Original Article

Osteoporosis International

, Volume 25, Issue 12, pp 2767-2775

First online:

Vitamin D insufficiency over 5 years is associated with increased fracture risk—an observational cohort study of elderly women

  • D. BuchebnerAffiliated withClinical and Molecular Osteoporosis Research Unit, Department of Clinical Science Malmö, Lund UniversityDepartment of Orthopaedics, Skåne University Hospital MalmöDepartment of Internal Medicine, Halmstad County Hospital
  • , F. McGuiganAffiliated withClinical and Molecular Osteoporosis Research Unit, Department of Clinical Science Malmö, Lund UniversityDepartment of Orthopaedics, Skåne University Hospital Malmö
  • , P. GerdhemAffiliated withDepartment of Clinical Science, Intervention and Technology, Karolinska InstituteDepartment of Orthopaedics, Karolinska University Hospital
  • , J. MalmAffiliated withDepartment of Laboratory Medicine, Section for Clinical Chemistry, Lund UniversityDepartment of Clinical Chemistry, Laboratory Medicine, Region Skåne, Skåne University Hospital Malmö
  • , M. RidderstråleAffiliated withClinical Obesity Research, Department of Clinical Sciences Malmö, Lund UniversitySteno Diabetes Center
  • , K. ÅkessonAffiliated withClinical and Molecular Osteoporosis Research Unit, Department of Clinical Science Malmö, Lund UniversityDepartment of Orthopaedics, Skåne University Hospital Malmö Email author 

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Abstract

Summary

This study of elderly Swedish women investigated the association between chronic vitamin D insufficiency and osteoporotic fractures occurring between ages 80–90. The incidence and risk of hip and major osteoporotic fractures was significantly higher in elderly women with low vitamin D levels maintained over 5 years.

Introduction

Vitamin D insufficiency among the elderly is common; however, relatively little is known about the effects of long-term hypovitaminosis D on fracture. We investigated sequential assessment of serum 25(OH)D at age 75 and 80 to determine if continuously low 25(OH)D levels are associated with increased 10-year fracture incidence.

Methods

One thousand forty-four Swedish women from the population-based OPRA cohort, all 75 years old, attended at baseline (BL); 715 attended at 5 years. S-25(OH)D was available in 987 and 640, respectively and categorized as: <50 (Low), 50–75 (Intermediate), and >75 nmol/L (High). Incident fracture data was collected with maximum follow-up to 90 years of age.

Results

Hip fracture incidence between age 80–85 was higher in women who had low 25(OH)D at both baseline and 5 years (22.2 % (Low) vs. 6.6 % (High); p = 0.003). Between age 80–90, hip fracture incidence was more than double that of women in the high category (27.9 vs. 12.3 %; p = 0.006). Within 5-years, 50 % of women in the continuously low group compared to 34 % in the continuously high 25(OH)D group had an osteoporotic fracture (p = 0.004) while 10-year incidence was higher compared to the intermediate (p = 0.020) but not the high category (p = 0.053). The 10-year relative risk of hip fracture was almost three times higher and osteoporotic fracture risk almost doubled for women in the lowest 25(OH)D category compared to the high category (HR 2.7 and 1.7; p = 0.003 and 0.023, respectively).

Conclusion

In these elderly women, 25(OH)D insufficiency over 5-years was associated with increased 10-year risk of hip and major osteoporotic fractures.

Keywords

Elderly women Fracture Longitudinal Vitamin D