Skip to main content
SpringerLink
Log in

The relationship between cumulative lifetime ultraviolet radiation exposure, bone mineral density, falls risk and fractures in older adults

  • Original Article
  • Published:
Osteoporosis International Aims and scope Submit manuscript

Abstract

Summary

Data linking cumulative lifetime vitamin D status with skeletal outcomes are lacking. We show that increasing cumulative sun exposure was associated with higher bone mineral density in younger males and protective against fractures in females independent of current vitamin D. This supports the concept that cumulative sun exposure is an important contributor to skeletal health.

Introduction

While low 25-hydroxyvitamin D levels are associated with increased fracture risk, this reflects only recent sun exposure. The Beagley-Gibson (BG) method utilises microtopographical skin changes to quantify cumulative lifetime ultraviolet radiation (sun) exposure. This study aimed to describe the relationship between BG grade, BMD, falls risk and fractures in older adults.

Methods

Eight hundred thirty-five community-dwelling adults aged 53–83 years had silicone casts from the dorsum of both hands graded by the BG method. BMD was measured using DXA and falls risk using the short form of the Physiological Profile Assessment. Vertebral deformities and symptomatic fractures were assessed by DXA and questionnaire, respectively.

Results

The relationship between BG grade, spine BMD and vertebral fracture varied depending upon sex. In females, increasing grade was associated with lower vertebral fracture prevalence (OR = 0.44/grade, p = 0.018) and fewer fractures (OR = 0.82/grade, p = 0.021), particularly major fractures (OR = 0.75/grade, p = 0.03). In males, increasing grade was associated with more DXA-detected vertebral deformities (RR = 1.28/grade, p = 0.001), but not symptomatic fractures. These relationships were independent of BMD, falls risk, smoking and current 25-hydroxyvitamin D. BG grade was not associated with falls risk. For BMD, there were interactions between BG grade and both age and sex and a positive trend with hip BMD in younger males.

Conclusions

BG grade demonstrated beneficial associations with fracture outcomes in females and BMD in younger males independent of current 25-hydroxyvitamin D. These data support the concept that cumulative ultraviolet radiation exposure is an important determinant of skeletal health. The association with vertebral deformities in males may reflect outdoor physical trauma in younger life.

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

Access this article

Log in via an institution

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

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

References

  1. Bischoff-Ferrari HA, Dietrich T, Orav EJ, Dawson-Hughes B (2004) Positive association between 25-hydroxy vitamin D levels and bone mineral density: a population-based study of younger and older adults. Am J Med 116:634–639

    Article  PubMed  CAS  Google Scholar 

  2. Bischoff-Ferrari HA, Kiel DP, Dawson-Hughes B, Orav JE, Li R, Spiegelman D et al (2009) Dietary calcium and serum 25-hydroxyvitamin D status in relation to BMD among U.S. adults. J Bone Miner Res 24:935–942

    Article  PubMed  CAS  Google Scholar 

  3. Kuchuk NO, Pluijm SM, van Schoor NM, Looman CW, Smit JH, Lips P (2009a) Relationships of serum 25-hydroxyvitamin D to bone mineral density and serum parathyroid hormone and markers of bone turnover in older persons. J Clin Endocrinol Metab 94:1244–1250

    Article  PubMed  CAS  Google Scholar 

  4. Kuchuk NO, van Schoor NM, Pluijm SM, Chines A, Lips P (2009b) Vitamin D status, parathyroid function, bone turnover, and BMD in postmenopausal women with osteoporosis: global perspective. J Bone Miner Res 24:693–701

    Article  PubMed  CAS  Google Scholar 

  5. Ooms ME, Lips P, Van Lingen A, Valkenburg HA (1993) Determinants of bone mineral density and risk factors for osteoporosis in healthy elderly women. J Bone Miner Res 8:669–675

    Article  PubMed  CAS  Google Scholar 

  6. Visser M, Deeg DJ, Lips P (2003) Low vitamin D and high parathyroid hormone levels as determinants of loss of muscle strength and muscle mass (sarcopenia): the Longitudinal Aging Study Amsterdam. Clin Endocrinol Metab 88:5766–5772

    Article  CAS  Google Scholar 

  7. Bischoff-Ferrari HA, Giovannucci E, Willett WC, Dietrich T, Dawson-Hughes B (2006) Estimation of optimal serum concentrations of 25-hydroxyvitamin D for multiple health outcomes. Am J Clin Nutr 84(1):18–28

    Article  PubMed  CAS  Google Scholar 

  8. 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

    Article  PubMed  CAS  Google Scholar 

  9. Stein MS, Wark JD, Scherer SC, Walton SL, Chick P, Di Carlantonio M et al (1999) Falls relate to vitamin D and parathyroid hormone in an Australian nursing home and hostel. J Am Geriatr Soc 47:1195–1201

    Article  PubMed  CAS  Google Scholar 

  10. Nguyen T, Sambrook P, Kelly P, Jones G, Lord S, Freund J et al (1993) Prediction of osteoporotic fractures by postural instability and bone density. BMJ 307(6912):1111–1115

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  11. Kanis JA, Oden A, Johnell O, Johansson H, De Laet C, Brown J et al (2007) The use of clinical risk factors enhances the performance of BMD in the prediction of hip and osteoporotic fractures in men and women. Osteoporosis Int 18:1033–1046

    Article  CAS  Google Scholar 

  12. Gillespie LD, Robertson MC, Gillespie WJ, Sherrington C, Gates S, Clemson LM et al (2012) Interventions for preventing falls in older people living in the community. Cochrane Database Syst Rev 9:CD007146

    Google Scholar 

  13. Muir SW, Montero-Odasso M (2011) Effect of vitamin D supplementation on muscle strength, gait and balance in older adults: a systematic review and meta-analysis. J Am Geriatr Soc 59:2291–2300

    Article  PubMed  Google Scholar 

  14. 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

    Article  PubMed  CAS  Google Scholar 

  15. Tang BM, Eslick GD, Nowson C, Smith C, Bensoussan A (2007) Use of calcium or calcium in combination with vitamin D supplementation to prevent fractures and bone loss in people aged 50 years and older: a meta-analysis. Lancet 370(9588):657–666

    Article  PubMed  CAS  Google Scholar 

  16. Vieth R (1999) Vitamin D supplementation, 25-hydroxyvitamin D concentrations, and safety. Am J Clin Nutr 69:842–856

    Article  PubMed  CAS  Google Scholar 

  17. Srikanth V, Fryer J, Venn A, Blizzard L, Newman L, Cooley H et al (2007) The association between non-melanoma skin cancer and osteoporotic fractures—a population-based record linkage study. Osteoporosis Int 18:687–692

    Article  CAS  Google Scholar 

  18. English DR, Armstrong BK, Kricker A, Winter MG, Heenan PJ, Randell PL (1998) Case-control study of sun exposure and squamous cell carcinoma of the skin. Int J Cancer 77:347–353

    Article  PubMed  CAS  Google Scholar 

  19. Holman CD, Armstrong BK, Evans PR, Lumsden GJ, Dallimore KJ, Meehan CJ et al (1984a) Relationship of solar keratosis and history of skin cancer to objective measures of actinic skin damage. Br J Dermatol 110:129–138

    Article  PubMed  CAS  Google Scholar 

  20. Battistutta D, Pandeya N, Strutton GM, Fourtanier A, Tison S, Green AC (2006) Skin surface topography grading is a valid measure of skin photoaging. Photodermatol Photoimmunol Photomed 22:39–45

    Article  PubMed  Google Scholar 

  21. Lucas RM, Ponsonby AL, Dear K, Taylor BV, Dwyer T, McMichael AJ et al (2009) Associations between silicone skin cast score, cumulative sun exposure, and other factors in the Ausimmune study: a multicenter Australian study. Cancer Epidemiol Biomark Prev 18:2887–2894

    Article  CAS  Google Scholar 

  22. Thompson M, Aitken D, van der Mei I, Otahal P, Cicolini J, Winzenberg T, Jones G (2016) Predictors of Beagley-Gibson skin cast grade in older adults. Skin Res Technol. doi:10.1111/srt.12328

    Article  PubMed  Google Scholar 

  23. Ding C, Cicuttini F, Parameswaran V, Burgess J, Quinn S, Jones G (2009) Serum levels of vitamin D, sunlight exposure, and knee cartilage loss in older adults: the Tasmanian Older Adult Cohort Study. Arthritis Rheum 60:1381–1389

    Article  PubMed  Google Scholar 

  24. Lord SR, Menz HB, Tiedemann A (2003) A physiological profile approach to falls risk assessment and prevention. Phys Ther 83:237–252

    PubMed  Google Scholar 

  25. Laslett LL, Just Nee Foley SJ, Quinn SJ, Winzenberg TM, Jones G (2012) Excess body fat is associated with higher risk of vertebral deformities in older women but not in men: a cross-sectional study. Osteoporosis Int 23:67–74

    Article  CAS  Google Scholar 

  26. Genant H, Wu C, Kuijk C, Nevitt M (1993) Vertebral fracture assessment using a semiquantitative technique. J Bone Miner Res 8:1137–1148

    Article  PubMed  CAS  Google Scholar 

  27. Ismail AA, O'Neill TW, Cooper C, Silman AJ (2000) Risk factors for vertebral deformities in men: relationship to number of vertebral deformities. European Vertebral Osteoporosis Study Group. J Bone Miner Res 15:278–283

    Article  PubMed  CAS  Google Scholar 

  28. Silman AJ, O'Neill TW, Cooper C, Kanis J, Felsenberg D (1997) Influence of physical activity on vertebral deformity in men and women: results from the European Vertebral Osteoporosis Study. J Bone Miner Res 12:813–819

    Article  PubMed  CAS  Google Scholar 

  29. Kleerekoper M, Villanueva AR, Stanciu J, Rao DS, Parfitt AM (1985) The role of three-dimensional trabecular microstructure in the pathogenesis of vertebral compression fractures. Calcif Tissue Int 37:594–597

    Article  PubMed  CAS  Google Scholar 

  30. Gardiner EM, Baldock PA, Thomas GP, Sims NA, Henderson NK, Hollis B et al (2000) Increased formation and decreased resorption of bone in mice with elevated vitamin D receptor in mature cells of the osteoblastic lineage. FASEB J 14:1908–1916

    Article  PubMed  CAS  Google Scholar 

  31. Reeve J, Meunier PJ, Parsons JA, Bernat M, Bijvoet OL, Courpron P et al (1980) Anabolic effect of human parathyroid hormone fragment on trabecular bone in involutional osteoporosis: a multicentre trial. BMJ 280:1340–1344

    Article  PubMed  CAS  Google Scholar 

  32. Holman CD, Evans PR, Lumsden GJ, Armstrong BK (1984b) The determinants of actinic skin damage: problems of confounding among environmental and constitutional variables. Am J Epidemiol 120:414–422

    Article  PubMed  CAS  Google Scholar 

  33. Denda M, Koyama J, Hori J, Horii I, Takahashi M, Hara M et al (1993) Age- and sex-dependent change in stratum corneum sphingolipids. Arch Dermatol Res 285:415–417

    Article  PubMed  CAS  Google Scholar 

  34. Verdier-Sevrain S, Bonte F, Gilchrest B (2006) Biology of estrogens in skin: implications for skin aging. Exp Dermatol 15:83–94

    Article  PubMed  CAS  Google Scholar 

  35. MacLaughlin J, Holick MF (1985) Aging decreases the capacity of human skin to produce vitamin D3. J Clin Invest 76:1536–1538

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  36. Johnell O, Gullberg B, Kanis JA, Allander E, Elffors L, Dequeker J et al (1995) Risk factors for hip fracture in European women: the MEDOS Study. Mediterranean Osteoporosis Study. J Bone Miner Res 10:1802–1815

    Article  PubMed  CAS  Google Scholar 

  37. Kanis J, Johnell O, Gullberg B, Allander E, Elffors L, Ranstam J et al (1999) Risk factors for hip fracture in men from southern Europe: the Mediterranean Osteoporosis Study. Osteoporosis Int 9:45–54

    Article  CAS  Google Scholar 

Download references

Acknowledgements

The TASOAC study was supported by the National Health and Medical Research Council of Australia, Tasmanian Community Fund, Masonic Centenary Medical Research Foundation, Royal Hobart Hospital Research Foundation and Arthritis Foundation of Australia. No funding body played any role in the design of the study, the analysis of its data or the drafting of the current manuscript.

Author information

Authors and Affiliations

  1. Menzies Institute for Medical Research, University of Tasmania, 17 Liverpool St, Hobart, Tasmania, 7000, Australia

    M. J. W. Thompson, D. A. Aitken, P. Otahal, T. M. Winzenberg & G. Jones

  2. University of Otago, Dunedin, Otago, New Zealand

    J. Cicolini

  3. Faculty of Health, University of Tasmania, Hobart, Tasmania, Australia

    T. M. Winzenberg

Authors
  1. M. J. W. Thompson
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. D. A. Aitken
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. P. Otahal
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. J. Cicolini
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. T. M. Winzenberg
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. G. Jones
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to M. J. W. Thompson.

Ethics declarations

Conflicts of interest

None.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Thompson, M.J.W., Aitken, D.A., Otahal, P. et al. The relationship between cumulative lifetime ultraviolet radiation exposure, bone mineral density, falls risk and fractures in older adults. Osteoporos Int 28, 2061–2068 (2017). https://doi.org/10.1007/s00198-017-4001-8

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00198-017-4001-8

Keywords

Search

Navigation