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. 2010 Mar;25(3):545-53.
doi: 10.1359/jbmr.090826.

Serum 25-hydroxyvitamin D and the risk of hip and nonspine fractures in older men

Jane A Cauley  1 , Neeta Parimi, Kristine E Ensrud, Douglas C Bauer, Peggy M Cawthon, Steven R Cummings, Andrew R Hoffman, James M Shikany, Elizabeth Barrett-Connor, Eric Orwoll; Osteoporotic Fractures in Men (MrOS) Research Group
Affiliations

Serum 25-hydroxyvitamin D and the risk of hip and nonspine fractures in older men

Jane A Cauley et al. J Bone Miner Res. 2010 Mar.

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 D(2) and vitamin D(3) 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 (> or =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.

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Figures

Fig. 1
Fig. 1
Restricted cubic spline plots of hazard ratios of nonspine with 25(OH)D.
Fig. 2
Fig. 2
Restricted cubic spline plots of hazard ratios of hip fracture with 25(OH)D.
See this image and copyright information in PMC

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