Osteoporosis International

, Volume 26, Issue 1, pp 163–171 | Cite as

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

  • S. Hwang
  • H. S. Choi
  • K. M. Kim
  • Y. Rhee
  • S. K. LimEmail author
Original Article



The association between 25-hydroxyvitamin D (25(OH)D) levels and bone mineral density (BMD) and proximal femur bone geometry was examined in the Korean population. A positive relationship between skeletal health and 25(OH)D levels was observed. However, there were no significant differences in skeletal health between the groups with 25(OH)D level of 50–75 nmol/L and greater than 75 nmol/L.


Vitamin D plays an important role in calcium and phosphate homeostasis and normal mineralization of bone. However, the optimal level of vitamin D for skeletal health has not been clearly established. We analyzed the associations between serum 25(OH)D and BMD and proximal femur bone geometry and determined the optimal 25(OH)D level.


This was a cross-sectional study of 10,062 participants (20–95 years, 4,455 men, 5,607 women) in the Fourth Korea National Health and Nutrition Examination Surveys (KNHANES IV) conducted from 2008 to 2009. Participants were divided into groups according to 25(OH)D level (<25, 25–50, 50–75, and 75 nmol/L). BMD and proximal femur geometric indices were measured.


The group with 25(OH)D levels of 50–75 nmol/L had greater bone density values, with the exception of the lumbar spine, and also had greater femur neck cortical thickness, cross-sectional area, and cross-sectional moment of inertia, as well as a lesser buckling ratio than the groups with 25(OH)D level of 25–50 nmol/L and less than 25 nmol/L. However, there were no significant differences in BMD and proximal femur geometry properties between the groups with 50–75 nmol/L and greater than 75 nmol/L of 25(OH)D.


The skeletal outcomes, including BMD and proximal femur geometric indices observed in this study, suggest that serum 25(OH)D levels of 50 to <75 nmol/L are optimal for skeletal health.


Bone geometry Bone mineral density Population study Vitamin D 



Bone mineral density


Buckling ratio


Cross-sectional area


Cross-sectional moment of inertia


Cortical thickness


Femur neck


Hip structure analysis


Institute of Medicine


Korean National Health and Nutrition Examination Surveys


Narrow neck


Parathyroid hormone


Randomized controlled trials



This work was supported by the National Research Foundation of Korea grant funded by the Korea government (No. 20110001024) and the Dongguk University Research Fund 2011.

Conflicts of interest



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Copyright information

© International Osteoporosis Foundation and National Osteoporosis Foundation 2014

Authors and Affiliations

  • S. Hwang
    • 1
  • H. S. Choi
    • 2
  • K. M. Kim
    • 3
  • Y. Rhee
    • 1
  • S. K. Lim
    • 1
    Email author
  1. 1.Division of Endocrinology and Metabolism, Department of Internal MedicineYonsei University College of MedicineSeoulSouth Korea
  2. 2.Division of Endocrinology and Metabolism, Department of Internal MedicineDongguk University Ilsan Hospital, Dongguk University College of MedicineGoyangSouth Korea
  3. 3.Division of Endocrinology and Metabolism, Department of Internal Medicine, Seoul National University Bundang HospitalSeoul National University College of MedicineSeongnamSouth Korea

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