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Vitamin D-deficiency and post-fracture changes in lower extremity function and falls in women with hip fractures

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We determined the prevalence of vitamin D deficiency and lower extremity function in women with hip fractures. Women with extremely low vitamin D levels had reduced lower extremity muscle function and increased falls 1 year later. Ensuring vitamin D sufficiency after a hip fracture may improve function and reduce falls.


Hip fractures are the most devastating of fractures, commonly leading to loss of independent ambulation and living. In this retrospective analysis we determined the prevalence of vitamin D deficiency in women with hip fractures and the association between 25-hydroxyvitamin D [25(OH)D] levels and functional impairment one year later.


One hundred ten community-dwelling women with hip fractures were recruited from Boston, MA (n = 30) and Baltimore, MD (n = 80) before 1998 and 25(OH)D levels were measured by radioimmunoassay. In a subset of women from Baltimore, a performance measure of the lower extremities using the lower extremity gain scale (LEGS) was measured at 2, 6, and 12 months. Falls, grip strength, chair rise time, walking speed, and balance were also determined.


Vitamin D insufficiency defined as a 25(OH)D ≤32 ng/mL was present in 96% of the women with hip fractures and 38% had extremely low levels ≤9 ng/mL. At 1 year post-fracture, compared to women with a 25(OH)D >9 ng/mL, those with 25(OH)D ≤9 ng/mL had poorer LEGS performance (p < 0.0001) and higher fall rates, without group differences in grip strength or balance.


Vitamin D sufficiency may have important effects on lower extremity function following hip fractures, without excessive healthcare costs.

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We thank Natalie Glass, B.A., M.A. for her assistance in manuscript preparation.

Dr. Jay Magaziner and Dr. Meryl LeBoff had full access to all of the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis.

All Funding Sources

Funding support, in part by: NIH R01 AG13519, NIH R01 AG 12271, and R01 25015 (MSL, JG), the NCRR, General Clinical Research Center (Brigham and Women’s Hospital), and R37 G09901 and R01 AG18668 CWH (WH, JY, JM). Support also was provided by the Claude D. Pepper Older Americans Independence Center (OAIC) P60 AG12583 (WH, JM).

Conflict of interest statement

Dr. LeBoff works on active research projects that are supported by the National Institutes of Health; she has an unrestricted Center of Excellence education grant from Abbott and served as a consultant for an advisory board dinner for Eli Lilly and Company. At the time of the study, Dr. LeBoff served on the Scientific Advisory Board for Incstar, which manufactured a vitamin D assay, but she is no longer a member of the board. Incstar did not provide any funding for this study, and the study is not about any technology that is owned by or contractually obligated to Incstar in any way. Dr. Magaziner consults for Merck and has active research projects that are supported by the National Institutes of Health, Merck, and Novartis Pharmaceuticals. He also has lectured for Pfizer and consulted for Amgen and GTx, Inc. in the past year. All other authors have no conflicts of interest.

The present study evaluates the impact of extremely low vitamin D levels on functional recovery from hip fractures over 1 year post-fracture according to validated assessments of lower extremity muscle function. In addition, we also determined the associations between extremely low vitamin D levels at the time of hip fracture and measures of grip strength, falls, balance, and body composition.

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Correspondence to M. S. LeBoff.

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LeBoff, M.S., Hawkes, W.G., Glowacki, J. et al. Vitamin D-deficiency and post-fracture changes in lower extremity function and falls in women with hip fractures. Osteoporos Int 19, 1283–1290 (2008).

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