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Total 25-hydroxyvitamin D levels predict fracture risk: results from the 15-year follow-up of the Japanese Population-based Osteoporosis (JPOS) Cohort Study

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Abstract

Summary

We found that community-dwelling women with 25-hydroxyvitamin D levels <20 ng/mL compared to levels ≥20 ng/mL indicated increased risks for clinical, non-vertebral, and fragility fractures during 5 years. Furthermore, the increased risks of non-vertebral fractures remained significant in 10 and 15 years after adjusting for age and bone mineral density.

Introduction

We examined whether total 25-hydroxyvitamin D (25[OH]D) levels are associated with fracture risk over 15 years in a Japanese female cohort.

Methods

Of 1437 community-dwelling women aged ≥50 years in the baseline survey, 1236 provided information regarding fractures during a 15-year follow-up period. The analysis included 1211 women without early menopause or diseases affecting bone metabolism.

Results

Over 15 years, 269 clinical (224 non-vertebral, 149 fragility) fracture events were confirmed. Incidence rates categorized by 25(OH)D levels (<10, 10–20, 20–30, and ≥30 ng/mL) indicated a significant divergence for any clinical fractures in 5 years (log rank test p = 0.016) and for non-vertebral fractures in 5, 10, and 15 years (p < 0.001, p = 0.001, p = 0.017, respectively). Hazard ratios (HRs) for 25(OH)D levels <10 and 10–20 ng/mL compared to levels ≥30 ng/mL during 5 years indicated significances for clinical fractures (HR 4.93 with p = 0.009, HR 3.00 with p = 0.034) and for non-vertebral fractures (HR 6.55 with p = 0.005, HR 3.49 with p = 0.036). Those with levels <20 ng/mL compared to those with levels ≥20 ng/mL indicated significant increased risks for clinical fractures (HR 1.72 with p = 0.010), non-vertebral fractures (HR 2.45 with p < 0.001), and fragility fractures (HR 2.00 with p = 0.032) in 5 years. The HR of non-vertebral fractures for levels <20 ng/mL remained significant during 15 years (HR 1.42 with p = 0.012) after adjustment for age and femoral neck bone mineral density.

Conclusions

Low 25(OH)D levels, especially <20 ng/mL, were associated with elevated fracture risks in Japanese women.

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Acknowledgments

This study was conducted by the JPOS Study Group, consisting of Hideo Yoneshima (the head representative of the Study Group, ex-chairman of the Board of Directors, Medical Corporation Shuuwakai), Fumiaki Marumo (Chairman of the Study Group, Professor Emeritus, Tokyo Medical and Dental University), Toshihisa Matsuzaki (Co-Chairman of the Study Group, Institute of Comprehensive Community Care), Tomoharu Matsukura (Kanazawa University), Takashi Yamagami (Hokuriku Health Service Association), and Yoshiko Kagawa (the former president of Kagawa Nutrition University), along with the authors of this manuscript. Financial support for the baseline survey was provided by the Japan Milk Promotion Board and the Japan Dairy Council. Follow-up surveys were supported by Grants-in-Aid for Scientific Research (B #10470114, 1998–2000; B #14370147, 2002–2003; B #18390201, 2006–2008; C #18590619, 2006–2009; B #23390180, 2011–2013; C #23590824, 2011–2013; and #23659362, 2011–2012) from the Japanese Society for the Promotion of Science; a grant (2000–2002) from the Research Society for Metabolic Bone Diseases, Japan; and a Grand-in-Aid (2006, 2011) from the Japan Dairy Association. The authors wish to express special thanks to the personnel of the health departments of Miyako-jima City, Sanuki City, Joetsu City, Nishi-Aizu Town, and Memuro Town for their excellent support of the study. Finally, the authors would like to express their thanks to personnel from SRL, Tokyo, Japan; Toyo Medic, Osaka, Japan; and Toyukai Medical Corporation, Tokyo, Japan, for their technical assistance with the surveys.

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Authors and Affiliations

  1. Department of Hygiene and Public Health, Osaka Medical College, 2-7 Daigaku-Machi, Takatsuki, Osaka, 569-8686, Japan

    J. Tamaki

  2. Department of Public Health, Faculty of Medicine, Kindai University, 377-2 Oono-higashi, Osakasayama, Japan

    M. Iki

  3. Department of Human Life, Jin-ai University, 3-1-1 Ohdecho, Echizen, Fukui, 915-8586, Japan

    Y. Sato

  4. Department of Public Health and Home Nursing, Graduate School of Medical Sciences, Nagoya University, 1-1-20 Daiko-Minami, Higashi-ku, Nagoya, Aichi, 461-8673, Japan

    E. Kajita

  5. Nippon Express Co., Inc. Toyama, 1-2-9 Takara-cho, Toyama, 930-0007, Japan

    H. Nishino

  6. Department of Blood Purification and Internal Medicine, Kidney Center, Tokyo Women’s Medical University, 8-1 Kawada-cho Shinjuku-ku, Tokyo, 162-8666, Japan

    T. Akiba

  7. Fuji Memorial Institute of Medical Sciences, University of Tokushima, 3-18-15 Kuramoto-cho, Tokushima, 770-8503, Japan

    T. Matsumoto

  8. University of Toyama, 2630 Sugitani, Toyama-shi, Toyama, 930-0194, Japan

    S. Kagamimori

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  1. J. Tamaki
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Correspondence to J. Tamaki.

Ethics declarations

The study protocol was approved by the Ethics Committee of the Kinki University School of Medicine. Written informed consent regarding all study procedures was obtained from each participant before baseline and follow-up studies.

Conflicts of interest

Grant support to MI, consulting fee to MT, and measurement of 25-hydroxyvitamin D were provided by Roche Diagnostics (Rotkreuz, Switzerland). The funding source did not play any role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; or preparation, review, or approval of the manuscript.

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Tamaki, J., Iki, M., Sato, Y. et al. Total 25-hydroxyvitamin D levels predict fracture risk: results from the 15-year follow-up of the Japanese Population-based Osteoporosis (JPOS) Cohort Study. Osteoporos Int 28, 1903–1913 (2017). https://doi.org/10.1007/s00198-017-3967-6

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