What question did this study set out to answer?

This study aims to clarify how serum 25-hydroxyvitamin D and calcium differentially affect trabecular and cortical bone mineral density in postmenopausal women.

June 21, 2026Open Access

Differential associations of serum 25-hydroxyvitamin D and calcium with trabecular and cortical bone mineral density in postmenopausal women assessed by peripheral quantitative computed tomography

Key Points

This study aims to clarify how serum 25-hydroxyvitamin D and calcium differentially affect trabecular and cortical bone mineral density in postmenopausal women.
Cross-sectional study involving 100 postmenopausal women aged 55–69 years
Measured serum 25(OH)D and calcium levels; assessed bone mineral density via pQCT
Employed Pearson correlation and multivariable linear regression analyses adjusted for age, BMI, and other factors.
Significant correlation of 25(OH)D with cortical BMD (r = 0.513, p < 0.001) but not with trabecular BMD (r = 0.027, p = 0.788)
Calcium shown to correlate with trabecular BMD (r = 0.534, p < 0.001) and, to a lesser extent, with cortical BMD (r = 0.231, p = 0.021)
Calcium and years since menopause independently predicted trabecular BMD, while age and calcium predicted cortical BMD.

Abstract

The differential effects of serum 25-hydroxyvitamin D 25(OH)D and calcium on trabecular versus cortical bone in postmenopausal osteoporosis remain unclear. This study evaluated their associations with compartment-specific bone mineral density (BMD) using peripheral quantitative computed tomography (pQCT). This cross-sectional study enrolled 100 postmenopausal women (aged 55–69 years) at LLRM Medical College and SVBP Hospital (May 2023–April 2024). Serum 25(OH)D and calcium were assayed biochemically; trabecular, cortical, and total volumetric BMD with bone strength index (BSI) were measured by pQCT (Stratec XCT 2000) at the distal radius. Pearson correlation and multivariable linear regression (adjusted for age, BMI, years since menopause, calcium, comorbidities) were performed. Mean age was 61.85 ± 4.24 years; duration since menopause, 14.50 ± 5.79 years. 25(OH)D deficiency (< 20 ng/mL) occurred in 48%; 55% had calcium < 8.5 mg/dL. 25(OH)D correlated significantly with cortical BMD ( r = 0.513, p < 0.001) but not with trabecular ( r = 0.027, p = 0.788) or total BMD ( r = 0.067, p = 0.506). Conversely, calcium showed a strong correlation with trabecular BMD ( r = 0.534, p < 0.001) and a weaker but significant correlation with cortical BMD ( r = 0.231, p = 0.021). Neither correlated significantly with BSI. On multivariable regression, calcium (β = 8.61, p < 0.001) and years since menopause (β = 1.75, p < 0.001) independently predicted trabecular BMD (adjusted R² = 0.871), while age (β = 5.39, p < 0.001) and calcium (β = 13.98, p = 0.010) predicted cortical BMD (adjusted R² = 0.280). Regression models for total BMD and BSI were non-significant. Multivariable regression identified serum calcium and years since menopause as independent predictors of trabecular BMD, while age—perfectly collinear with serum 25(OH)D in this cohort—and serum calcium independently predicted cortical BMD. Serum 25(OH)D and calcium are differentially associated with bone compartments, with 25(OH)D predominantly linked to cortical bone and calcium to trabecular bone. The high prevalence of both deficiencies supports routine screening and combined supplementation for comprehensive osteoporosis prevention in postmenopausal women.

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