Osteoporosis International

, Volume 25, Issue 12, pp 2767–2775 | Cite as

Vitamin D insufficiency over 5 years is associated with increased fracture risk—an observational cohort study of elderly women

  • D. Buchebner
  • F. McGuigan
  • P. Gerdhem
  • J. Malm
  • M. Ridderstråle
  • K. ÅkessonEmail author
Original Article



This study of elderly Swedish women investigated the association between chronic vitamin D insufficiency and osteoporotic fractures occurring between ages 80–90. The incidence and risk of hip and major osteoporotic fractures was significantly higher in elderly women with low vitamin D levels maintained over 5 years.


Vitamin D insufficiency among the elderly is common; however, relatively little is known about the effects of long-term hypovitaminosis D on fracture. We investigated sequential assessment of serum 25(OH)D at age 75 and 80 to determine if continuously low 25(OH)D levels are associated with increased 10-year fracture incidence.


One thousand forty-four Swedish women from the population-based OPRA cohort, all 75 years old, attended at baseline (BL); 715 attended at 5 years. S-25(OH)D was available in 987 and 640, respectively and categorized as: <50 (Low), 50–75 (Intermediate), and >75 nmol/L (High). Incident fracture data was collected with maximum follow-up to 90 years of age.


Hip fracture incidence between age 80–85 was higher in women who had low 25(OH)D at both baseline and 5 years (22.2 % (Low) vs. 6.6 % (High); p = 0.003). Between age 80–90, hip fracture incidence was more than double that of women in the high category (27.9 vs. 12.3 %; p = 0.006). Within 5-years, 50 % of women in the continuously low group compared to 34 % in the continuously high 25(OH)D group had an osteoporotic fracture (p = 0.004) while 10-year incidence was higher compared to the intermediate (p = 0.020) but not the high category (p = 0.053). The 10-year relative risk of hip fracture was almost three times higher and osteoporotic fracture risk almost doubled for women in the lowest 25(OH)D category compared to the high category (HR 2.7 and 1.7; p = 0.003 and 0.023, respectively).


In these elderly women, 25(OH)D insufficiency over 5-years was associated with increased 10-year risk of hip and major osteoporotic fractures.


Elderly women Fracture Longitudinal Vitamin D 



Thanks are extended to the research nurses at the Clinical and Molecular Osteoporosis Research Unit, Malmö and to all the women who kindly participated in the study.

This work was supported by grants from the Swedish Research Council (K2012-52X-14691-10-3), FAS (2007–2125), Greta and Johan Kock Foundation, A. Påhlsson Foundation, A. Osterlund Foundation, the H Järnhardt foundation, King Gustav V and Queen Victoria Foundation, Åke Wiberg Foundation, Thelma Zoegas Foundation, The Swedish Rheumatism Association, Skåne University Hospital Research Fund, Research and Development Council of Region Skåne, Sweden.

PG was supported by funding from the regional agreement on medical training and clinical research (ALF) between Stockholm County Council and Karolinska Institutet and by the Karolinska Institutet research funds.

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 2014

Authors and Affiliations

  • D. Buchebner
    • 1
    • 2
    • 3
  • F. McGuigan
    • 1
    • 2
  • P. Gerdhem
    • 4
    • 5
  • J. Malm
    • 6
    • 7
  • M. Ridderstråle
    • 8
    • 9
  • K. Åkesson
    • 1
    • 2
    Email author
  1. 1.Clinical and Molecular Osteoporosis Research Unit, Department of Clinical Science MalmöLund UniversityLundSweden
  2. 2.Department of OrthopaedicsSkåne University Hospital MalmöMalmoSweden
  3. 3.Department of Internal MedicineHalmstad County HospitalHalmstadSweden
  4. 4.Department of Clinical Science, Intervention and TechnologyKarolinska InstituteSolnaSweden
  5. 5.Department of OrthopaedicsKarolinska University HospitalStockholmSweden
  6. 6.Department of Laboratory Medicine, Section for Clinical ChemistryLund UniversityMalmöSweden
  7. 7.Department of Clinical Chemistry, Laboratory Medicine, Region SkåneSkåne University Hospital MalmöMalmoSweden
  8. 8.Clinical Obesity Research, Department of Clinical Sciences MalmöLund UniversityMalmöSweden
  9. 9.Steno Diabetes CenterGentofteDenmark

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