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Does Diet Offset the Effect of Veiling on Bone Mineral Density of premenopausal Indian women

Objective: To determine the effect of veiling on bone mineral density (BMD) and to evaluate its association with Vitamin D, Vitamin B12, and folate status. Materials and Methods: Design: Cross-sectional observational study. Subjects : Two hundred and forty-seven women in the perimenopausal stage in the age range between 40 and 50 years were evaluated by dual energy X-ray absorptiometry for BMD status of the spine, femur, and forearm. Serum calcium, phosphorus, alkaline phosphatase, 25 (OH) D, Vitamin D, Vitamin B12 and folate were estimated. This study group was segregated into veiled and unveiled depending upon the coverage during day time with a dark cloth. Sunlight exposure and levels of physical activity were assessed by a questionnaire. Biochemical variables and BMD at various sites across the skeleton were compared. Results: The veiled group had significant hypovitaminosis D as compared to the unveiled. The Vitamin D in the veiled group was 11.3 ± 17.2 ng/ml versus 19.9 ± 27.6 ng/ml (P < 0.001) in the unveiled. Women in the veiled group had less sunlight exposure and were less physically active (P < 0.001 and 0.05 respectively). The basic biochemical parameters were comparable in both groups. Vitamin B12 was higher in the veiled group, and folate levels were higher in the unveiled group the difference being statistically significant. Homocysteine levels were minimally higher in the veiled group. The BMD across the different skeletal sites did not differ, though the unveiled group had a slightly higher BMD at all sites apart from the trochanter. Conclusions: BMD is affected by multiple factors, and its complex interaction may explain the normal biochemical parameters of bone metabolism even in the presence of hypovitaminosis D in the veiled group.