Suboptimal Plasma Vitamin C is Significantly Correlated with Bone Mineral Density in Male Subjects

by | Oct 27, 2022 | 2022, Bone Health, Vitamin C

Written by Taylor Woosley, Staff Writer. Study findings show that plasma vitamin C levels in two categories (suboptimal (≤8.8 mg/L) and sufficient (>8.8 mg/L)) were positively associated with BMD at the spine in men (p = 0.004). However, no association was noted in women (p = 0.552). 

vitamin COsteoporosis is a global clinical and public health problem and is associated with an increased risk for fragility fractures which can lead to pain, disability, and increased morbidity and mortality1. Osteoporosis is a musculoskeletal disease characterized by decreased bone mass and destruction of bone microstructure2. It is a systemic skeletal disease resulting in low bone mineral density (BMD) and deterioration of bone architecture3. Osteoporosis is associated with an imbalance in bone remodeling, in which there is relatively greater bone resorption than bone formation4.

Diet is a major modifiable risk factor for the prevention of bone loss among adults, with fruit and vegetable intake being associated with higher BMD5. One dietary component of fruits and vegetables is vitamin C, an antioxidant and water-soluble vitamin6. Vitamin C is important in bone metabolism because it is related to the hydroxylation of collagen7. Furthermore, it is required for the differentiation of the cells (osteoclasts) necessary for optimal bone mineral density and bone health8.

Lan et al. conducted a retrospective cross-sectional study to examine associations between the lumbar spine BMD and the four selected circulating nutrients (vitamin C, vitamin D, vitamin B12, and folic acid) as well as anthropometric characteristics. Primary outcomes included determining possible associations between circulating nutrients and low BMD at the lumbar spine by comparing subjects with the highest BMD to those with the lowest BMD. Secondary outcomes included exploring the distribution differences of the BMD at the spine among three categories of plasma vitamin C (deficient, insufficient, and sufficient). Subjects were included in the study if they were before 20 to 49 years, who participated in a DXA examination, with available blood samples of plasma vitamin C, serum 25-hydoxyvitamin D [25(OH)D], vitamin B12, and folic acid.

Subjects (male, n=866 and female, n=589) were divided into two age groups: young (20-35) and early middle-aged (36-49). Body mass index (BMI) was calculated, and subjects were graded and divided into four BMI groups: underweight, normal weight, overweight, and obesity. The Kolmogorov-Smirnov test was used to test for normality of data and the Mann-Whitney U-test was used for the comparison of non-normally distributed data. The chi-square test was used to determine the significance of differences in categorical variables. Multiple logistic regression with adjustments for confounding factors including age, BMI, vitamin C, 25(OH)D, vitamin B12, folic acid and season were adjusted to identify the independent predictors for low BMD to estimate adjusted odds ratios (OR) and their 95% CI in multiple logistic models. Significant findings of the study are as follows:

  • The proportion of low BMI in subjects with the highest BMD at the spine tended to be lower than that in subjects with the middle and lowest BMD for both genders (p=0.009 in men, p<0.001 in women).
  • Men with the lowest lumbar spine BMD had a significantly greater prevalence (60.8%) of suboptimal plasma C compared to those in the middle (43.8%) and highest lumbar spine BMD (49.0%) (p<0.001).
  • Univariate logistic regression in men identified three factors with statistical significance: suboptimal plasma vitamin C (p = 0.004), suboptimal serum vitamin B12 (p = 0.062), and low BMI (p = 0.011). In multivariate logistic regressions, the impacts of these factors remained to independently predict low BMD at the spine: suboptimal plasma vitamin C (adjusted OR 1.64, 95% CI 1.16, 2.31), suboptimal serum vitamin B12 (adjusted OR 2.05, 95% CI 1.02, 4.12), and low BMI (adjusted OR 1.68, 95% CI 1.12, 2.53).
  • In multivariate logistic regressions, the factor of low BMI was the only independent predictor of the lowest lumbar spine BMD for women (AOR 3.42, 95% CI 2.13, 5.50).

Results of the study show that the prevalence of suboptimal plasma vitamin C in male subjects with the lowest tertile of the lumbar spine BMD was significantly higher than in those with the middle and highest BMD. Additionally, plasma vitamin C in two categories (sufficient and suboptimal) was positively associated with bone mineral density at the lumbar spine only in the young men group. Study limitations include the use of a restricted study population, the lack of examination of further circulating nutrients, and the design of the study not being able to examine the causal relationship between vitamins and BMD.

Source: Lan, Kuo-Mao, Li-Kai Wang, Yao-Tsung Lin, Kuo-Chuan Hung, Li-Ching Wu, Chung-Han Ho, Chia-Yu Chang, and Jen-Yin Chen. “Suboptimal Plasma Vitamin C Is Associated with Lower Bone Mineral Density in Young and Early Middle-Aged Men: A Retrospective Cross-Sectional Study.” Nutrients 14, no. 17 (2022): 3556.

© 2022 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https:// creativecommons.org/licenses/by/ 4.0/).

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Posted October 26, 2022.

Taylor Woosley studied biology at Purdue University before becoming a 2016 graduate of Columbia College Chicago with a major in Writing. She currently resides in Glen Ellyn, IL.

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