Sex-specific associations of vitamin D and bone biomarkers with bone density and physical function during recovery from hip fracture: the Baltimore Hip Studies

Abstract

Less is known about recovery from hip fracture in men. We found differences in 25-hydroxyvitamin D and bone biomarkers between men and women during the year after hip fracture, underscoring the importance of vitamin D assessment in older men and pharmaceutical treatment to reduce bone resorption after hip fracture.

Purpose: Less is known about recovery from hip fracture in men compared to women. We examined differences between men and women in 25-hydroxyvitamin D (25OHD) and bone turnover markers, and associations with bone mineral density (BMD) and physical function, during the year after a hip fracture.

Methods: Community-dwelling, ambulatory adults aged 65 years and over (157 men and 154 women) enrolled in the Baltimore Hip Studies 7th cohort were included. We analyzed 25OHD, C-terminal telopeptide (β-CTX-I), procollagen type I N-terminal propeptide (PINP), PTH, and femoral neck BMD at baseline, 2, 6, and 12 months after hip fracture, and short physical performance battery (SPPB) at 2, 6, and 12 months.

Results: During admission for hip fracture, median 25OHD levels were 15.2 ng/mL (IQR 10.0) in men compared with 23.9 ng/mL (IQR 13.4) in women and remained lower in men at 2, 6, and 12 months (all p < 0.001). β-CTX-I was higher in men on admission, and at 2 and 6 months (all p < 0.05), and PINP was higher in men at 6 months (p = 0.04), with no significant differences between men and women in PTH. Higher 25OHD and PINP concentrations in women only and lower β-CTX-I and PTH concentrations in both sexes were associated with greater BMD. Higher 25OHD concentrations were associated with higher SPPB scores in both sexes.

Conclusions: These findings underscore the importance of vitamin D assessment in older men and missed opportunities in both sexes for vitamin D supplementation and pharmaceutical treatment to reduce bone resorption after hip fracture.

Keywords: 25-Hydroxyvitamin D; C-Telopeptide; DXA; Procollagen type 1 amino-terminal propeptide; Short physical performance battery.

Fig. 1

Mean 25OHD, β-CTX-I, PINP, and PTH levels at each time point, stratified by sex. Error bars represent 95% confidence intervals. Mean estimates and confidence intervals were obtained from GEE models. Median levels from raw data for each time point are presented below each graph. N = 152 at baseline, 95 at 2 months, 76 at 6 months, and 68 at 12 months for men. N = 145 at baseline, 108 at 2 months, 78 at 6 months, and 69 at 12 months for women

Fig. 1

Mean 25OHD, β-CTX-I, PINP, and PTH levels at each time point, stratified by sex. Error bars represent 95% confidence intervals. Mean estimates and confidence intervals were obtained from GEE models. Median levels from raw data for each time point are presented below each graph. N = 152 at baseline, 95 at 2 months, 76 at 6 months, and 68 at 12 months for men. N = 145 at baseline, 108 at 2 months, 78 at 6 months, and 69 at 12 months for women