Free and Bioavailable Vitamin D Levels of Patients with Type 1 Diabetes Mellitus and Association with Bone Metabolism

Overview

Journal J Diabetes Metab Disord

Specialty Endocrinology

Date 2022 Jun 8

PMID 35673502

Authors

Ceyda Dincer Yazan

Ali Yaman

Goncagul Haklar

Onder Sirikci

Oguzhan Deyneli

Affiliations

Soon will be listed here.

Abstract

Aim: Vitamin D deficiency is known to be associated with metabolic bone diseases. The aim of this study is to evaluate vitamin D and calculated free and bioactive vitamin D levels of type 1 diabetic patients and to evaluate the association with bone turnover markers.

Method: This cross-sectional study includes 60 patients admitted to endocrinology outpatient clinic with diagnosis of type 1 diabetes mellitus and 60 controls. Weight, height and waist circumference were recorded and blood samples were taken for measurement of 25-hydroxyvitamin D (25(OH)D), vitamin D binding protein (VDBP), osteocalcin, bone alkaline phosphatase (bone-ALP), c-telopeptide. Free and bioavailable vitamin D levels were calculated with formula.

Results: Vitamin D levels of type 1 diabetic patients were significantly higher (p = 0.01). Parathormone levels of the group with vitamin D level under 20 ng/ml was significantly higher (p = 0.029). VDBP levels were similar in both groups. Correlation analysis of free and bioavailable vitamin D level with osteocalcin, c-telopeptide, bone alkaline phosphatase revealed only a weak significant correlation between free vitamin D and osteocalcin (r = -0.201; p = 0.028). A negative correlation was determined between 25(OH)D and parathormone levels (r = -0.294; p < 0.005). Serum osteocalcin, bone alkaline phosphatase and c-telopeptide levels of control group were significantly higher.

Conclusion: 25(OH)D levels of the study population was extremely low. The measurement of VDBP and calculated free and bioactive vitamin D levels did not show a better correlation with bone turnover markers according to 25(OH)D levels.

References

Lauridsen A, Vestergaard P, Nexo E . Mean serum concentration of vitamin D-binding protein (Gc globulin) is related to the Gc phenotype in women. Clin Chem. 2001; 47(4):753-6. View

Hernandez J, Olmos J, Pariente E, Nan D, Martinez J, Llorca J . Influence of vitamin D status on vertebral fractures, bone mineral density, and bone turnover markers in normocalcemic postmenopausal women with high parathyroid hormone levels. J Clin Endocrinol Metab. 2013; 98(4):1711-7. DOI: 10.1210/jc.2012-3931. View

Chun R, Shieh A, Gottlieb C, Yacoubian V, Wang J, Hewison M . Vitamin D Binding Protein and the Biological Activity of Vitamin D. Front Endocrinol (Lausanne). 2019; 10:718. PMC: 6821678. DOI: 10.3389/fendo.2019.00718. View

Murray C, Coleman C . Impact of Diabetes Mellitus on Bone Health. Int J Mol Sci. 2019; 20(19). PMC: 6801685. DOI: 10.3390/ijms20194873. View

Powe C, Evans M, Wenger J, Zonderman A, Berg A, Nalls M . Vitamin D-binding protein and vitamin D status of black Americans and white Americans. N Engl J Med. 2013; 369(21):1991-2000. PMC: 4030388. DOI: 10.1056/NEJMoa1306357. View

Blanton D, Han Z, Bierschenk L, Linga-Reddy M, Wang H, Clare-Salzler M . Reduced serum vitamin D-binding protein levels are associated with type 1 diabetes. Diabetes. 2011; 60(10):2566-70. PMC: 3178281. DOI: 10.2337/db11-0576. View

Bhan I, Powe C, Berg A, Ankers E, Wenger J, Karumanchi S . Bioavailable vitamin D is more tightly linked to mineral metabolism than total vitamin D in incident hemodialysis patients. Kidney Int. 2012; 82(1):84-9. PMC: 3376220. DOI: 10.1038/ki.2012.19. View

Makris K, Bhattoa H, Cavalier E, Phinney K, Sempos C, Ulmer C . Recommendations on the measurement and the clinical use of vitamin D metabolites and vitamin D binding protein - A position paper from the IFCC Committee on bone metabolism. Clin Chim Acta. 2021; 517:171-197. PMC: 8080555. DOI: 10.1016/j.cca.2021.03.002. View

Thrailkill K, Jo C, Cockrell G, Moreau C, Fowlkes J . Enhanced excretion of vitamin D binding protein in type 1 diabetes: a role in vitamin D deficiency?. J Clin Endocrinol Metab. 2010; 96(1):142-9. PMC: 3038488. DOI: 10.1210/jc.2010-0980. View

10.

Jemielita T, Leonard M, Baker J, Sayed S, Zemel B, Shults J . Association of 25-hydroxyvitamin D with areal and volumetric measures of bone mineral density and parathyroid hormone: impact of vitamin D-binding protein and its assays. Osteoporos Int. 2015; 27(2):617-26. PMC: 4924926. DOI: 10.1007/s00198-015-3296-6. View

11.

Khazai N, Beck Jr G, Umpierrez G . Diabetes and fractures: an overshadowed association. Curr Opin Endocrinol Diabetes Obes. 2009; 16(6):435-45. PMC: 3746497. DOI: 10.1097/MED.0b013e328331c7eb. View

12.

Feng R, Li Y, Li G, Li Z, Zhang Y, Li Q . Lower serum 25 (OH) D concentrations in type 1 diabetes: A meta-analysis. Diabetes Res Clin Pract. 2015; 108(3):e71-5. DOI: 10.1016/j.diabres.2014.12.008. View

13.

Bikle D, Gee E, Halloran B, Haddad J . Free 1,25-dihydroxyvitamin D levels in serum from normal subjects, pregnant subjects, and subjects with liver disease. J Clin Invest. 1984; 74(6):1966-71. PMC: 425383. DOI: 10.1172/JCI111617. View

14.

Wood J, Connor C, Cheng P, Ruedy K, Tamborlane W, Klingensmith G . Vitamin D status in youth with type 1 and type 2 diabetes enrolled in the Pediatric Diabetes Consortium (PDC) is not worse than in youth without diabetes. Pediatr Diabetes. 2015; 17(8):584-591. PMC: 4882286. DOI: 10.1111/pedi.12340. View

15.

Bikle D . Vitamin D: newly discovered actions require reconsideration of physiologic requirements. Trends Endocrinol Metab. 2010; 21(6):375-84. PMC: 2880203. DOI: 10.1016/j.tem.2010.01.003. View

16.

Bluestone J, Herold K, Eisenbarth G . Genetics, pathogenesis and clinical interventions in type 1 diabetes. Nature. 2010; 464(7293):1293-300. PMC: 4959889. DOI: 10.1038/nature08933. View

17.

CLEVE H, Constans J . The mutants of the vitamin-D-binding protein: more than 120 variants of the GC/DBP system. Vox Sang. 1988; 54(4):215-25. DOI: 10.1111/j.1423-0410.1988.tb03908.x. View

18.

Powe C, Ricciardi C, Berg A, Erdenesanaa D, Collerone G, Ankers E . Vitamin D-binding protein modifies the vitamin D-bone mineral density relationship. J Bone Miner Res. 2011; 26(7):1609-16. PMC: 3351032. DOI: 10.1002/jbmr.387. View

19.

Schwetz V, Trummer C, Pandis M, Grubler M, Verheyen N, Gaksch M . Effects of Vitamin D Supplementation on Bone Turnover Markers: A Randomized Controlled Trial. Nutrients. 2017; 9(5). PMC: 5452162. DOI: 10.3390/nu9050432. View

20.

Kujath A, Quinn L, Elliott M, LeCaire T, Binkley N, Molino A . Different health behaviours and clinical factors associated with bone mineral density and bone turnover in premenopausal women with and without type 1 diabetes. Diabetes Metab Res Rev. 2014; 31(4):421-32. PMC: 4406845. DOI: 10.1002/dmrr.2627. View