Subscribe to RSS
Osteometabolic and Osteogenetic Pattern of Turkish Immigrants in Germany
received 25 April 2012
first decision 25 April 2012
accepted 28 June 2012
06 September 2012 (online)
The etiology of osteoporosis comprises environmental and genetic factors. This study investigated vitamin D deficiency and specific genetic alterations of bone metabolism in a group of 183 Turkish immigrants in Germany in comparison with 46 age and sex matched healthy German controls (females in both groups were pre-menopausal).
Bone mineral density (BMD) was measured by dual-energy X-ray absorptiometry. Serum levels of osteologic parameters were determined after overnight fasting. Polymorphisms of the vitamin D receptor (VDR) and lactase genes were genotyped using genomic DNA from peripheral leukocytes. Statistical analysis comprised student’s t-test, Mann-Whitney rank sum test, Chi-square analysis and Fisher’s exact test.
Severe 25-OH D3 hypovitaminosis (83.1%) and elevated parathyroid hormone (82%) were common among immigrants. Osteoporosis but not osteopenia was more prevalent in immigrants. Among immigrants with osteoporosis, TRAP5b was elevated in 26.7%, and β-crosslaps in 13.3%. Only the FokI FF VDR-gene-polymorphism was significantly more prevalent among immigrants. In contrast, Ff-genotyped Turkish women exhibited significantly decreased BMD. Lactase polymorphisms were significantly more common among immigrants (84.2% vs. 30.4%) and the CC genotype was commonly associated with reduced BMD (41.6%) but rarely osteoporosis (8.4%).
Vitamin D deficiency, secondary hyperparathyroidism and osteoporosis are common among Turkish immigrants in Germany. Thus, in this population osteologic parameters and BMD should be analyzed and deficiencies be treated. Specifically, the VDR gene polymorphism FokI Ff is of clinical value in identifying females at risk of osteoporosis. In contrast, LCT polymorphisms, though common, do not appear to be a risk factor.
Key wordsbone mineral density - osteoporosis - vitamin D deficiency - vitamin D receptor polymorphism - lactase polymorphism
* I. H. Tarner and M. Z. Erkal contributed equally to this study.
- 1 Bartley J. Prevalence of vitamin D deficiency among patients attending a multidisciplinary tertiary pain clinic. N Z Med J 2008; 28: 57-62
- 2 Lips P. Vitamin D status and nutrition in Europe and Asia. J Steroid Biochem Mol Biol 2007; 103: 620-625
- 3 Gugatschka M, Dobnig H, Fahrleitner-Pammer A et al. Molecularly-defined lactose malabsorption, milk consumption and anthropometric differences in adult males. Q J Med 2005; 98: 857-863
- 4 Erkal MZ, Wilde J, Bilgin Y et al. High prevalence of vitamin D deficiency, secondary hyperparathyreoidism and generalized bone pain in Turkish immigrants in Germany: identification of risk factors. Osteoporos Int 2006; 17: 1133-1140
- 5 Hintzpeter B, Scheidt-Naeve C, Müller MJ et al. Higher prevalence of vitamin D deficiency is associated with immigrant background among children and adolescents in Germany. J Nutr 2008; 138: 1482-1490
- 6 Holick MF. Vitamin D: A millenium perspective. J Cell Biochem 2003; 88: 296-307
- 7 Holick MF. Vitamin D: importance in the prevention of cancers, type 1 diabetes, heart disease, and osteoporosis. Am J Clin Nutr 2004; 79: 362-371
- 8 Meyer HE, Falch JA, Sogaard AJ et al. Vitamin D deficiency and secondary hyperparathyreoidism and the association with bone mineral density in persons with Pakistani and Norwegian background living in Oslo, Norway. The Oslo Health Study. Bone 2004; 35: 412-417
- 9 Francis RM, Selby PL. Osteomalacia. Baillières Clin Endocrinol Metabol 1997; 11: 145-163
- 10 Takeuchi Y. Pathophysiology in rickets/osteomalacia. Clin Calcium 2007; 17: 1508-1513
- 11 Obermayer-Pietsch BM, Lange U, Tauber G et al. Vitamin D receptor initiation codon polymorphism, bone density and inflammatory activity of patients with ankylosing spondylitis. Osteoporos Int 2003; 14: 995-1000
- 12 Rizzoli R, Bonjour JP, Ferrari SL. Osteoporosis, genetics and hormones. J Mol Endocrinol 2001; 26: 79-94
- 13 Enattah N, Pekkarinen T, Välimäki MJ et al. Genetically defined adult-type hypolactasia and self-reported lactose intolerance as risk factors of osteoporosis in Finnish postmenopausal women. Eur J Clin Nutrition 2005; 59: 1105-1111
- 14 Enattah N, Pekkarinen T, Välimäki MJ et al. Calcium supply, bone mineral density and genetically defined lactose maldigestion in a cohort of elderly men. J Endocrinol Invest 2007; 30: 46-51
- 15 Obermayer-Pietsch BM, Gugatschka M, Reitter S et al. Adult-type hypolactasia and calcium availability: decreased calcium intake or impaired calcium absorption?. Osteoporos Int 2007; 18: 445-451
- 16 Obermayer-Pietsch BM, Bonelli CM, Walter DE et al. Genetic predisposition for Adult Lactose Intolerance and Relation to Diet, Bone Density, and Bone Fractures. J Bone Miner Res 2004; 19: 42-47
- 17 Gross C, Eccleshall TR, Malloy PJ et al. The presence of a polymorphism at the translation initiation site of the vitamin D receptor gene is associated with low bone mineral density in postmenopausal Mexican-American women. J Bone Miner Res 1996; 11: 1850-1855
- 18 Obermayer-Pietsch BM, Frühauf GE, Chararas K et al. Association of the vitamin D receptor geneotype BB with low bone density in hyperthyroidism. J Bone Miner Res 2000; 15: 1950-1955
- 19 Maxwell JP, Pi HT, Liu HAC et al. Further studies in adult rickets (osteomalacia) and foetal rickets. Proc Roy Soc Med 1939; 32: 287-297
- 20 Albright F, Reifenstein E. The parathyroid glands and metabolic bone disease: selected studies. Baltimore: Williams & Wilkins; 1948
- 21 Offermann G, Manhold C. Osteomalacia in Turkish Guest-Workers in Germany. Inn Med 1978; 5: 103-111
- 22 Chapuy MC, Arlot ME, Duboeuf F et al. Vitamin D3 and calcium to prevent hip fractures in elderly women. N Engl J Med 1992; 327: 1637-1642
- 23 Wemeau JL. Calciotropic hormones and ageing. Horm Res 1995; 43: 76-79
- 24 Halleen JM. Tartrate-resistant acid phosphatase 5B is a specific and sensitive marker of bone resorption. Anticancer Res 2003; 23: 1027-1029
- 25 Delmas PD. Treatment of osteoporosis. Lancet 2002; 359: 2018-2026
- 26 Enattah NS, Sahi T, Savilahti E et al. Identification of a variant associated with adult-type hypolactasia. Nat Genet 2002; 30: 233-237
- 27 Corazza GR, Benati G, Di Sario A et al. Lactose intolerance and bone mass in postmenopausal Italian women. Br J Nutr 1995; 73: 479-487