There is controversy over whether African Americans have higher vitamin D requirements than recommended by the Institute of Medicine. We previously reported that maintaining serum 25(OH)D above 30 ng/mL does not prevent age-related bone loss. Herein, we report that bone strength is also unaffected by maintaining this level in this population.
The role of vitamin D in bone strength has not been investigated in the African American (AA) population.
A 3-year randomized controlled trial was designed to examine the effect of vitamin D supplementation on physical performance, bone loss, and bone strength in healthy older AA women. A total of 260 postmenopausal AA women, ages ≥ 60 years were randomized to a vitamin D3 or placebo arm. Vitamin D3 dose was adjusted to maintain serum 25OHD > 30 ng/mL. Bone mineral density, femoral axis length, and femoral neck (FN) width were measured by dual-energy X-ray absorptiometry. Composite indices of FN strength [compression strength index (CSI), bending strength index (BSI), and impact strength index (ISI)] were computed.
The mean age of participants was 68.2 ± 4.9 years. Baseline characteristics between groups were similar. The average dose of vitamin D3 was 3490 ± 1465 IU/day in the active group. The mean serum 25OHD was 46.8 ± 1.2 ng/mL versus 20.7 ± 1.1 ng/mL in the active versus placebo group. Serum 25OHD did not correlate with any composite indices. The longitudinal differences observed in FN width, CSI, BSI, and ISI in both groups were not statistically significant (all p values > 0.05). Further, there was no group × time interaction effect for any of the composite indices (all p values > 0.05).
Maintaining serum 25OHD > 30 ng/mL (75 nmol/L) does not affect bone strength in older AA women. There is no evidence to support vitamin D intake greater than the recommended RDA by the Institute of Medicine in this population for bone strength.
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25-Hydroxy vitamin D
Bone mineral density
Bending strength index
Compression strength index
Dual-energy X-ray absorptiometry
Femoral neck width
Hip axis length
Hip structure analysis
Impact strength index
Fang J, Freeman R, Jeganathan R, Alderman MH (2004) Variations in hip fracture hospitalization rates among different race/ethnicity groups in New York City. Ethn Dis 14(2):280–284
Griffin MR, Ray WA, Fought RL, Melton LJ 3rd. (1992) Black-white differences in fracture rates. Am J Epidemiol 136(11):1378–1385
Karagas MR, Lu-Yao GL, Barrett JA, Beach ML, Baron JA (1996) Heterogeneity of hip fracture: age, race, sex, and geographic patterns of femoral neck and trochanteric fractures among the US elderly. Am J Epidemiol 143(7):677–682
Aloia JF (2008) African Americans, 25-hydroxyvitamin D, and osteoporosis: a paradox. Am J Clin Nutr 88(2):545S–550S
Looker AC, Pfeiffer CM, Lacher DA, Schleicher RL, Picciano MF, Yetley EA (2008) Serum 25-hydroxyvitamin D status of the US population: 1988-1994 compared with 2000-2004. Am J Clin Nutr 88(6):1519–1527
Nelson DA, Barondess DA, Hendrix SL, Beck TJ (2000) Cross-sectional geometry, bone strength, and bone mass in the proximal femur in black and white postmenopausal women. J Bone Miner Res 15(10):1992–1997
Nelson DA, Beck TJ, Wu G, Lewis CE, Bassford T, Cauley JA, LeBoff M, Going SB, Chen Z (2011) Ethnic differences in femur geometry in the women’s health initiative observational study. Osteoporos Int 22(5):1377–1388
Peacock M, Buckwalter KA, Persohn S, Hangartner TN, Econs MJ, Hui S (2009) Race and sex differences in bone mineral density and geometry at the femur. Bone 45(2):218–225
Aloia JF, Talwar SA, Pollack S, Yeh J (2005) A randomized controlled trial of vitamin D3 supplementation in African American women. Arch Intern Med 165(14):1618–1623
Nieves JW, Cosman F, Grubert E, Ambrose B, Ralston SH, Lindsay R (2012) Skeletal effects of vitamin D supplementation in postmenopausal black women. Calcif Tissue Int 91(5):316–324
Institute of Medicine (US) Committee to Review Dietary Reference Intakes for Vitamin D and Calcium; Ross AC TC, Yaktine AL, Del Valle HB, editors. Dietary Reference Intakes for Calcium and Vitamin D. Washington (DC): National Academies Press (US). 2011
Holick MF, Binkley NC, Bischoff-Ferrari HA, Gordon CM, Hanley DA, Heaney RP, Murad MH, Weaver CM, Endocrine Society (2011) Evaluation, treatment, and prevention of vitamin D deficiency: an Endocrine Society clinical practice guideline. J Clin Endocrinol Metab 96(7):1911–1930
Heaney RP, Holick MF (2011) Why the IOM recommendations for vitamin D are deficient. J Bone Miner Res 26(3):455–457
Holick MF (2011) The D-batable Institute of Medicine report: a D-lightful perspective. Endocr Pract 17(1):143–149
Dhaliwal R, Mikhail M, Usera G, Stolberg A, Islam S, Ragolia L, Aloia JF (2018) The relationship of physical performance and osteoporosis prevention with vitamin D in older African Americans (PODA). Contemp Clin Trials 65:39–45
Aloia J, Fazzari M, Islam S, Mikhail M, Shieh A, Katumuluwa S, Dhaliwal R, Stolberg A, Usera G, Ragolia L (2018) Vitamin D supplementation in elderly black women does not prevent bone loss: a randomized controlled trial. J Bone Miner Res 33(11):1916–1922
Allolio B (1999) Risk factors for hip fracture not related to bone mass and their therapeutic implications. Osteoporos Int 9(Suppl 2):S9–S16
Alonso CG, Curiel MD, Carranza FH, Cano RP, Perez AD (2000) Femoral bone mineral density, neck-shaft angle and mean femoral neck width as predictors of hip fracture in men and women. Multicenter project for research in osteoporosis. Osteoporos Int 11(8):714–720
Heaney RP, Barger-Lux MJ, Davies KM, Ryan RA, Johnson ML, Gong G (1997) Bone dimensional change with age: interactions of genetic, hormonal, and body size variables. Osteoporos Int 7(5):426–431
Beck TJ, Petit MA, Wu G, LeBoff MS, Cauley JA, Chen Z (2009) Does obesity really make the femur stronger? BMD, geometry, and fracture incidence in the women’s health initiative-observational study. J Bone Miner Res 24(8):1369–1379
Karlamangla AS, Barrett-Connor E, Young J, Greendale GA (2004) Hip fracture risk assessment using composite indices of femoral neck strength: the Rancho Bernardo study. Osteoporos Int 15(1):62–70
Aloia JF, Rubinova R, Fazzari M, Islam S, Mikhail M, Ragolia L (2019) Vitamin D and falls in older African American women: the PODA randomized clinical trial. J Am Geriatr Soc 67(5):1043–1049
Danielson ME, Beck TJ, Karlamangla AS, Greendale GA, Atkinson EJ, Lian Y, Khaled AS, Keaveny TM, Kopperdahl D, Ruppert K, Greenspan S, Vuga M, Cauley JA (2013) A comparison of DXA and CT based methods for estimating the strength of the femoral neck in post-menopausal women. Osteoporos Int 24(4):1379–1388
Rubin DB (1976) Inference and missing data. Biometrika 63(3):581–592
Ibrahim JG, Molenberghs G (2009) Missing data methods in longitudinal studies: a review. Test (Madr) 18(1):1–43
Barrett-Connor E, Siris ES, Wehren LE, Miller PD, Abbott TA, Berger ML, Santora AC, Sherwood LM (2005) Osteoporosis and fracture risk in women of different ethnic groups. J Bone Miner Res 20(2):185–194
Siris ES, Miller PD, Barrett-Connor E, Faulkner KG, Wehren LE, Abbott TA, Berger ML, Santora AC, Sherwood LM (2001) Identification and fracture outcomes of undiagnosed low bone mineral density in postmenopausal women: results from the National Osteoporosis Risk Assessment. JAMA. 286(22):2815–2822
Kaptoge S, Beck TJ, Reeve J, Stone KL, Hillier TA, Cauley JA, Cummings SR (2008) Prediction of incident hip fracture risk by femur geometry variables measured by hip structural analysis in the study of osteoporotic fractures. J Bone Miner Res 23(12):1892–1904
Cummings SR, Cauley JA, Palermo L et al (1994) Racial differences in hip axis lengths might explain racial differences in rates of hip fracture. Study of Osteoporotic Fractures Research Group. Osteoporos Int 4(4):226–229
Danielson ME, Beck TJ, Lian Y, Karlamangla AS, Greendale GA, Ruppert K, Lo J, Greenspan S, Vuga M, Cauley JA (2013) Ethnic variability in bone geometry as assessed by hip structure analysis: findings from the hip strength across the menopausal transition study. J Bone Miner Res 28(4):771–779
Mikhail MB, Vaswani AN, Aloia JF (1996) Racial differences in femoral dimensions and their relation to hip fracture. Osteoporos Int 6(1):22–24
Ishii S, Cauley JA, Greendale GA, Danielson ME, Safaei Nili N, Karlamangla A (2012) Ethnic differences in composite indices of femoral neck strength. Osteoporos Int 23(4):1381–1390
Hwang S, Choi HS, Kim KM, Rhee Y, Lim SK (2015) Associations between serum 25-hydroxyvitamin D and bone mineral density and proximal femur geometry in Koreans: the Korean National Health and Nutrition Examination Survey (KNHANES) 2008-2009. Osteoporos Int 26(1):163–171
Jackson RD, Wright NC, Beck TJ, Sherrill D, Cauley JA, Lewis CE, LaCroix A, LeBoff M, Going S, Bassford T, Chen Z (2011) Calcium plus vitamin D supplementation has limited effects on femoral geometric strength in older postmenopausal women: the Women’s Health Initiative. Calcif Tissue Int 88(3):198–208
Martin EN, Haney EM, Shannon J, Cauley JA, Ensrud KE, Keaveny TM, Zmuda JM, Orwoll ES, Harrison SL, Marshall LM (2015) Femoral volumetric bone density, geometry, and strength in relation to 25-hydroxy vitamin D in older men. J Bone Miner Res 30(3):562–569
Dhaliwal R, Aloia JF (2017) Effect of vitamin D on falls and physical performance. Endocrinol Metab Clin N Am 46(4):919–933
Bischoff-Ferrari HA, Dawson-Hughes B, Orav EJ, Staehelin HB, Meyer OW, Theiler R, Dick W, Willett WC, Egli A (2016) Monthly high-dose vitamin D treatment for the prevention of functional decline: a randomized clinical trial. JAMA Intern Med 176(2):175–183
Cauley JA, Danielson ME, Boudreau R et al (2011) Serum 25-hydroxyvitamin D and clinical fracture risk in a multiethnic cohort of women: the Women’s Health Initiative (WHI). J Bone Miner Res 26(10):2378–2388
Faulkner KA, Cauley JA, Zmuda JM, Landsittel DP, Newman AB, Studenski SA, Redfern MS, Ensrud KE, Fink HA, Lane NE, Nevitt MC (2006) Higher 1,25-dihydroxyvitamin D3 concentrations associated with lower fall rates in older community-dwelling women. Osteoporos Int 17(9):1318–1328
Beaudart C, Buckinx F, Rabenda V, Gillain S, Cavalier E, Slomian J, Petermans J, Reginster JY, Bruyère O (2014) The effects of vitamin D on skeletal muscle strength, muscle mass, and muscle power: a systematic review and meta-analysis of randomized controlled trials. J Clin Endocrinol Metab 99(11):4336–4345
Aloia JF, Vaswani A, Ma R, Flaster E (1996) Body composition in normal black women: the four-compartment model. J Clin Endocrinol Metab 81(6):2363–2369
Kritchevsky SB, Tooze JA, Neiberg RH, Schwartz GG, Hausman DB, Johnson MA, Bauer DC, Cauley JA, Shea MK, Cawthon PM, Harris TB, Rubin SM, Tylavsky FA, Houston DK, Health ABC Study (2012) 25-Hydroxyvitamin D, parathyroid hormone, and mortality in black and white older adults: the health ABC study. J Clin Endocrinol Metab 97(11):4156–4165
Cauley JA, Lui LY, Stone KL, Hillier TA, Zmuda JM, Hochberg M, Beck TJ, Ensrud KE (2005) Longitudinal study of changes in hip bone mineral density in Caucasian and African-American women. J Am Geriatr Soc 53(2):183–189
Manson JE, Cook NR, Lee IM et al (2019) Vitamin D supplements and prevention of cancer and cardiovascular disease. N Engl J Med 380(1):33–44
Urashima M, Ohdaira H, Akutsu T et al (2019) Effect of vitamin D supplementation on relapse-free survival among patients with digestive tract cancers: the AMATERASU randomized clinical trial. JAMA 321(14):1361–1369
We thank the study participants and staff at the Bone Mineral Research Center for their contribution, and the Data Safety and Monitoring Board Committee Members: Munro Peacock, MD, DSc; Bess Dawson-Hughes, MD; Lynette Smith, MS; Judy Hannah, PhD; Rebecca Costello, PhD; Christopher Sempos, PhD; Andy Hoofnagle MD, PhD, Director, Nutrition and Obesity Research Center, University of Washington.
This research was supported by grants from the National Institute of Health (NIH) and Office of Dietary Supplements (ODS); R01-AG032440-05.
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Dhaliwal, R., Islam, S., Mikhail, M. et al. Effect of vitamin D on bone strength in older African Americans: a randomized controlled trial. Osteoporos Int (2020) doi:10.1007/s00198-019-05275-1
- Bone strength
- Clinical trial
- Fracture prevention
- Vitamin D