Abstract
The association between vitamin D levels and incident fractures in older men is uncertain. To test the hypothesis that low serum 25-hydroxyvitamin D [(25(OH)D] levels are associated with an increased risk of fracture, we performed a case-cohort study of 436 men with incident nonspine fractures, including 81 hip fractures, and a random subcohort of 1608 men; average follow-up time 5.3 years. Serum vitamin D2 and vitamin D3 were measured on baseline sera using mass spectrometry and summed for total vitamin D. Modified Cox proportional hazards models were used to estimate the hazard ratio (HR) of fracture with 95% confidence intervals (CIs). Multivariable models included age, clinic, season, race, height, weight, and physical activity. The mean (SD) total 25(OH)D was 24.6 (7.8) ng/mL in nonspine fracture subjects, 21.5 (7.9) ng/mL in hip fracture subjects, and 25.2 (7.8) ng/mL in controls (nonspine fracture subjects versus nonpatients, p = .14; hip fracture subjects versus controls, p < .0001). 25(OH)D levels were unrelated to nonspine fractures. One SD decrease in total 25(OH)D was associated with an increased risk of hip fracture (multivariate HR = 1.60; 95% CI 1.18–2.17). Compared with men in the top quartile of total 25(OH)D (≥28), the HR of hip fracture was 2.36 (95% CI 1.08–5.15) for men in the lowest quartile (<20) (p = .009 for trend). Adjusting for hip bone mineral density attenuated the association by more than 50% (p = .065 for trend). Low serum 25(OH)D concentrations are associated with a higher risk of hip fracture in older men. Measurement of 25(OH)D may be useful in identifying men at high risk of hip fracture. © 2010 American Society for Bone and Mineral Research.
Highlights
Vitamin D deficiency is common in older adults,(1–3) including community-dwelling seniors hospitalized for acute hip fracture.[4]. An evidence-based report on vitamin D and bone health concluded that the evidence for an association between levels of serum 25-hydroxyvitamin D [25(OH)D] and fracture was inconsistent [5] and highlighted the paucity of data on circulating vitamin D and fractures in men
Vitamin D could contribute to fractures by influencing muscle strength and balance, both of which contribute to falls and disability.[8,9,10] a metaanalysis and at least one randomized, controlled trial did not demonstrate a reduction in falls among older men taking vitamin D supplements.[9,11] low levels of 25(OH)D have been linked to frailty and poor health status, which could contribute to an association with fractures.[10]
A similar association was observed between vitamin D3 and hip fracture, but vitamin D2 was unrelated to hip fractures
Summary
Vitamin D deficiency is common in older adults,(1–3) including community-dwelling seniors hospitalized for acute hip fracture.[4]. Vitamin D could contribute to fractures by influencing muscle strength and balance, both of which contribute to falls and disability.[8,9,10] a metaanalysis and at least one randomized, controlled trial did not demonstrate a reduction in falls among older men taking vitamin D supplements.[9,11] low levels of 25(OH)D have been linked to frailty and poor health status, which could contribute to an association with fractures.[10]. We conducted a case-cohort study within the Osteoporotic Fractures in Men Study (MrOS) among 436 subjects with incident
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