N C Harvey

Maternal vitamin D status during pregnancy and child outcomes.

Objective:To investigate whether exposure to high maternal concentrations of 25(OH)-vitamin D in pregnancy poses any risk to the child.Design:Prospective study.Setting:Princess Anne Maternity Hospital, Southampton, UK.Subjects:A group of 596 pregnant women were recruited. A total of 466 (78%) children were examined at birth, 440 (74%) at age 9 months and 178 (30%) at age 9 years.Methods:Maternal 25 (OH)-vitamin D concentrations were measured in late pregnancy. Anthropometry of the child was recorded at birth, 9 months and 9 years. At 9 months, atopic eczema was assessed. At 9 years, children had an echocardiogram and a dual energy x-ray absorptiometry scan, blood pressure, arterial compliance and carotid intima-media thickness were measured and intelligence and psychological function assessed.Results:There were no associations between maternal 25(OH)-vitamin D concentrations and the childs body size or measures of the childs intelligence, psychological health or cardiovascular system. Children whose mothers had a 25(OH)-vitamin D concentration in pregnancy >75 nmol/l had an increased risk of eczema on examination at 9 months (OR 3.26, 95% CI 1.15–9.29, P=0.025) and asthma at age 9 years (OR 5.40, 95% CI, 1.09–26.65, P=0.038) compared to children whose mothers had a concentration of <30 nmol/l.Conclusion:Exposure to maternal concentrations of 25(OH)-vitamin D in pregnancy in excess of 75 nmol/l does not appear to influence the childs intelligence, psychological health or cardiovascular system; there could be an increased risk of atopic disorders, but this needs confirmation in other studies.Sponsorship:The study was supported by the Medical Research Council and WellChild (previously known as Children Nationwide).

Relationship between low bone mineral density and fractures with incident cardiovascular disease: a systematic review and meta-analysis

An increasing evidence base suggests that low bone mineral density (BMD) and fractures are associated with cardiovascular disease (CVD). We conducted a systematic review and meta‐analysis summarizing the evidence of low BMD and fractures as risk factors for future CVD. Two independent authors searched major databases from inception to August 1, 2016, for longitudinal studies reporting data on CVD incidence (overall and specific CVD) and BMD status and fractures. The association between low BMD, fractures, and CVD across longitudinal studies was explored by calculating pooled adjusted hazard ratios (HRs) ±95% confidence intervals (CIs) with a random‐effects meta‐analysis. Twenty‐eight studies (18 regarding BMD and 10 fractures) followed a total of 1,107,885 participants for a median of 5 years. Taking those with higher BMD as the reference, people with low BMD were at increased risk of developing CVD during follow‐up (11 studies; HR = 1.33; 95%CI, 1.27 to 1.38; I2 = 53%), after adjusting for a median of eight confounders. This finding was confirmed using a decrease in one standard deviation of baseline BMD (9 studies; HR = 1.16; 95% CI, 1.09 to 1.24; I2 = 69%). The presence of fractures at baseline was associated with an increased risk of developing CVD (HR = 1.20; 95% CI, 1.06 to 1.37; I2 = 91%). Regarding specific CVDs, low BMD was associated with an increased risk of developing coronary artery disease, cerebrovascular conditions, and CVD‐associated death. Fractures at baseline was associated with an increased risk of cerebrovascular conditions and death due to CVD. In conclusion, low BMD and fractures are associated with a small, but significant increased risk of CVD risk and possibly death.

Maternal vitamin D insufficiency and fetal bone development

S FROM THE BRS MEETING Abstracts Presented at the Bone Research Society Meeting Manchester, UK 23-25 June 2008s Presented at the Bone Research Society Meeting Manchester, UK 23-25 June 2008

SOCIAL INEQUALITY AND HIP FRACTURE: SECULAR TRENDS IN THE DANISH POPULATION

Objective: Menisceal tears can occur as a result of the cartilage degenerative process in osteoarthritis (OA) and are associated with impaired balance and mobility. The relationship between degenerative menisceal tears and subsequent falls, however, have not been adequately studied. We therefore conducted a case–control study to determine the influence of menisceal tears on postural control in older fallers. Material and Methods: Cases consisted of individuals aged ≥65 years with a history of two falls or one injurious fall over the past 12 months while controls aged ≥65 years with no falls in the previous year were recruited through word-of-mouth and media advertising. The presence of menisceal tears were determined with 3 T magnetic resonance image (MRI). Postural control was evaluated with a balance platform (Balance master, Neurocom, USA) using the limits of stability (LOS), sit-to-stand (STS) and a modified clinical test of sensory interaction on balance (mCTSIB) assessments. Results: 32 subjects (12 fallers, 20 non-fallers), mean age(SD)=70.97(4.771), 75 % women, were recruited. 21 subjects had a menisceal tear by MRI with 20 of them had on medial side only, 1 on lateral, and 3 on both compartments. No significant difference was found in the presence of menisceal tears among fallers and non-fallers (75 vs. 60 %, p=0.465). Subjects with menisceal tears were more likely to have worse percentage of rising index during STS test compared to the subjects without tears (19.90±7.18 vs. 34.81±20.21, p= 0.005). While fallers with menisceal tears were found significantly worse score in the percentage of symmetrical weight distribution in STS (15.78±8.38 vs. 6.75±5.64, p=0.008), further end point (59.89±9.53 vs. 47.92±11.04, p=0.017) and further maximal excursion (84.22±3.78 vs. 68.58± 13.87, p=0.006) to the left, right and backwards compared to the non-fallers with menisceal tears. In a regression analyses, presence ofmenisceal tears remained associatedwith poor rising index even after controlling for age and history of falls (p=0.027). Conclusion: This study discovered that presence of menisceal tears among the older adults was found strongly associated with impaired rising index in STS test and was not mediated by history of falls. In addition, despite having menisceal tears in knee, the non-fallers showed better percentage of left/right symmetry weight distribution in STS test compared to fallers. While better score found in LOS among fallers with menisceal tears when compared to the non-fallers with menisceal tears can be postulated that, the non-fallers with high risk of fall might have restricted their movement which simultaneously reduce their possibility to get fall. This findings suggested that, aiming to improve STS scores can become the main objective in any intervention involving elderly fallers with meniscus tears in knee OA in order to improve their functional status for daily living. Acknowledgements: We wish to acknowledge both radiologist Dr Faizzatul Izza and Dr Farhana for helping us withMRI readings.