The Prevalence of Vitamin D and Calcium Supplement use and Association with Serum 25‑Hydroxy‑vitamin D (25(OH)D) and Demographic and Socioeconomic Variables in Iranian Elderly

Sara Mansouri, Maryam Safabakhsh, Abbas Rahimi Forooshani, Sakineh Shab‑Bidar


Aims: The objective of this study was to determine the prevalence of vitamin D and calcium supplement use, and association with serum 25‑hydroxy‑vitamin D(25(OH)D) and demographic and socioeconomic variables in Iranian elderly.

Settings and Design: This cross‑sectional study was conducted in health centers of Tehran, capital of Iran.

Methods: A total of 600 men and women were recruited using a two‑stage cluster sampling method from 60 health centers. Participant’s inclusion criteria included enrolling older adults over 60 years old who able to answer questions. We used valid and reliable questionnaires to record dietary intake of vitamin D and calcium. Any dietary supplements which included vitamin D/calcium were recorded. 25(OH)D level was measured. Participants were categorized as supplement users if they had taken supplements during last month.

Results: The mean age of participants was 67.16 ± 6.07 years. Vitamin D supplements were used more often by females (OR = 11.89, 95% confidence interval (CI): 4.82–29.34), high educated subjects (OR = 3.49, 95% CI: 1.45–8.44), participants who did more physical activities (OR = 2.75, 95% CI: 1.52–5.00), and subjects who took antiosteoporosis medications (OR = 6.90, 95% CI: 2.84‑16.78). Calcium supplements were used more often by females (OR = 13.05, 95% CI: 5.19–32.81), more physical activities participants (OR = 2.17, 95% CI: 1.20–3.92), and antiosteoporosis users (OR = 8.31, 95% CI: 3.43–20.14). Significant positive associations were seen between 25(OH) D levels and osteoporosis (P = 0.020), vitamin D supplement use (P < 0.0001), and sun exposure (P = 0.093).

Conclusion: In this population of Tehranian adults, the prevalence of vitamin D and calcium supplement use may be attributed to educational level and underlying disease. Vitamin D supplementation, osteoporosis, and sun exposure were the strong predictors of vitamin D status.


Calcium supplements; elderly; Iran, serum vitamin D; vitamin D supplements

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Imam SN, Palla KR, Lee TA. Vitamin D deficiency/insufficiency

practice patterns in a veterans health administration long‑term

care population: A retrospective analysis. J Am Med Dir Assoc


Alipour S, Saberi A, Seifollahi A, Shirzad N, Hosseini L. Risk

factors and prevalence of vitamin D deficiency among Iranian

women attending two university hospitals. Iran Red Crescent

Med J 2014;16:15461.

Scott D, Sanders KM, Ebeling PR. Vitamin D, muscle

function, and falls in older adults: Does reduced deposition of

intramuscular adipose tissue influence the relationship? J Clin

Endocrinol Metab 2013;98:3968‑70.

Hashemipour S, Larijani B, Adibi H, Javadi E, Sedaghat M,

Pajouhi M, et al. Vitamin D deficiency and causative factors in

the population of Tehran. BMC Public Health 2004;4:38.

Gaugris S, Heaney RP, Boonen S, Kurth H, Bentkover JD,

Sen SS. Vitamin D inadequacy among post‑menopausal women:

A systematic review. QJM 2005;98:667‑76.

Tang BMP, Eslick GD, Nowson C, Smith C, Bensoussan A.

Use of calcium or calcium in combination with vitamin D

supplementation to prevent fractures and bone loss in people aged

years and older: A meta‑analysis. Lancet 2007;370:657‑66.

Bischoff‑Ferrari HA, Willett WC, Wong JB, Giovannucci E,

Dietrich T, Dawson‑Hughes B. Fracture prevention with vitamin

D supplementation: A meta‑analysis of randomized controlled

trials. JAMA 2005;293:2257‑64.

Holick MF. High Prevalence of Vitamin D Inadequacy and

Implications for Health. Mayo Clinic Proceedings. Elsevier;

Dawson‑Hughes B. A revised clinician’s guide to the prevention

and treatment of osteoporosis. J Clin Endocrinol Metab


Ervin RB, Kennedy‑Stephenson J. Mineral intakes of elderly

adult supplement and non‑supplement users in the third national

health and nutrition examination survey. J Nutr 2002;132:3422‑7.

Radimer K, Bindewald B, Hughes J, Ervin B, Swanson C,

Picciano MF. Dietary supplement use by US adults: Data from

the national health and nutrition examination survey, 1999–2000.

Am J Epidemiol 2004;160:339‑49.

Foote JA, Murphy SP, Wilkens LR, Hankin JH, Henderson BE,

Kolonel LM. Factors associated with dietary supplement use

among healthy adults of five ethnicities the multiethnic cohort

study. Am J Epidemiol 2003;157:888‑97.

Espino DV, Oakes SL, Owings K, Markides KS, Wood R,

Becho J. Factors associated with use of calcium and calcium/

vitamin D supplements in older Mexican Americans: Results

of the Hispanic EPESE study. Am J Geriatr Pharmacother


Maddah M, Sharami SH. Intake of calcium/vitamin D

supplement in Iranian postmenopausal women. Arch Osteoporos


Mirmiran P, Hosseini Esfahani F, Mehrabi Y, Hedayati M,

Azizi F. Reliability and relative validity of an FFQ for nutrients

in the Tehran lipid and glucose study. Public Health Nutr


Moghaddam MB, Aghdam FB, Jafarabadi MA,

Allahverdipour H, Nikookheslat SD, Safarpour S. The Iranian

version of international physical activity questionnaire (IPAQ)

in Iran: Content and construct validity, factor structure, internal

consistency and stability. World Appl Sci J 2012;18:1073‑80.

Sharifi F, Alizadeh‑Khoei M, Saghebi H, Angooti‑Oshnari L,

Fadaee S, Hormozi S, et al. Validation study of ADL‑Katz scale

in the Iranian elderly nursing homes. Ageing Int 2018;43:508‑23.

Bailey RL, Gahche JJ, Lentino CV, Dwyer JT, Engel JS,

Thomas PR, et al. Dietary supplement use in the United States,

‑2006. J Nutr 2011;141:261‑6.

Rozga MR, Stern JS, Stanhope K, Havel PJ, Kazaks AG.

Dietary supplement users vary in attitudes and sources of dietary

supplement information in east and west geographic regions.

Complement Altern Med 2013;13:200.

Rock CL. Multivitamin/mineral supplements: Who uses them?

Am J Clin Nutr 2007;85:277s‑9s.

Fan T, Nocea G, Modi A, Stokes L, Sen SS. Calcium and

vitamin D intake by postmenopausal women with osteoporosis

in Spain: An observational calcium and vitamin D intake study.

Clin Interv Aging 2013;8:689‑96.

Czernichow S, Fan T, Nocea G, Sen SS. Calcium and vitamin D

intake by postmenopausal women with osteoporosis in France.

Curr Med Res Opin 2010;26:1667‑74.

Heaney RP, Holick MF, Lips P, Meunier PJ, Vieth R. Estimates

of optimal vitamin D status. Osteoporos Int 2005;16:713‑6.

Miettinen ME, Kinnunen L, Leiviskä J Keinänen‑Kiukaanniemi S, Korpi‑Hyövälti E, Niskanen L, et al.

Association of serum 25‑hydroxyvitamin D with lifestyle factors

and metabolic and cardiovascular disease markers. PLoS One


Qiao Z, Li‑Xing S, Nian‑Chun P, Shu‑Jing X, Miao Z, Hong L,

et al. Serum 25(OH) D level and parathyroid hormone in

chinese adult population: A cross‑sectional study in Guiyang

Urban Community from Southeast of China. Int J Endocrinol


Soteriades E, Coolidge JA, Mudgal S, Dawson‑Hughes B.

Vitamin D insufficiency and hyperparathyroidism in

a low income, multiracial, elderly population. J Clin

Endocrinol Metab 2000;85:4125‑30.

Hintzpeter B, Mensink GB, Thierfelder W, Müller MJ,

Scheidt‑Nave C. Vitamin D status and health correlates among

German adults. Eur J Clin Nutr 2008;62:1079‑89.

Burgaz A, Akesson A, Oster A, Michaëlsson K, Wolk A.

Associations of diet, supplement use, and ultraviolet B radiation

exposure with vitamin D status in Swedish women during winter.

Am J Clin Nutr 2007;86:1399‑404.

Brot C, Vestergaard P, Kolthoff N, Gram J, Hermann AP,

Sørensen OH. Vitamin D status and its adequacy in healthy

Danish perimenopausal women: Relationships to dietary intake,

sun exposure and serum parathyroid hormone. Br J Nutr


Millen AE, Wactawski‑Wende J, Pettinger M, Melamed ML,

Tylavsky FA, Liu S, et al. Predictors of serum 25‑hydroxyvitamin

D concentrations among postmenopausal women. Am J Clin

Nutr. 2010;91:1324‑35.

Jungert A, Neuhäuser‑Berthold M. Sex‑specific determinants

of serum 25‑hydroxyvitamin D3 concentrations in an elderly

German cohort. Nutr Metab 2015;12:2.