CONTEXT: Blood levels of 25-hydroxyvitamin D [25(OH)D] is the generally accepted indicator of vitamin D status, but no universal reference level has been reached. OBJECTIVE: The objective of the study was to determine the threshold at which low plasma 25(OH)D levels are associated with fractures in elderly men and clarify the importance of low levels on total fracture burden. DESIGN AND PARTICIPANTS: In the Uppsala Longitudinal Study of Adult Men, a population-based cohort (mean age, 71 yr, n = 1194), we examined the relationship between 25(OH)D and risk for fracture. Plasma 25(OH)D levels were measured with high-pressure liquid chromatography-mass spectrometry. SETTING: The study was conducted in the municipality of Uppsala in Sweden, a country with a high fracture incidence. MAIN OUTCOME MEASURE: Time to fracture was measured. RESULTS: During follow-up (median 11 yr), 309 of the participants (26%) sustained a fracture. 25(OH)D levels below 40 nmol/liter, which corresponded to the fifth percentile of 25(OH)D, were associated with a modestly increased risk for fracture, multivariable-adjusted hazard ratio 1.65 (95% confidence interval 1.09-2.49). No risk difference was detected above this level. Approximately 3% of the fractures were attributable to low 25(OH)D levels in this population. CONCLUSIONS: Vitamin D insufficiency is not a major cause of fractures in community-dwelling elderly men in Sweden. Despite the fact that cutaneous synthesis of previtamin D during the winter season is undetectable at this northern latitude of 60 degrees, only one in 20 had 25(OH)D levels below 40 nmol/liter, the threshold at which the risk for fracture started to increase. Genetic adaptations to limited UV light may be an explanation for our findings.
CONTEXT: Blood levels of 25-hydroxyvitamin D [25(OH)D] is the generally accepted indicator of vitamin D status, but no universal reference level has been reached. OBJECTIVE: The objective of the study was to determine the threshold at which low plasma 25(OH)D levels are associated with fractures in elderly men and clarify the importance of low levels on total fracture burden. DESIGN AND PARTICIPANTS: In the Uppsala Longitudinal Study of Adult Men, a population-based cohort (mean age, 71 yr, n = 1194), we examined the relationship between 25(OH)D and risk for fracture. Plasma 25(OH)D levels were measured with high-pressure liquid chromatography-mass spectrometry. SETTING: The study was conducted in the municipality of Uppsala in Sweden, a country with a high fracture incidence. MAIN OUTCOME MEASURE: Time to fracture was measured. RESULTS: During follow-up (median 11 yr), 309 of the participants (26%) sustained a fracture. 25(OH)D levels below 40 nmol/liter, which corresponded to the fifth percentile of 25(OH)D, were associated with a modestly increased risk for fracture, multivariable-adjusted hazard ratio 1.65 (95% confidence interval 1.09-2.49). No risk difference was detected above this level. Approximately 3% of the fractures were attributable to low 25(OH)D levels in this population. CONCLUSIONS:Vitamin Dinsufficiency is not a major cause of fractures in community-dwelling elderly men in Sweden. Despite the fact that cutaneous synthesis of previtamin D during the winter season is undetectable at this northern latitude of 60 degrees, only one in 20 had 25(OH)D levels below 40 nmol/liter, the threshold at which the risk for fracture started to increase. Genetic adaptations to limited UV light may be an explanation for our findings.
Authors: Å von Berens; T Cederholm; R A Fielding; T Gustafsson; D Kirn; J Laussen; M Nydahl; T G Travison; K Reid; A Koochek Journal: J Nutr Health Aging Date: 2018 Impact factor: 4.075
Authors: Adriana J van Ballegooijen; Cassianne Robinson-Cohen; Ronit Katz; Michael Criqui; Matthew Budoff; Dong Li; David Siscovick; Andy Hoofnagle; Steven J Shea; Gregory Burke; Ian H de Boer; Bryan Kestenbaum Journal: Bone Date: 2015-05-11 Impact factor: 4.398
Authors: M Osima; T T Borgen; M Lukic; G Grimnes; R M Joakimsen; E F Eriksen; Å Bjørnerem Journal: Osteoporos Int Date: 2017-11-14 Impact factor: 4.507
Authors: Gregory P Levin; Cassianne Robinson-Cohen; Ian H de Boer; Denise K Houston; Kurt Lohman; Yongmei Liu; Stephen B Kritchevsky; Jane A Cauley; Toshiko Tanaka; Luigi Ferrucci; Stefania Bandinelli; Kushang V Patel; Emil Hagström; Karl Michaëlsson; Håkan Melhus; Thomas Wang; Myles Wolf; Bruce M Psaty; David Siscovick; Bryan Kestenbaum Journal: JAMA Date: 2012-11-14 Impact factor: 56.272
Authors: Keith R Reinhardt; Lionel E Lazaro; Ben-Paul Umunna; Michael B Cross; David L Helfet; Joseph M Lane; Dean G Lorich Journal: HSS J Date: 2013-01-24