Osteoporosis International

, Volume 25, Issue 3, pp 923–932 | Cite as

Prospective evaluation of renal function, serum vitamin D level, and risk of fall and fracture in community-dwelling elderly subjects

  • D. RothenbacherEmail author
  • J. Klenk
  • M. D. Denkinger
  • F. Herbolsheimer
  • T. Nikolaus
  • R. Peter
  • B. O. Boehm
  • K. Rapp
  • D. Dallmeier
  • W. Koenig
  • for the ActiFE Study Group
Original Article



This prospective study in elderly showed that kidney function plays a minor role in explaining the high prevalence of vitamin D deficiency seen in noninstitutionalized elderly subjects. However, 25-hydroxyvitamin D levels were clearly inversely associated with risk for first fall, which was especially seen in subjects with calcium levels above median.


Few prospective studies in elderly exist that have investigated the association of renal dysfunction and vitamin D status on risk of falls. The aim of this study is to evaluate the association of renal function with 25-hydroxyvitamin D (25-OH-D) levels and, secondly, to assess the role of both factors on the risk of falls and subsequent bone fractures.


This is a prospective population-based cohort study among noninstitutionalized elderly subjects during a 1-year follow-up. 25-OH-D levels and renal function were estimated, the latter by cystatin C-based equations. Information on falls was assessed prospectively.


Overall, 1,385 subjects aged 65 and older were included in the study (mean age 75.6 years), of whom 9.2 % had a 25-OH-D serum level above 75 nmol/L (US units 30 ng/mL); 41.4 %, between 50 and 75 nmol/L (US units 20 to 29 ng/mL, insufficiency); and 49.4 %, <50 nmol/L (US units <20 ng/mL, deficiency). We found no association of chronic kidney disease with risk of first fall. In contrast, 25-OH-D serum categories were clearly associated with risk of first fall and we found evidence of effect modification with calcium levels. In the group with a calcium level above the median (≥9.6 mg/dL), subjects with 25-OH-D serum level between 50 and 75 nmol/L and with concentrations <50 nmol/L had a hazard rate ratio (HRR) of 1.75 (1.03–2.87) and 1.93 (1.10–3.37) for risk of first fall. 25-OH-D serum levels were also associated with several markers of inflammation and hemodynamic stress.


We demonstrated an association of 25-OH-D serum levels and risk of first fall, which was especially evident in subjects with serum calcium in upper normal, independent of renal function.


Elderly Falls Prospective cohort study Renal function Vitamin D 



The study was funded by a grant from the Ministry of Science, Research and Arts, state of Baden-Wuerttemberg, Germany, as part of the Geriatric Competence Center, Ulm University and by funds from the Department of Internal Medicine II-Cardiology, Ulm University. The authors would like to thank Mrs. Gerlinde Trischler for the expert technical assistance. The funders had no role in the study design, data collection and analysis, decision to publish, or preparation of the manuscript.

Conflicts of interest



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Copyright information

© International Osteoporosis Foundation and National Osteoporosis Foundation 2013

Authors and Affiliations

  • D. Rothenbacher
    • 1
    Email author
  • J. Klenk
    • 1
  • M. D. Denkinger
    • 2
  • F. Herbolsheimer
    • 1
  • T. Nikolaus
    • 2
  • R. Peter
    • 1
    • 3
  • B. O. Boehm
    • 4
  • K. Rapp
    • 5
  • D. Dallmeier
    • 1
    • 6
  • W. Koenig
    • 6
  • for the ActiFE Study Group
  1. 1.Institute of Epidemiology and Medical BiometryUlm UniversityUlmGermany
  2. 2.Agaplesion Bethesda Clinic UlmUlmGermany
  3. 3.Institute of the History, Philosophy and Ethics of MedicineUlm UniversityUlmGermany
  4. 4.Division of Endocrinology and DiabetesUniversity of Ulm Medical CenterUlmGermany
  5. 5.Clinic for Geriatric RehabilitationRobert-Bosch HospitalStuttgartGermany
  6. 6.Department of Internal Medicine II-CardiologyUniversity of Ulm Medical CentreUlmGermany

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