.0 Unported, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

            Categories
            Review Article

            Endocrinology & Diabetes

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