Do Low Vitamin D Levels Correlate With Osteoporosis?

Do Low Vitamin D Levels Correlate With Osteoporosis?
Shashi Agarwal, MD, FACC, East Orange, NJ; Neil Argarwal, Edison, NJ

INTRODUCTION: Osteoporosis is related to many factors, including a
family history of the disease, tobacco use, steroid use, major preexisting
medical diseases and vitamin D deficiency. This retrospective study was
done to see if low vitamin D levels correlate with the presence of
osteoporosis.

METHODS: We reviewed the records of 101 consecutive
patients who had DXA scans and vitamin D levels done over the period
of one calendar year. Bone mineral density was measured at the hip and
spine by dual-energy X-ray absorptiometry. T scores were considered
normal between +1 and -1, osteopenia between -1 and -2.5 and
osteoporosis if lower than -2.5. Vitamin D was measured as serum 25-
hydroxy vitamin D by the DiaSorin ICMA method. Vitamin D levels were
categorized as: normal levels: 30ng/ml or higher; mild deficiency:
20ng/ml-29ng/ml; moderate deficiency: 10ng/ml-19ng/ml and severe
deficiency: 0ng/ml-9ng/ml.

RESULTS: Of the 101 patients (ages 20 to 88
years) [54 (53.5%) males; 47 (46.5%) females], 19 (18.8%) had normal
vitamin D levels and 82 (81.2%) had low levels. Of the 19 with normal
levels, 6 (31.6%) had normal DXA scan, 8 (42.1%) had osteopenia and 5
(26.3%) had osteoporosis. Of the 82 with low vitamin D levels, 39
(47.6%) had normal DXA scans, 32 (39.0%) had osteopenia and 11
(13.4%) had osteoporosis. Of the 28 with mild deficiency, 12 (42.9%)
were normal, 13 (46.4%) were osteopenic and 3 (10.7%) were
osteoporotic. Of the 50 with moderate deficiency, 27 (54.0%) were
normal, 17 (34.0%) were osteopenic and 6 (12.0%) were osteoporotic.
Of the 4 with severe deficiency, 0 (0.0%) were normal, 2 (50.0%) were
osteopenic and 2 (50.0%) were osteoporotic. The average age of those
who were normal was 52.59 years, those with osteopenia was 56.38
years, and those with osteoporosis was 57.91 years.

CONCLUSION: We
found that approximately one half of the patients with mild or moderate
vitamin D deficiency had evidence of either osteopenia or osteoporosis
on DXA scanning. All patients with severe deficiency were osteopenic or
osteoporotic. Osteoporotic patients tended to be older. However, there
was no diagnostic correlation between low vitamin D levels and the
presence of osteoporosis.

Presented at the Family Medicine Forum 2011, Montreal, November 2011

Postural Instability in Schizophrenics: A Study Using Computerized Static and Dynamic Posturography

Neil K Agarwal, Rutgers Univ, New Brunswick, NJ; Shashi K Agarwal, Agarwal Health Ctr, East Orange, NJ, USA

Abstract presented  at the 19th European Congress of Psychiatry, Vienna, Austria on March 15, 2011

ABSTRACT:

Introduction: Schizophrenic patients have a high incidence of falls and fractures. We evaluated postural stability in schizophrenic patients using computerized static and dynamic posturography (CDP).

Objective: To measure normal and perturbed stability in schizophrenics.

Aim: To objectively demonstrate postural abnormalities in schizophrenics.

Methods: A retrospective study of 54 consecutive schizophrenic patients with was done. CDP was done using FallTrak (R). Patients performed normal stability – eyes open (NS/EO), normal stability- eyes closed (NS/EC), perturbed stability – eyes open (PS/EO), and perturbed stability – eyes closed (PS/EC) for 30 seconds each. Findings were classified as normal or abnormal based on age-matched normative data.

Results: The ages ranged from 31 to 77 years. There were 34 (63.0%) males and 20 (37.0%) females. Of the total 54 patients, 48 (88.9%) exhibited abnormalities on CDP testing. NS-EO was abnormal in 29 (53.7%), NS-EC was abnormal in 37 (68.5%); both NS-EO and NS-EC were abnormal in 25 (46.3%); PS-EO was abnormal in 27 (50.0%) and PS-EC was abnormal in 20 (37.0%). Both PS-EO and PS-EC were abnormal in 14 (25.9%). Both PS and NS were abnormal in 26 (48.1%). NS was normal in 13 (24.1%) and PS was normal in 21 (38.9%). Both NS and PS were normal in 6 (11.1%) patients.

Conclusions: Most schizophrenic patients show abnormalities in both normal and perturbed stability when tested using static and dynamic posturography. Balance was normal in only 11.1 % of the patients. Further studies are needed to evaluate the clinical significance of these findings.

Vitamin D: An Important Supplement to Prevent Cardiovascular Diseases in African-American Patients with Hypertension

Neil K Agarwal , Rutgers Univ, New Brunswick, NJ; Shashi K Agarwal, MD, FACC, Agarwal Health Ctr, East Orange, NJ

Presented at Preventive Medicine 2011, San Antonio, Texas, February 16-19, 2011

Purpose: African-Americans suffer from high rates of hypertension (HTN), a major risk factor for cardiovascular disease (CVD). African-Americans are also at a higher risk of developing vitamin D deficiency due to their increased skin pigmentation. A strong correlation exists between vitamin D deficiency and CVD. This study was done to assess the presence of vitamin D deficiency in African-American patients with HTN.

Methods: A retrospective review of charts and reports of consecutive blood tests done on African-American hypertensive patients over an eight month period was done. Vitamin D was measured as 25-hydroxyvitamin D in the blood and reported as ng/ml. The levels were classified as follows: 30 ng/ml or above: normal; 20 to 29 ng/ml: mild deficiency; 10 to 19 ng/mL: moderate deficiency; 9 ng/ml or less: severe deficiency

Results: 214 African American patients had their blood drawn during the study period. Of these, 108 (50.5%) were males and 106 (49.5%) were females. Their ages ranged from 21 to 91 years. Of the total, 183 (85.5%) had low levels of 25-hydroxyvitamin D and 31 (14.5%) had normal levels. Of the patients with low levels, 15 (8.2%) had severe deficiency [9 (60.0%) males and 6 (40.0%) females], 122 (66.7%) had moderate deficiency [58 (47.5%) males and 64 (52.5%) females], and 46 (25.1%) had mild deficiency [22 (47.8%) males and 24 (52.2%) females].

Conclusion: An extremely high percentage (85.5%) of African-American patients with HTN suffers from vitamin D deficiency. The majority of these patients (74.9%) suffer from moderate to severe deficiency.

Public Health Implication: African-Americans with HTN should be routinely tested for vitamin D deficiency. Further, as most of these patients have moderate or severe deficiency, they may need much higher doses of vitamin D supplementation, than those generally recommended.

Data Source Utilized: Patient charts and lab reports in a Cardiologists Office.

Presence of Subclinical Anxiety in Hypertensive Patients

Neil K. Agarwal, Shashi K. Agarwal, MD

Presented at CSANZ, Annual  Scientific  Meeting, Perth, Australia, 11-14  August  2011

Introduction: Both hypertension and anxiety are common medical conditions. Since anxiety is associated with an increased incidence of sudden death, its presence in hypertensive patients may have prognostic significance. Although symptomatic anxiety is usually diagnosed and treated, subclinical anxiety may remain undiagnosed. This study was undertaken to evaluate the presence of subclinical anxiety in treated hypertensive patients.

Methods: One hundred consecutive hypertensive patients under treatment without clinically diagnosed anxiety were given the self administered Zung Self-Rating Anxiety Scale test. The scores (20-80) were classified as follows: NormalRange: 20-44; Mild Anxiety: 45-59; Moderate Anxiety: 60-74 and Severe Anxiety: 75-80. Hypertensive patients with an established clinical diagnosis of anxiety were excluded.

Results: Of the 100 patients (ages: 29 – 95 years), there were 52 (52.0%) females and 48 (48.0%) males. Of these, 28 (28.0%) [16 (57.1%) females; 12 (42.9%) males] had anxiety scores over 45. Of these 28 patients, 24 (85.7%) [15 (62.5%) females; 9 (37.5%) males] had mild anxiety and 4 (14.3%) [1 (25.0%) female; 3 (75.0%) males] had moderate anxiety. None had severe anxiety.

Conclusions:  The interrelationship between anxiety and hypertension is not well studied. Our study reveals that a significant number of treated hypertensives suffer from ‘subclinical’ anxiety.  Further studies are needed to evaluate the benefits of diagnosing and treating subclinical anxiety in these patients

Clonidine requests in a cardiologist’s office: An indicator of drug addiction?

Neil K Agarwal, Rutgers Univ, New Brunswick, NJ; Shashi K Agarwal, Agarwal Health Ctr, East Orange, NJ

Presented at the 42nd Annual Medical Scientific Conference of the American Society of Addiction Medicine ,Washington, DC. April 14-17, 2011

 Introduction: Clonidine is a centrally acting alpha-agonist hypotensive agent. It is also used in opiate addiction to help alleviate withdrawal symptoms. Its use to prolong the effects of alprazolam and to get additional sedation is however not well known.

Methods: A retrospective review of 200 consecutive new office patients was done.  Their physical examinations and medication histories were reviewed.

Results: Of the 200 patients, 31 (15.5%) claimed that were on clonidine for hypertension. Of these 31, verification of hypertension could not be obtained in 28 (90.3%). There were 17 (60.7%) males and 11 (39.3%) females. Their ages ranged from 26 to 54. 3 (9.7%) had track marks and confirmed previous IV drug use. 2 (6.4%) were on methadone.  26 (83.9%) were on aloprazolam. The other 3 (9.7%) were females (ages 66 to 75 years). They were wearing clonidine patches, and were also on other verifiable antihypertensive drugs. They gave no history of opiate or benzodiazepine use.

Conclusions:  1. Clonidine request in a cardiologist’s office should raise the suspicion of drug abuse.  2.  In the majority of our patients, the drug abused was alprazolam.  3. These patients are usually younger, evasive in giving information and do not exhibit hypertension. 4. Due to the dangers of suddenly stopping clonidine, these patients need to be educated. 5.  Further studies are needed to study the abuse of clonidine in patients addicted to alprazolam.

Smoking In Institutionized Schizophrenic Patients

Neil K Agarwal, Rutgers Univ, New Brunswick, NJ; Shashi K Agarwal, Agarwal Health Ctr, East Orange, NJ

Abstract Presented  at the 19th European Congress of PsychiatryVienna, Austria on March 15, 2011.

Introduction:  Schizophrenia and smoking are closely linked. Non-instutionalized schizophrenics have a much higher rate of smoking and smoke more cigarettes than the  general population. We studied the smoking patterns in institutionalized schizophrenic patients.

Objectives: Boarding Homes (BH) provide boarding with daily activity and health care supervision. All residents are over 18 years old, ambulatory and do not require skilled nursing care. The objective of the study was to evaluate the smoking patterns in schizophrenics living in these institutions.

 Aims: The aim was to evaluate the effect of supervision on the smoking habits of institutionalized schizophrenic patients

Methods: Smoking history was obtained from 100 consecutive BH schizophrenics sent to our office for annual physicals. All were under care of psychiatrists.

 Results: Of the 100 patients [54 (54%) males; 46 (46%) females], 96 [52 (54%) males; 44 (46%) females] were current smokers. 32 [20 (63%) males; 12 (37%) females] reported smoking  up to 10 cigarettes per day, 42 [22 (52%) males; 20 (48%) females) up to 20 cigarettes per day, while 22 [10 (45%) males, 12 (54%) females] 30 or more cigarettes per day.

Conclusions: Schizophrenics living in institutions have extremely high rates of smoking, in spite of being supervised. These rates are higher than that reported with schizophrenics living independently and extremely higher than the general population. They also smoke more cigarettes per day.  Strategies to reduce smoking and protect this population from the harmful effects of this addiction need to be established.

Osteopenia and Osteoporosis in a Hypertensive Population

Presented at  CSANZ  Annual  Scientific  Meeting, Perth, Australia, 11-14  August  2011

Neil K. Agarwal,  Shashi K. Agarwal, MD

Introduction:  Hypertension is a common risk factor for coronary artery disease and stroke, two serious causes of cardiovascular morbidity and mortality. Osteoporosis related hip fractures result in pain, disability, diminished quality of life and increased mortality rates in men and women. The presence of osteoporosis in a hypertensive population may therefore prognosticate a worse clinical course. This study was undertaken to assess the prevalence of osteopenia and osteoporosis in hypertensive patients.

Methods: We reviewed dual-emission X-ray absorptiometry (DXA) scans of 220 consecutive hypertensive patients. Bone mineral density (BMD) was measured at the hip and spine. T scores were considered normal between +1 and -1. T scores were classified as osteopenia between -1 and -2.5 and osteoporosis if lower than -2.5.

Results: Of the 220 patients (ages: 20 – 87 years) [123 (55.9%) males; 97 (44.1%) females], 102 (46.4%) [67 (65.7%) males; 35 (34.3%) females] had normal T scores. 118 (53.6%) [56 (47.5%) males; 62 (52.5%) females] had abnormal T scores. Of these, 75 (63.6%) [35 (46.7%) males; 40 (53.3%) females] had T scores consistent with osteopenia and 43 (36.4%) [20 (46.5%) males; 23 (53.5%) females] had T scores consistent with osteoporosis.

Conclusion: Osteopenia and osteoporosis are common in hypertensive patients. T scores consistent with osteopenia were found in approximately 34% and those consistent with osteoporosis were found in approximately 20% of our hypertensive population. Hypertensive treatment combined with strategies to prevent and treat osteoporosis may improve the clinical course of these patients.

LOW CARDIAC OUTPUT IN ASYMPTOMATIC HYPERTENSIVE PATIENTS: A PRE-HEART FAILURE SYNDROME?

NK. Agarwal (1) , S. Agarwal (2)  – (1) Rutgers University, Piscataway, New Jersey, United States of America (2) Agarwal Health Center, East Orange, New Jersey, United States of America

Presented at 16th World Congress on Heart disease, International Academy of Cardiology, Vancouver, Canada, July 23-26, 2011

Objectives: To evaluate the presence of subnormal cardiac output (CO) in asymptomatic hypertensive patients with no objective signs of failure.

Background: Subnormal CO along with pertinent symptoms and signs is pathognomic of heart failure (HF).

Methods: We retrospectively reviewed charts of 100 consecutive treated hypertensive patients who were asymptomatic with no clinical signs of HF and normal ejection fractions (>55%). Blood pressure (BP) was controlled (139/89 or less) or uncontrolled (140/90 or higher). CO was considered abnormal if the Cardiac Index (CI) was less than 2.6 L / min / m squared (Impedence cardiography-BioZ Cardiac Output Monitor). Transthoracic echocardiographic studies were performed using commercially available machines with phased-array transducers.

Results: Of the 100 (ages 23-91) [57 males; 43 females] asymptomatic hypertensive patients, 53 (53.0%) [31 males; 22 females] had low CI.  Of the 53 patients with low CI, 14 (26.4%) had uncontrolled BP and 39 (73.6%) had controlled BP. Of the 100 patients, 23 (23.0%) had uncontrolled BP. Of these 23, 14 (60.9%) [8 males; 6 females] had low CI. Of the 77 [45 males; 32 females] with controlled BP, 39 (50.6%) [23 males; 16 females] had low CI.

Conclusions: Many asymptomatic hypertensive patients under treatment (irrespective of their BP control status) and with no echocardiographic or clinical signs of heart failure demonstrate subnormal cardiac output on non-invasive hemodynamic monitoring. These patients may represent a pre-HF group. Further studies are needed to evaluate the clinical course of this subset of treated hypertensive patients.