Skip to main content
Log in

Defining physiologically “normal” vitamin D in African Americans

  • Original Article
  • Published:
Osteoporosis International Aims and scope Submit manuscript

Abstract

Summary

The relationship between serum 25(OH)D and intact parathyroid hormone (iPTH) was evaluated in the Multicenter Osteoarthritis Study (MOST). No further change in iPTH was observed for African Americans with 25(OH)D levels above 20 ng/ml, suggesting that compared to Caucasians, lower vitamin D targets for sufficiency may be appropriate for African Americans.

Introduction

Vitamin D levels ≥30 ng/ml are commonly considered “normal” based upon maximal suppression of iPTH; however, this has recently been challenged and the optimal 25(OH)D level among non-Caucasians is unclear. We evaluated the cross-sectional relationship between serum 25(OH)D and iPTH in a sample of Caucasian and African American adults.

Methods

We used baseline serum samples of participants from the Multicenter Osteoarthritis Study (MOST) for this analysis and used three methods to model the relationship between 25(OH)D and iPTH: ordinary least squares regression (OLS), segmented regression and Helmert contrasts.

Results

Among Caucasians (n = 1,258), 25(OH)D and iPTH ranged from 4 to 51 ng/ml and 2 to 120 pg/ml and from 3 to 32 ng/ml and 3 to 119 pg/ml in African Americans (n = 423). We observed different thresholds between African Americans and Caucasians using each analytic technique. Using 25(OH)D as a categorical variable in OLS, iPTH was statistically higher at lower 25(OH)D categories than the 24–32 ng/ml referent group among Caucasians. However, in African Americans, the mean iPTH was only significantly higher at 25(OH)D levels below 15 ng/ml. Using segmented regression, iPTH appeared to stabilize at a lower 25(OH)D level in African Americans (19–23 ng/ml) compared to in Caucasians (>32 ng/ml). Helmert contrasts also revealed a lower threshold in African Americans than Caucasians.

Conclusion

Among MOST participants, the 25(OH)D thresholds at which no further change in iPTH was observed was approximately 20 ng/ml in African Americans versus approximately 30 ng/ml in Caucasians, suggesting optimal vitamin D levels in Caucasians may not be applicable to African Americans.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

References

  1. Holick MF (2009) Vitamin D status: measurement, interpretation, and clinical application. Ann Epidemiol 19(2):73–78. doi:10.1016/j.annepidem.2007.12.001

    Article  PubMed  Google Scholar 

  2. Chapuy MC, Preziosi 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(5):439–443

    Article  PubMed  CAS  Google Scholar 

  3. Dawson-Hughes B, Heaney RP, Holick MF, Lips P, Meunier PJ, Vieth R (2005) Estimates of optimal vitamin D status. Osteoporos Int 16(7):713–716

    Article  PubMed  CAS  Google Scholar 

  4. Heaney RP (2005) Serum 25-hydroxyvitamin D and parathyroid hormone exhibit threshold behavior. J Endocrinol Invest 28(2):180–182

    PubMed  CAS  Google Scholar 

  5. Heaney RP, Dowell MS, Hale CA, Bendich A (2003) Calcium absorption varies within the reference range for serum 25-hydroxyvitamin D. J Am Coll Nutr 22(2):142–146

    PubMed  CAS  Google Scholar 

  6. Need AG, Horowitz M, Morris HA, Nordin BC (2000) Vitamin D status: effects on parathyroid hormone and 1, 25-dihydroxyvitamin D in postmenopausal women. Am J Clin Nutr 71(6):1577–1581

    PubMed  CAS  Google Scholar 

  7. Sai AJ, Walters RW, Fang X, Gallagher JC (2011) Relationship between vitamin D, parathyroid hormone, and bone health. J Clin Endocrinol Metab 96(3):E436–446. doi:10.1210/jc.2010-1886

    Article  PubMed  CAS  Google Scholar 

  8. Osteoporosis WSGotPaMo (2003) Prevention and managment of osteoporosis: report of a WHO scientific group. Geneva

  9. Holick MF (2007) Vitamin D deficiency. N Engl J Med 357(3):266–281. doi:10.1056/NEJMra070553

    Article  PubMed  CAS  Google Scholar 

  10. Gaugris S, Heaney RP, Boonen S, Kurth H, Bentkover JD, Sen SS (2005) Vitamin D inadequacy among post-menopausal women: a systematic review. QJM 98(9):667–676

    Article  PubMed  CAS  Google Scholar 

  11. Holick MF, Siris ES, Binkley N, Beard MK, Khan A, Katzer JT, Petruschke RA, Chen E, de Papp AE (2005) Prevalence of vitamin D inadequacy among postmenopausal North American women receiving osteoporosis therapy. J Clin Endocrinol Metab 90(6):3215–3224

    Article  PubMed  CAS  Google Scholar 

  12. Nesby-O'Dell S, Scanlon KS, Cogswell ME, Gillespie C, Hollis BW, Looker AC, Allen C, Doughertly C, Gunter EW, Bowman BA (2002) Hypovitaminosis D prevalence and determinants among African American and White women of reproductive age: third National Health and Nutrition Examination Survey, 1988–1994. Am J Clin Nutr 76(1):187–192

    PubMed  Google Scholar 

  13. Calvo MS, Whiting SJ (2003) Prevalence of vitamin D insufficiency in Canada and the United States: importance to health status and efficacy of current food fortification and dietary supplement use. Nutr Rev 61(3):107–113

    Article  PubMed  Google Scholar 

  14. Parikh SJ, Edelman M, Uwaifo GI, Freedman RJ, Semega-Janneh M, Reynolds J, Yanovski JA (2004) The relationship between obesity and serum 1,25-dihydroxy vitamin D concentrations in healthy adults. J Clin Endocrinol Metab 89(3):1196–1199

    Article  PubMed  CAS  Google Scholar 

  15. Aloia JF, Talwar SA, Pollack S, Feuerman M, Yeh JK (2006) Optimal vitamin D status and serum parathyroid hormone concentrations in African American women. Am J Clin Nutr 84(3):602–609

    PubMed  CAS  Google Scholar 

  16. Gutierrez OM, Farwell WR, Kermah D, Taylor EN (2010) Racial differences in the relationship between vitamin D, bone mineral density, and parathyroid hormone in the National Health and Nutrition Examination Survey. Osteoporos Int. doi:10.1007/s00198-010-1383-2

  17. Ross CATC, Yaktine AK, Del Valle HB (eds) (2011) Dietary reference intakes for calcium and vitamin D. The National Academies Press, Washington, DC

    Google Scholar 

  18. Vitamin D, 25-Hydroxy. Laboratory Corporation of America Holdings and Lexi-Comp Inc. https://www.labcorp.com/wps/portal/!ut/p/c1/04_SB8K8xLLM9MSSzPy8xBz9CP0os_hACzO_QCM_IwMLXyM3AyNjMycDU2dXQwN3M6B8JG55AwMCuv088nNT9SP1o8zjQ11Ngg09LY0N_N2DjQw8g439TfyM_MzMLAz0Q_QjXYCKIvEqKsiNKDfUDVQEAAzyjqE!/dl2/d1/L0lJWXBwZyEhL3dIRUJGUUFnc2FBRUJyQ0svWUk1eWx3ISEvN19VRTRTMUk5MzBPR1MyMElTM080TjJONjY4MC92aWV3VGVzdA!!/?testId = 408405. Accessed August 24, 2011 2011

  19. Dawson-Hughes B (2011) Msculoskeletal health and the cutoff of 30. Paper presented at the American Society for Bone and Mineral Research, San Diego, CA

    Google Scholar 

  20. Felson DT, Nevitt MC (2004) Epidemiologic studies for osteoarthritis: new versus conventional study design approaches. Rheum Dis Clin North Am 30(4):783–797. doi:10.1016/j.rdc.2004.07.005

    Article  PubMed  Google Scholar 

  21. Binkley N, Krueger D, Cowgill CS, Plum L, Lake E, Hansen KE, DeLuca HF, Drezner MK (2004) Assay variation confounds the diagnosis of hypovitaminosis D: a call for standardization. J Clin Endocrinol Metab 89(7):3152–3157

    Article  PubMed  CAS  Google Scholar 

  22. Wootton AM (2005) Improving the measurement of 25-hydroxyvitamin D. Clin Biochem Rev 26(1):33–36

    PubMed  Google Scholar 

  23. Julious SA (2001) Inference and estimation in a changepoint regression problem. J R Stat Soc 50(1):51–61, Series D (The Statistician)

    Article  Google Scholar 

  24. Ruberg SJ (1989) Contrasts for identifying the minimum effective dose. J Am Stat Assoc 84:816–822

    Article  Google Scholar 

  25. Tamhane AC, Hochberg Y, Dunnett CW (1996) Multiple test procedures for dose finding. Biometrics 52(1):21–37

    Article  PubMed  CAS  Google Scholar 

  26. Bell NH, Greene A, Epstein S, Oexmann MJ, Shaw S, Shary J (1985) Evidence for alteration of the vitamin D-endocrine system in blacks. J Clin Invest 76(2):470–473

    Article  PubMed  CAS  Google Scholar 

  27. Cosman F, Nieves J, Morgan D, Shen V, Sherwood D, Parisien M, Lindsay R (1999) Parathyroid hormone secretory response to EDTA-induced hypocalcemia in Black and White premenopausal women. Calcif Tissue Int 65(4):257–261

    Article  PubMed  CAS  Google Scholar 

  28. Fuleihan GE, Gundberg CM, Gleason R, Brown EM, Stromski ME, Grant FD, Conlin PR (1994) Racial differences in parathyroid hormone dynamics. J Clin Endocrinol Metab 79(6):1642–1647

    Article  PubMed  CAS  Google Scholar 

  29. Kleerekoper M, Nelson DA, Peterson EL, Flynn MJ, Pawluszka AS, Jacobsen G, Wilson P (1994) Reference data for bone mass, calciotropic hormones, and biochemical markers of bone remodeling in older (55–75) postmenopausal White and Black women. J Bone Miner Res 9(8):1267–1276

    Article  PubMed  CAS  Google Scholar 

  30. M'Buyamba-Kabangu JR, Fagard R, Lijnen P, Bouillon R, Lissens W, Amery A (1987) Calcium, vitamin D–endocrine system, and parathyroid hormone in Black and White males. Calcif Tissue Int 41(2):70–74

    Article  PubMed  Google Scholar 

  31. Meier DE, Luckey MM, Wallenstein S, Lapinski RH, Catherwood B (1992) Racial differences in pre- and postmenopausal bone homeostasis: association with bone density. J Bone Miner Res 7(10):1181–1189. doi:10.1002/jbmr.5650071010

    Article  PubMed  CAS  Google Scholar 

  32. Cosman F, Morgan DC, Nieves JW, Shen V, Luckey MM, Dempster DW, Lindsay R, Parisien M (1997) Resistance to bone resorbing effects of PTH in Black women. J Bone Miner Res 12(6):958–966

    Article  PubMed  CAS  Google Scholar 

  33. Weinstein RS, Bell NH (1988) Diminished rates of bone formation in normal Black adults. N Engl J Med 319(26):1698–1701. doi:10.1056/NEJM198812293192603

    Article  PubMed  CAS  Google Scholar 

  34. Weaver CM, McCabe LD, McCabe GP, Braun M, Martin BR, Dimeglio LA, Peacock M (2008) Vitamin D status and calcium metabolism in adolescent Black and White girls on a range of controlled calcium intakes. J Clin Endocrinol Metab 93(10):3907–3914. doi:10.1210/jc.2008-0645

    Article  PubMed  CAS  Google Scholar 

  35. Arabi A, Baddoura R, El-Rassi R, El-Hajj Fuleihan G (2010) Age but not gender modulates the relationship between PTH and vitamin D. Bone 47(2):408–412. doi:10.1016/j.bone.2010.05.002

    Article  PubMed  CAS  Google Scholar 

  36. 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(1):185–191

    Article  PubMed  CAS  Google Scholar 

  37. Steingrimsdottir L, Gunnarsson O, Indridason OS, Franzson L, Sigurdsson G (2005) Relationship between serum parathyroid hormone levels, vitamin D sufficiency, and calcium intake. JAMA 294(18):2336–2341. doi:10.1001/jama.294.18.2336

    Article  PubMed  CAS  Google Scholar 

Download references

Acknowledgements

The MOST study is funded by the following grants from the National Institutes of Health: Boston University (David Felson, MD—1 U01 AG18820), University of Iowa (James Torner, PhD—1 U01 AG18832), University of Alabama at Birmingham (Cora E. Lewis, MD MSPH—1 U01 AG18947) and University of California San Francisco (Michael Nevitt, PhD—1 U01 AG19069). Assays for vitamin D and iPTH were supported, in part, by a research grant from the Investigator-Initiated Studies Program of Merck & Co., Inc to JRC. Dr. Curtis receives support from the NIH (AR053351) and AHRQ (R01HS018517). Dr. Neogi is supported by 5K23AR055127.

Conflicts of interest

None.

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to J. R. Curtis.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Wright, N.C., Chen, L., Niu, J. et al. Defining physiologically “normal” vitamin D in African Americans. Osteoporos Int 23, 2283–2291 (2012). https://doi.org/10.1007/s00198-011-1877-6

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00198-011-1877-6

Keywords

Navigation