Association of Glucocorticoid Use and Low 25-Hydroxyvitamin D Levels: Results from the National Health and Nutrition Examination Survey (NHANES): 2001–2006

• Published in: The journal of clinical endocrinology and metabolism Vol. 96; no. 12; pp. 3838 - 3845
• Main Authors: Skversky, Amy L, Kumar, Juhi, Abramowitz, Matthew K, Kaskel, Frederick J, Melamed, Michal L
• Format: Journal Article
• Language: English
• Published: Bethesda, MD Endocrine Society 01-12-2011; Copyright by The Endocrine Society
• Subjects: Adolescent; Adult; Aged; Aged, 80 and over; Biological and medical sciences; Child; Child, Preschool; Cross-Sectional Studies; Diabetes. Impaired glucose tolerance; Endocrine pancreas. Apud cells (diseases); Endocrine Research; Endocrinopathies; Etiopathogenesis. Screening. Investigations. Target tissue resistance; Feeding. Feeding behavior; Female; Fundamental and applied biological sciences. Psychology; Glucocorticoids - adverse effects; Glucocorticoids - therapeutic use; Humans; Infant; Male; Medical sciences; Middle Aged; Nutrition Surveys; Vertebrates: anatomy and physiology, studies on body, several organs or systems; Vertebrates: endocrinology; Vitamin D - analogs & derivatives; Vitamin D - blood; Vitamin D Deficiency - blood; Vitamin D Deficiency - chemically induced; Endocrinopathy; Obesity; Nutrition; Steroid hormone; Nutrition survey; Diabetes mellitus; Use; Nutrition disorder; Metabolic diseases; Glucocorticoid; Feeding; Result; Association; Health status; Vitamin D; Cholecalciferol(25-hydroxy); Endocrinology; Nutritional status; Public health
• ISSN: 0021-972X; 1945-7197
• DOI: 10.1210/jc.2011-1600

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.