Skip to main content

Advertisement

Log in

Vitamin A intake and the risk of hip fracture in postmenopausal women: the Iowa Women’s Health Study

Osteoporosis International Aims and scope Submit manuscript

Abstract

Excessive intake of vitamin A is postulated to have a detrimental effect on bone by inducing osteoporosis. This may lead to an increased risk of fracture, particularly in persons who are already at risk of osteoporosis. However, few studies have specifically examined the association of vitamin A intake through diet and supplement use, with fractures in a cohort of older, community-dwelling women. We prospectively followed a cohort of 34,703 postmenopausal women from the Iowa Women’s Health Study to determine if high levels of vitamin A and retinol intake through food and supplement use were associated with an increased risk of hip or all fractures. A semiquantitative food frequency questionnaire was used to obtain the participants’ baseline vitamin A and retinol intake. Participants were followed for a mean duration of 9.5 years for incident self-reported hip and nonhip fractures. After multivariate adjustment, it was revealed that users of supplements containing vitamin A had a 1.18-fold increased risk of incident hip fracture (n=525) compared with nonusers (95% CI, 0.99 to 1.41), but there was no evidence of an increased risk of all fractures (n=6,502) among supplement users. There was also no evidence of a dose-response relationship in hip fracture risk with increasing amounts of vitamin A or retinol from supplements. Furthermore, our results showed no association between vitamin A or retinol intake from food and supplements, or food only, and the risk of hip or all fractures. In conclusion, we found little evidence of an increased risk of hip or all fractures with higher intakes of vitamin A or retinol among a cohort of older, postmenopausal women.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Binkley N, Krueger D (2000) Hypervitaminosis A and bone. Nutr Rev 58:138–144

    CAS  PubMed  Google Scholar 

  2. Togari A, Kondo M, Arai M et al (1991) Effects of retinoic acid on bone formation and resorption in cultured mouse calvaria. Gen Pharmacol 22:287–292

    Article  CAS  PubMed  Google Scholar 

  3. Scheven BA, Hamilton NJ (1990) Retinoic acid and 1,25-dihydroxyvitamin D3 stimulate osteoclast formation by different mechanisms. Bone 11:53–59

    CAS  PubMed  Google Scholar 

  4. Rohde CM, Manatt M, Clagett-Dame M et al (1999) Vitamin A antagonizes the action of vitamin D in rats. J Nutr 129:2246–2250

    CAS  PubMed  Google Scholar 

  5. Rothman KJ, Moore LL, Singer MR et al (1995) Teratogenicity of high vitamin A intake. N Engl J Med 333:1369–1373

    Article  CAS  PubMed  Google Scholar 

  6. Frame B, Jackson CE, Reynolds WA et al (1974) Hypercalcemia and skeletal effects in chronic hypervitaminosis A. Ann Intern Med 80:44–48

    CAS  PubMed  Google Scholar 

  7. Hathcock JN, Hattan DG, Jenkins MY et al (1990) Evaluation of vitamin A toxicity. Am J Clin Nutr 52:183–202

    CAS  PubMed  Google Scholar 

  8. Bendich A, Langseth L (1989) Safety of vitamin A. Am J Clin Nutr 49:358–371

    CAS  PubMed  Google Scholar 

  9. DiGiovanna JJ, Sollitto RB, Abangan DL et al (1995) Osteoporosis is a toxic effect of long-term etretinate therapy. Arch Dermatol 131:1263–1267

    Article  CAS  PubMed  Google Scholar 

  10. Okada N, Nomura M, Morimoto S et al (1994) Bone mineral density of the lumbar spine in psoriatic patients with long term etretinate therapy. J Dermatol 21:308–311

    CAS  PubMed  Google Scholar 

  11. Kindmark A, Rollman O, Mallmin H et al (1998) Oral isotretinoin therapy in severe acne induces transient suppression of biochemical markers of bone turnover and calcium homeostasis. Acta Derm Venereol 78:266–269

    Article  CAS  PubMed  Google Scholar 

  12. Sowers MF, Wallace RB (1990) Retinol, supplemental vitamin A and bone status. J Clin Epidemiol 43:693–699

    CAS  PubMed  Google Scholar 

  13. Yano K, Heilbrun LK, Wasnich RD et al (1985) The relationship between diet and bone mineral content of multiple skeletal sites in elderly Japanese-American men and women living in Hawaii. Am J Clin Nutr 42:877–888

    CAS  PubMed  Google Scholar 

  14. Freudenheim JL, Johnson NE, Smith EL (1986) Relationships between usual nutrient intake and bone-mineral content of women 35–65 years of age: longitudinal and cross-sectional analysis. Am J Clin Nutr 44:863–876

    CAS  PubMed  Google Scholar 

  15. Sowers MR, Wallace RB, Lemke JH (1985) Correlates of mid-radius bone density among postmenopausal women: a community study. Am J Clin Nutr 41:1045–1053

    CAS  PubMed  Google Scholar 

  16. Willett W (1998) Nature of variation in diet. In: Nutritional epidemiology. Oxford University Press, New York, pp 33–49

  17. Melhus H, Michaelsson K, Kindmark A et al (1998) Excessive dietary intake of vitamin A is associated with reduced bone mineral density and increased risk for hip fracture. Ann Intern Med 129:770–778

    CAS  PubMed  Google Scholar 

  18. Promislow JH, Goodman-Gruen D, Slymen DJ et al (2002) Retinol intake and bone mineral density in the elderly: the Rancho Bernardo Study. J Bone Miner Res 17:1349–1358

    CAS  PubMed  Google Scholar 

  19. Feskanich D, Singh V, Willett WC et al (2002) Vitamin A intake and hip fractures among postmenopausal women. JAMA 287:47–54

    Article  CAS  PubMed  Google Scholar 

  20. Michaelsson K, Lithell H, Vessby B et al (2003) Serum retinol levels and the risk of fracture. N Engl J Med 348:287–294

    Article  CAS  PubMed  Google Scholar 

  21. Koplan JP, Annest JL, Layde PM et al (1986) Nutrient intake and supplementation in the United States (NHANES II). Am J Public Health 76:287–289

    CAS  PubMed  Google Scholar 

  22. Stewart ML, McDonald JT, Levy AS et al (1985) Vitamin/mineral supplement use: a telephone survey of adults in the United States. J Am Diet Assoc 85:1585–1590

    CAS  PubMed  Google Scholar 

  23. Whiting SJ, Lemke B (1999) Excess retinol intake may explain the high incidence of osteoporosis in northern Europe. Nutr Rev 57:192–195

    CAS  PubMed  Google Scholar 

  24. Folsom AR, Kaye SA, Prineas RJ et al (1990) Increased incidence of carcinoma of the breast associated with abdominal adiposity in postmenopausal women. Am J Epidemiol 131:794–803

    CAS  PubMed  Google Scholar 

  25. Kushi LH, Kaye SA, Folsom AR et al (1988) Accuracy and reliability of self-measurement of body girths. Am J Epidemiol 128:740–748

    CAS  PubMed  Google Scholar 

  26. Willett WC, Sampson L, Browne ML et al (1988) The use of a self-administered questionnaire to assess diet four years in the past. Am J Epidemiol 127:188–199

    PubMed  Google Scholar 

  27. Munger RG, Folsom AR, Kushi LH et al (1992) Dietary assessment of older Iowa women with a food frequency questionnaire: nutrient intake, reproducibility, and comparison with 24-hour dietary recall interviews. Am J Epidemiol 136:192–200

    PubMed  Google Scholar 

  28. Bush TL, Miller SR, Golden AL et al (1989) Self-report and medical record report agreement of selected medical conditions in the elderly. Am J Public Health 79:1554–1556

    CAS  PubMed  Google Scholar 

  29. National Osteoporosis Foundation (2003) Fast facts on osteoporosis. National Osteoporosis Foundation, Washington, DC. http://www.nof.org/osteoporosis/stats.htm. Cited 22 May 2003

Download references

Acknowledgements

The Iowa Women’s Health Study was funded by research grant R01 CA39742 from the National Cancer Institute. Special thanks to Ching-Ping Hong for her statistical support and William Thomas, PhD, for his comments and feedback.

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to A. R. Folsom.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Lim, L.S., Harnack, L.J., Lazovich, D. et al. Vitamin A intake and the risk of hip fracture in postmenopausal women: the Iowa Women’s Health Study. Osteoporos Int 15, 552–559 (2004). https://doi.org/10.1007/s00198-003-1577-y

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00198-003-1577-y

Keywords

Navigation