Abstract
Vitamin D supplements have been used to prevent fractures. The effect may be mediated through increased bone mass, but also through reduced falling propensity. The aim of this study was to evaluate the association between 25-hydroxy vitamin D levels (25OHD), fall-associated variables (including tests of functional performance), and fracture in ambulatory women. At baseline 25OHD was measured in 986 women. Fall-associated variables were investigated at baseline. Fractures were recorded during a 3-year follow-up. Four percent of the women had 25OHD levels below 20 ng/ml (50 nmol/l), and 26% had 25OHD levels below 30 ng/ml (75 nmol/l). 25OHD correlated with gait speed ( r =0.17, P <0.001), the Romberg balance test ( r =0.14, P <0.001), self-estimated activity level ( r =0.15, P <0.001), and thigh muscle strength ( r =0.08, P =0.02). During the 3-year follow-up, 119 out of the 986 women sustained at least one fracture. The Cox proportional hazard ratio (HR) (95% confidence interval) for sustaining a fracture during the follow-up was 2.04 (1.04–4.04) for the group of women with 25OHD below 20 ng/ml, in which 9 out of 43 women sustained a fracture. Thirty-two of the 256 women with 25OHD levels below 30 ng/ml sustained a fracture during the follow-up, with a non-significant HR of 1.07 (1.07–1.61). This cohort of elderly, ambulatory women had a high mean 25OHD. A low 25OHD was associated with inferior physical activity level, gait speed and balance. A 25OHD level below 30 ng/ml was not associated with an increased risk of fractures in this study. However, a subgroup of women with 25OHD levels below 20 ng/ml had a tendency to an increased risk of fractures, which may be associated with an inferior physical activity and postural stability.
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References
Kanis JA (2002) Diagnosis of osteoporosis and assessment of fracture risk. Lancet 359:1929–1936
Gillespie LD, Gillespie WJ, Robertson MC, Lamb SE, Cumming RG, Rowe BH (2002) Interventions for preventing falls in elderly people (Cochrane Review). Cochrane Library, www.cochrane.org
Holick MF (2002) Vitamin D: the underappreciated D-lightful hormone that is important for skeletal and cellular health. Curr Opin Endocrinol Diabetes:87–98
Lips P (2001) Vitamin D deficiency and secondary hyperparathyroidism in the elderly: consequences for bone loss and fractures and therapeutic implications. Endocr Rev 22:477–501
Pfeifer M, Begerow B, Minne HW (2002) Vitamin D and muscle function. Osteoporos Int 13:187–194
Bischoff HA, Stahelin HB, Urscheler N, Ehrsam R, Vonthein R, Perrig-Chiello P, Tyndall A, Theiler R (1999) Muscle strength in the elderly: its relation to vitamin D metabolites. Arch Phys Med Rehabil 80:54–58
Mowe M, Haug E, Bohmer T (1999) Low serum calcidiol concentration in older adults with reduced muscular function. J Am Geriatr Soc 47:220–226
Schott GD, Wills MR (1976) Muscle weakness in osteomalacia. Lancet 1:626–629
Glerup H, Mikkelsen K, Poulsen L, Hass E, Overbeck S, Andersen H, Charles P, Eriksen EF (2000) Hypovitaminosis D myopathy without biochemical signs of osteomalacic bone involvement. Calcif Tissue Int 66:419–424
Pfeifer M, Begerow B, Minne HW, Abrams C, Nachtigall D, Hansen C (2000) Effects of a short-term vitamin D and calcium supplementation on body sway and secondary hyperparathyroidism in elderly women. J Bone Miner Res 15:1113–1118
Dhesi JK, Bearne LM, Moniz C, Hurley MV, Jackson SH, Swift CG, Allain TJ (2002) Neuromuscular and psychomotor function in elderly subjects who fall and the relationship with vitamin D status. J Bone Miner Res 17:891–897
Bischoff HA, Stahelin HB, Dick W, Akos R, Knecht M, Salis C, Nebiker M, Theiler R, Pfeifer M, Begerow B, Lew RA, Conzelmann M (2003) Effects of vitamin D and calcium supplementation on falls: a randomized controlled trial. J Bone Miner Res 18:343–351
Stein MS, Wark JD, Scherer SC, Walton SL, Chick P, Di Carlantonio M, Zajac JD, Flicker L (1999) Falls relate to vitamin D and parathyroid hormone in an Australian nursing home and hostel. J Am Geriatr Soc 47:1195–1201
Gillespie WJ, Avenell A, Henry DA, O’Connell DL, Robertson J (2001) Vitamin D and vitamin D analogues for preventing fractures associated with involutional and post-menopausal osteoporosis. Cochrane Database Syst Rev:CD000227
Bischoff-Ferrari HA, Dawson-Hughes B, Willett WC, Staehelin HB, Bazemore MG, Zee RY, Wong JB (2004) Effect of Vitamin D on falls: a meta-analysis. JAMA 291:1999–2006
McKenna MJ (1992) Differences in vitamin D status between countries in young adults and the elderly. Am J Med 93:69–77
Cummings SR, Browner WS, Bauer D, Stone K, Ensrud K, Jamal S, Ettinger B (1998) Endogenous hormones and the risk of hip and vertebral fractures among older women. Study of Osteoporotic Fractures Research Group. N Engl J Med 339:733–738
Gerdhem P, Ringsberg KA, Magnusson H, Obrant KJ, Akesson K (2003) Bone mass cannot be predicted by estimations of frailty in elderly ambulatory women. Gerontology 49:168–172
Ringsberg K, Gerdhem P, Johansson J, Obrant KJ (1999) Is there a relationship between balance, gait performance and muscular strength in 75-year-old women? Age Ageing 28:289–293
Gerdhem P, Akesson K, Obrant KJ (2003) Effect of previous and present physical activity on bone mass in elderly women. Osteoporos Int 14:208–212
Malabanan A, Veronikis IE, Holick MF (1998) Redefining vitamin D insufficiency. Lancet 351:805–806
Chapuy MC, Preziosi P, Maamer M, Arnaud S, Galan P, Hercberg S, Meunier PJ (1997) Prevalence of vitamin D insufficiency in an adult normal population. Osteoporos Int 7:439–443
Melin AL, Wilske J, Ringertz H, Saaf M (1999) Vitamin D status, parathyroid function and femoral bone density in an elderly Swedish population living at home. Aging (Milano) 11:200–207
Moreland J, Richardson J, Chan DH, O’Neill J, Bellissimo A, Grum RM, Shanks L (2003) Evidence-based guidelines for the secondary prevention of falls in older adults. Gerontology 49:93–116
Cummings SR, Nevitt MC, Browner WS, Stone K, Fox KM, Ensrud KE, Cauley J, Black D, Vogt TM (1995) Risk factors for hip fracture in white women. Study of Osteoporotic Fractures Research Group. N Engl J Med 332:767–773
Nelson ME, Meredith CN, Dawson-Hughes B, Evans WJ (1988) Hormone and bone mineral status in endurance-trained and sedentary postmenopausal women. J Clin Endocrinol Metab 66:927–933
Bell NH, Godsen RN, Henry DP, Shary J, Epstein S (1988) The effects of muscle-building exercise on vitamin D and mineral metabolism. J Bone Miner Res 3:369–373
Bischoff HA, Dietrich T, Orav EJ, Zhang Y, W. KE, Dawson-Hughes B (2003) Higher 25-hydroxyvitamin D levels are associated with better lower extremity function in active and inactive ambulatory elderly in the US (abstract). J Bone Miner Res 18:S52
Bates CJ, Carter GD, Mishra GD, O’Shea D, Jones J, Prentice A (2003) In a population study, can parathyroid hormone aid the definition of adequate vitamin D status? A study of people aged 65 years and over from the British National Diet and Nutrition Survey. Osteoporos Int 14:152–159
Gloth FM, 3rd, Smith CE, Hollis BW, Tobin JD (1995) Functional improvement with vitamin D replenishment in a cohort of frail, vitamin D-deficient older people. J Am Geriatr Soc 43:1269–1271
Corless D, Dawson E, Fraser F, Ellis M, Evans SJ, Perry JD, Reisner C, Silver CP, Beer M, Boucher BJ (1985) Do vitamin D supplements improve the physical capabilities of elderly hospital patients? Age Ageing 14:76–84
Meyer HE, Henriksen C, Falch JA, Pedersen JI, Tverdal A (1995) Risk factors for hip fracture in a high incidence area: a case-control study from Oslo, Norway. Osteoporos Int 5:239–246
Feskanich D, Willett WC, Colditz GA (2003) Calcium, vitamin D, milk consumption, and hip fractures: a prospective study among postmenopausal women. Am J Clin Nutr 77:504–511
Trivedi DP, Doll R, Khaw KT (2003) Effect of four monthly oral vitamin D3 (cholecalciferol) supplementation on fractures and mortality in men and women living in the community: randomised double blind controlled trial. BMJ 326:469
Dawson-Hughes B, Harris SS, Krall EA, Dallal GE (1997) Effect of calcium and vitamin D supplementation on bone density in men and women 65 years of age or older. N Engl J Med 337:670–676
Lips P, Chapuy MC, Dawson-Hughes B, Pols HA, Holick MF (1999) An international comparison of serum 25-hydroxyvitamin D measurements. Osteoporos Int 9:394–397
Binkley N, Krueger D, Cowgill CS, Plum L, Lake E, Hansen KE, DeLuca HF, Drezner MK (2004) Assay variation confounds the diagnosis of hypovitaminosis D: a call for standardization. J Clin Endocrinol Metab 89:3152–3157
Hollis BW (2004) Editorial: the determination of circulating 25-hydroxyvitamin D: no easy task. J Clin Endocrinol Metab 89:3149–3151
Roth HJ, Zahn I, Alkier R, Schmidt H (2001) Validation of the first automated chemiluminescence protein-binding assay for the detection of 25-hydroxycalciferol. Clin Lab 47:357–365
Heaney RP, Dowell MS, Hale CA, Bendich A (2003) Calcium absorption varies within the reference range for serum 25-hydroxyvitamin D. J Am Coll Nutr 22:142–146
Acknowledgements
Funds for this study were received from the Albert Påhlsson Foundation, the Alfred Österlund Foundation and the Swedish Research Council. The Nichols Institute Diagnostics, Calif., and ElectraBox, Sweden, provided assay kits and supported the work for the analysis of 25-hydroxy vitamin D.
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Gerdhem, P., Ringsberg, K.A.M., Obrant, K.J. et al. Association between 25-hydroxy vitamin D levels, physical activity, muscle strength and fractures in the prospective population-based OPRA Study of Elderly Women. Osteoporos Int 16, 1425–1431 (2005). https://doi.org/10.1007/s00198-005-1860-1
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DOI: https://doi.org/10.1007/s00198-005-1860-1