ORIGINAL RESEARCH article
Front. Nutr.
Sec. Nutrition and Metabolism
Volume 12 - 2025 | doi: 10.3389/fnut.2025.1666496
Association of bone turnover C-terminal telopeptide levels, 25-hydroxyvitamin D concentrations and calcium intake in Malaysian adolescents
Provisionally accepted
Hazreen Majid1*
Muzaitul Akma Mustapa Kamal Basha2Marjolijn C.E. Bragt3Ellen G.H.M. van den Heuve3Muhammad Yazid Jalaludin4- 1AECC University College, Bournemouth, United Kingdom
- 2International Islamic University Malaysia Kulliyyah of Medicine, Kuantan, Malaysia
- 3FrieslandCampina, Stationsplein 4, Post Box 1551, Amersfoort 3800 BN, Netherlands
- 4Department of Paediatrics, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
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The C-terminal telopeptide (CTX), vitamin D, and calcium intake are key factors in bone health research. However, data on the associations among CTX, vitamin D levels, and low calcium intake remain limited. This study aimed to investigate these associations among adolescents. A cross-sectional study was conducted involving 1,234 students (15-year-olds) from public schools in Selangor, Perak, and Kuala Lumpur, Malaysia. The levels of CTX, 25-hydroxyvitamin D (25(OH)D), and calcium intake were measured. A generalized linear model was used to quantify the relationship between 25(OH)D concentrations and calcium intake with CTX levels. The results showed that the CTX log concentration was higher in females than males (mean±SD; 1.32±0.47 ng/mL vs. 1.24±0.44 ng/mL). Regarding vitamin D, the percentage of participants with 25(OH)D concentrations below 50 nmol/L was higher among females than males (91.9% vs. 45.4%). In terms of calcium intake, all participants consumed less than 50% (indicating low calcium intake) of the recommended amount, with intakes ranging from 282.0 mg/day to 543.1 mg/day. No significant association was found between 25(OH)D levels below 50 nmol/L and CTX concentrations (p-value > 0.1), but there was a significant association between CTX levels and calcium intake status (β=0.161, p-value < 0.01). This study suggests that higher bone turnover, indicated by elevated CTX levels, is associated with low calcium intake but not with low 25(OH)D levels.
Keywords: bone turnover, C-terminal telopeptide (CTX), Vitamin D Deficiency, Calcium intake, adolescents
Received: 15 Jul 2025; Accepted: 29 Sep 2025.
Copyright: © 2025 Majid, Mustapa Kamal Basha, Bragt, van den Heuve and Jalaludin. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence: Hazreen Majid, hmajid@aecc.ac.uk
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