The relationship of 25-hydroxyvitamin D values and risk of fracture:​ a population-based retrospective cohort study

Aul, A. J.; Dudenkov, D. V.; Mara, K. C.; Juhn, Y. J.; Wi, C. I.; Maxson, J. A.; Thacher, T. D.

Affiliations

¹Mayo Clinic Alix School of Medicine, Mayo Clinic, Rochester, USA

²Department of Internal Medicine, Mayo Clinic, Jacksonville, USA

³Division of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, USA

⁴Department of Community Pediatric and Adolescent Medicine, Mayo Clinic, Rochester, USA

⁵Department of Family Medicine, Mayo Clinic, Rochester, USA

Abstract and keywords

Summary: Our study investigates 25-hydroxyvitamin D levels and fracture risk using population-level data. 25-Hydroxyvitamin D values < 12, 12–19, and > 50 ng/mL were not associated with increased risk of fractures overall compared with values 20–50 ng/mL. Severely low levels may be associated with increased risk of osteoporotic fracture, particularly of the wrist.

Introduction: Studies of the relationship between serum 25-hydroxyvitamin D (25(OH)D) levels and fracture risk have been inconsistent. We hypothesized that high 25(OH)D concentrations (> 50 ng/mL) would be associated with increased risk of fracture.

Methods: We identified all adult patients living in Olmsted County, Minnesota, between January 1, 2005 and December 31, 2011, who had at least one 25(OH)D measurement. Fracture outcomes were retrieved starting 30 days after 25(OH)D measurement and until patients’ final clinical visit as an Olmsted County resident, December 31, 2014, or death. Data were analyzed using Cox proportional hazard regression.

Results: Of 11,002 individuals with a 25(OH)D measurement, 5.8% had a 25(OH)D value < 12 ng/mL, and 5.1% had a value > 50 ng/mL. Compared with subjects with 25(OH)D values 20–50 ng/mL (reference group), values < 12, 12–19, and > 50 ng/mL displayed no association with overall fracture risk. After adjusting for a prior diagnosis of osteoporosis/osteopenia, only individuals with values < 12 ng/mL had increased risk of any osteoporotic fracture (aHR = 1.41; 95% CI 1.05–1.89) and wrist fracture (aHR = 2.11; 95% CI 1.27–3.48) compared with the reference group. Compared with the reference group, values < 12 ng/mL were associated with increased risk of any fracture (aHR = 1.35; 95% CI 1.01–1.80), osteoporotic fracture (aHR = 2.18; 95% CI 1.44–3.31), and wrist fracture (aHR = 2.39; 95% CI 1.19–4.81) in subjects without a prior diagnosis of osteoporosis/osteopenia, but not in those with a prior diagnosis of osteoporosis/osteopenia.

Conclusion: Severely low 25(OH)D levels may be associated with increased risk of osteoporotic fracture, particularly of the wrist, but 25(OH)D values > 50 ng/mL were not associated with increased fracture risk.

Keywords: Epidemiology; Osteoporosis; Osteopenia; Vitamin D

Links

DOI: 10.1007/s00198-020-05436-7

PubMed: 32377805

WoS: 000530801200001

History

Received: 2019-12-17

Accepted: 2020-04-22

Online: 2020-05-06

Cited Works (2)

Year	Entry
1992	Chapuy MC, Arlot ME, Duboeuf F, Brun J, Crouzet B, Arnaud S, Delmas PD, Meunier PJ. Vitamin D₃ and calcium to prevent hip fractures in elderly women. NEJM. December 3, 1992;327(23):1637-1642.
2019	Burt LA, Billington EO, Rose MS, Raymond DA, Hanley DA, Boyd SK. Effect of high-dose vitamin D supplementation on volumetric bone density and bone strength: a randomized clinical trial. JAMA. August 27, 2019;322(8):736-745.