Hip Fractures and Bone Mineral Density in the Elderly—Importance of Serum 25-Hydroxyvitamin D

Steingrímsdóttir, Laufey; Halldórsson, Thorhallur I.; Siggeirsdóttir, Kristín; Cotch, Mary Frances; Einarsdottir, Berglind O.; Eiríksdóttir, Guðný; Sigurðsson, Sigurður; Launer, Lenore J.; Harris, Tamara B.; Gudnason, Vilmundur; Sigurðsson, Gunnar

doi:10.1371/journal.pone.0091122

Cited by 37 publications

(46 citation statements)

References 38 publications

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“…The data set chosen to estimate the relation of hip fractures to 25(OH)D concentration comes from Iceland. In that study, 5764 men and women aged 66–96 y were followed up for 5.4 y 69 . Using data for hip fracture rates given in Figure 1 of that study, increasing 25(OH)D concentration to above 100 nmol/L would reduce fracture rates by an estimated 22%.…”

Section: Methodsmentioning

confidence: 99%

Estimated economic benefit of increasing 25-hydroxyvitamin D concentrations of Canadians to or above 100 nmol/L

Grant

Whiting

Schwalfenberg

et al. 2016

Dermato-Endocrinology

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Mounting evidence from observational and clinical trials indicates that optimal vitamin D reduces the risk of many diseases. We used observational studies and recent data on 25-hydroxyvitamin D [25(OH)D] concentrations of Canadians from Cycle 3 of the Canadian Health Measures Survey to estimate the reduction in disease incidence, mortality rates, and the total economic burden (direct plus indirect) of disease if 25(OH)D concentrations of all Canadians were raised to or above 100 nmol/L. Recently, the mean 25(OH)D concentration of Canadians varied depending on age and season (51–69 nmol/L), with an overall mean of 61 nmol/L. The diseases affected by 25(OH)D concentration included cancer, cardiovascular disease, dementia, diabetes mellitus, multiple sclerosis, respiratory infections, and musculoskeletal disorders. We used 25(OH)D concentration–health outcome relations for breast cancer and cardiovascular disease and results of clinical trials with vitamin D for respiratory infections and musculoskeletal disorders to estimate the reductions in disease burden for increased 25(OH)D concentrations. If all Canadians attained 25(OH)D concentrations>100 nmol/L, the calculated reduction in annual economic burden of disease was $12.5 ± 6 billion on the basis of economic burdens for 2016 and a reduction in annual premature deaths by 23,000 (11,000–34,000) on the basis of rates for 2011. However, the effects on disease incidence, economic burden, and mortality rate would be phased in gradually over several years primarily because once a chronic disease is established, vitamin D affects its progression only modestly. Nevertheless, national policy changes are justified to improve vitamin D status of Canadians through promotion of safe sun exposure messages, vitamin D supplement use, and/or facilitation of food fortification.

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Section: Methodsmentioning

confidence: 99%

Estimated economic benefit of increasing 25-hydroxyvitamin D concentrations of Canadians to or above 100 nmol/L

Grant

Whiting

Schwalfenberg

et al. 2016

Dermato-Endocrinology

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“…Steingrimsdottir et al . performed a prospective study of 5764 men and women, and showed that, compared with reference values (50–75 nmol/L), values <30 nmol/L were associated with significantly lower BMD of the femoral neck.…”

Section: Introductionmentioning

confidence: 99%

Analysis of Related Factors of Brittle Hip Fracture in Postmenopausal Women with Osteoporosis

Zhuang

Wang

et al. 2020

Orthopaedic Surgery

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Objective To investigate the effects of age, body mass index (BMI), bone mineral density (BMD), and levels of serum 25‐hydroxyvitamin D (25OHD) on hip fracture on the condition of the bone density of femoral neck having reached the threshold of osteoporosis. Methods A total of 252 postmenopausal women patients, whose bone density had reached the threshold of osteoporosis and age ≥50 years (50–98 years), collected from the Second Affiliated Hospital of Fujian Medical University from January 2015 to December 2018, were performed by retrospective analysis. According to whether or not they had a hip fracture, including femoral neck fracture or intertrochanteric fracture, the patients were divided into two groups, including 117 cases (50–84 years old) in the non‐hip fracture group and 135 cases (57–98 years old) in the hip fracture group. BMD was measured by Hologic Discovery A DXA bone mineral densitometer. Levels of serum 25OHD were detected by ROCHE detection instrument. Comparisons of age, BMI, bone density of femoral neck, and levels of serum 25OHD between the two groups were performed by using the Student's t‐test. Furthermore, the statistically significant factors were analyzed by multiple regression analysis to investigate the independent risk factors of hip fracture. Results The group without hip fracture: 117 cases; average age: 67.4 ± 8.5 years; BMI: 22.3 ± 3.2 kg/m2; bone density of femoral neck: (0.504 ± 0.067) g/cm2; T‐value of femoral neck: −3.1 ± 0.6; levels of serum 25OHD: (24.9 ± 8.5) ng/mL. The group with brittle hip fracture: 135 cases; average age: 80.7 ± 7.6 years; BMI: 20.3 ± 3.5 kg/m2; bone density of femoral neck: (0.426 ± 0.077) g/cm2; T‐value of femoral neck: −3.8 ± 0.7; levels of serum 25OHD: (15.9 ± 8.9) ng/mL. Age, BMI, bone density of femoral neck, and 25OHD level of the group without hip fracture were markedly lower than hip fracture group (P < 0.05). The results of logistic regression analysis suggested that age, bone density of femoral neck, and levels of serum 25OHD were independent risk factors for fragile hip fracture on the condition of the bone density of femoral neck having reached the threshold of osteoporosis. Conclusion Higher age, lower levels of bone density and 25OHD are the main risk factors of hip fracture on the condition of the bone density of femoral neck having reached the threshold of osteoporosis.

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“…A body of published evidence consistently demonstrates associations of low serum 25-hydroxyvitamin D [25(OH)D] concentrations with lower bone mineral density (BMD) and fractures [1–5]. Results of these observational studies contrast to some extent with findings from meta-analyses of low-dose vitamin D supplementation trials, which demonstrate only modest or null effects on BMD and fracture prevention [6–8].…”

Section: Introductionmentioning

confidence: 99%

Vitamin D metabolites and bone mineral density: The multi-ethnic study of atherosclerosis

Ballegooijen

Robinson‐Cohen

Katz

et al. 2015

Bone

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Previous studies demonstrate associations of low 25-hydroxyvitamin D (25(OH)D) concentrations with low bone mineral density (BMD) and fractures, motivating widespread use of vitamin D supplements for bone health. However, previous studies have been limited to predominantly White populations despite differences in the distribution and metabolism of 25(OH)D by race/ethnicity. We determined associations of serum 25(OH)D, 24,25-dihydroxyvitamin D (24,25(OH2)D3), and parathyroid hormone (PTH) with BMD among 1,773 adult participants in the Multi-Ethnic Study of Atherosclerosis (MESA) in a staggered cross-sectional study design. Vitamin D metabolites were measured using liquid chromatography-mass spectroscopy and PTH using a 2-site immunoassay from serum collected in 2000–2002. Volumetric trabecular lumbar BMD was measured from computed tomography scans performed in 2002–2005 expressed as g/cm3. We used linear regression and graphical methods to compare associations of vitamin D metabolite and PTH concentrations with BMD as the outcomes measure among White (n=714), Black (n=353), Chinese (n=249), and Hispanic (n=457) participants. Serum 25(OH)D and 24,25(OH2)D3 concentrations were highest among Whites and lowest among Blacks. BMD was greatest among Black participants. Higher serum 25(OH)D was only associated with higher BMD among Whites and Chinese participants (P-for interaction=0.054). Comparing the lowest category of 25(OH)D (<20 ng/ml) to the highest (≥30 ng/ml), the adjusted mean difference in BMD was −8.1 g/cm3 (95% CI −14.8, −1.4) for Whites; −10.2 g/cm3 (−20.4, 0.0) for Chinese vs. 8.8 g/cm3 (−2.8, 20.5) for Black and −1.1 g/cm3 (−8.3, 6.2) for Hispanic. Similar results were observed for serum 24,25(OH2)D3. Serum PTH was not associated with BMD. In a multi-ethnic population, associations of 25(OH)D with BMD were strongest among White and Chinese participants and null among Black and Hispanic participants. Further studies are needed to determine optimal biomarkers for bone health for multiple ethnic groups.

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Hip Fractures and Bone Mineral Density in the Elderly—Importance of Serum 25-Hydroxyvitamin D

Cited by 37 publications

References 38 publications

Estimated economic benefit of increasing 25-hydroxyvitamin D concentrations of Canadians to or above 100 nmol/L

Estimated economic benefit of increasing 25-hydroxyvitamin D concentrations of Canadians to or above 100 nmol/L

Analysis of Related Factors of Brittle Hip Fracture in Postmenopausal Women with Osteoporosis

Vitamin D metabolites and bone mineral density: The multi-ethnic study of atherosclerosis

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