Journal of Orthopaedic Science

, Volume 16, Issue 4, pp 418–423 | Cite as

Serum 25-hydroxyvitamin D status in hip and spine-fracture patients in Japan

  • Mayumi Sakuma
  • Naoto Endo
  • Hiroshi Hagino
  • Atsushi Harada
  • Yasumoto Matsui
  • Tetsuo Nakano
  • Kozo Nakamura
Original Article



Serum 25-hydroxyvitamin D (25(OH)D) is used as an index that reflects the level of vitamin D. We have previously reported, on the basis of a study in Sado in Niigata, that patients with hip fracture have lower serum 25(OH)D levels than non-hip-fracture cases. In this study, the serum 25(OH)D status in hip-fracture cases was examined in four regions in Japan. Although most hip-fracture patients have experienced past spine-compression fractures, the relationship of these fractures and 25(OH)D is unknown. Therefore, we also examined the 25(OH)D level in spine-compression fracture patients in the same locations and time periods.


The levels of 25(OH)D, intact parathyroid hormone (intact PTH), undercarboxylated osteocalcin (ucOC), urine N-terminal crosslinking telopeptide of type I collagen (NTX), and bone mineral density were examined in patients with hip and spine fracture due to osteoporosis in several regions in Japan.


There were no significant differences in age, BMI, serum 25(OH)D, serum intact PTH, and serum ucOC among the regions. Levels of serum 25(OH)D were low in patients with hip fracture and spine fracture. The average serum 25(OH)D level was significantly lower in hip-fracture patients than in spine-fracture patients (16.3 vs. 18.1 ng/mL, P < 0.05). High serum ucOC was found in 37% of hip-fracture patients and 44% of spine-fracture patients.


Both hip and spine-fracture patients have vitamin D insufficiency, with similar results found in elderly patients in four areas of Japan. The severity of this condition tends to be more serious in hip-fracture patients than in spine-fracture patients.


  1. 1.
    Morita Y, Endo N, Iga T, Tokunaga K, Ohkawa Y. The incidence of cervical and trochanteric fractures of the proximal femur in 1999 in Niigata Prefecture, Japan. J Bone Miner Metab. 2002;20(5):311–8.PubMedCrossRefGoogle Scholar
  2. 2.
    Oinuma T, Sakuma M, Endo N. Secular change of the incidence of four fracture types associated with senile osteoporosis in Sado, Japan: the results of a 3-year survey. J Bone Miner Metab. 2010;28(1):55–9.PubMedCrossRefGoogle Scholar
  3. 3.
    Nuti R, Martini G, Valenti R, Gambera D, Gennari L, Salvadori S, Avanzati A. Vitamin D status and bone turnover in women with acute hip fracture. Clin Orthop Relat Res. 2004;422:208–13.PubMedCrossRefGoogle Scholar
  4. 4.
    LeBoff MS, Kohlmeier L, Hurwitz S, Franklin J, Wright J, Glowacki J. Occult vitamin D deficiency in postmenopausal US women with acute hip fracture. JAMA. 1999;281(16):1505–11.PubMedCrossRefGoogle Scholar
  5. 5.
    Sakuma M, Endo N, Oinuma T, Hayami T, Endo E, Yazawa T, Watanabe K, Watanabe S. Vitamin D and intact PTH status in patients with hip fracture. Osteoporos Int. 2006;17:1608–14.PubMedCrossRefGoogle Scholar
  6. 6.
    Nakamura K. Vitamin D insufficiency in Japanese populations: from the viewpoint of the prevention of osteoporosis. J Bone Miner Metab 2006;24(1):1–6 (Review).Google Scholar
  7. 7.
    Okano T, Tsugawa N, Suhara Y, Tanaka K, Ishida H, Uenishi K, Kubota E, Fukunaga M, Hosoi T, Shiraki M. Vitamin D status and bone metabolic markers of adult, especially elderly women in Japan. Osteoporos Jpn 2004;12:76–79 (in Japanese).Google Scholar
  8. 8.
    Hagino H, Yamamoto K, Ohshiro H, Nakamura T, Kishimoto H, Nose T. Changing Incidence of hip, distal radius and proximal humerus fractures in Tottori Prefecture, Japan. Bone (NY). 1999;24:265–70.Google Scholar
  9. 9.
    Cummings S, Cauley J, Palermo L, Ross PD, Wasnich RD, Black D, Faulkner K. Racial difference in hip axis length might explain racial differences in rates of hip fracture. Osteoporos Int. 1994;4:226–9.PubMedCrossRefGoogle Scholar
  10. 10.
    Kanis JA, Johnell O, De Leat C, Jonsson B, Oden A, Ogelsby AK. International variation in hip fracture probabilities : Implication for risk assessment. J Bone Miner Res. 2002;17:1237–44.PubMedCrossRefGoogle Scholar
  11. 11.
    Hollis BW. Circulating 25-hydroxyvitamin D levels indicative of vitamin D sufficiency: implications for establishing a new effective dietary intake recommendation for vitamin D. J Nutr. 2005;135:317–22.PubMedGoogle Scholar
  12. 12.
    Malabanan A, Veronikis E, Holick MF. Redefining vitamin D insufficiency. Lancet. 1998;351:805–6.PubMedCrossRefGoogle Scholar
  13. 13.
    Need AG, Horowitz M, Morris HA, Nordin BC. Vitamin D status: effects on parathyroid hormone and 1,25-dihydroxyvitamin D in postmenopausal women. Am J Clin Nutr. 2000;71:1577–81.PubMedGoogle Scholar
  14. 14.
    Yamaoka M, Inomata K, Wakiya S, Baba H, Yamashita H, Yamashita H, Noguchi S. Zenjidou denkikagaku hakkoumeneki sokuteisouchi “ECLusys 2010” ni yoru fukukoujousenn horumon sokutei no kentou. Jpn J Med Pharm Sci 2001;46(5):753–758 (in Japanese).Google Scholar
  15. 15.
    Thomas L. Parathyroid hormone (PTH). Clinical laboratory diagnosis. 1st English ed. Frankfurt: TH-Books; 1998. pp. 248–250.Google Scholar
  16. 16.
    Segersten U, Correa P, Hewison M, Hellman P, Dralle H, Carling T, Akerstrom G, Westin G. 25-Hydroxyvitamin D(3)-1alpha-hydroxylase expression in normal and pathological parathyroid glands. J Clin Endocrinol Metab. 2002;87(6):2967–72.PubMedCrossRefGoogle Scholar
  17. 17.
    World Health Organization. Prevention and management of osteoporosis, technical report series 2003; No. 921, pp. 38–31.Google Scholar
  18. 18.
    Tsugawa N, Shiraki M, Suhara Y, Kamao M, Ozaki R, Tanaka K, Okano T. Low plasma phylloquinone concentration is associated with high incidence of vertebral fracture in Japanese women. J Bone Miner Metab. 2008;26(1):79–85.PubMedCrossRefGoogle Scholar
  19. 19.
    Shiraki M, Aoki C, Yamazaki N, Ito Y, Tsugawa N, Suhara Y, Okano T. Clinical assessment of undercarboxylated osteocalcin measurement in serum using an electrochemiluminescence immunoassay: Establishments of cut-off value to determine vitamin K insufficiency in bone and to predict fracture leading to clinical use of vitamin K2. Jpn J Med Pharm Sci 2007;57(4):537-546 (in Japanese).Google Scholar
  20. 20.
    Nisimura J, Arai N, Tohmatsu J. Measurement of serum undercarboxylated osteocalcin by electro chemiluminescence immunoassay with the “Picolumi ucOC “kit. Jpn J Med Pharm Sci 2007;57(4):523–535 (in Japanese).Google Scholar
  21. 21.
    Kaneki M, Hodges SJ, Hosoi T, Fujiwara S, Lyons A, Crean SJ, Ishida N, Nakagawa M, Takechi M, Sano Y, Mizuno Y, Hoshino S, Miyao M, Inoue S, Horiki K, Shiraki M, Ouchi Y, Orimo H. Japanese fermented soybean food as the major determinant of the large geographic difference in circulating levels of vitamin K2: possible implications for hip-fracture risk. Nutrition. 2001;4:315–21.CrossRefGoogle Scholar
  22. 22.
    Tsugawa N, Shiraki M, Suhara Y, Kamao M, Ozaki R, Tanaka K, Okano T. Low plasma phylloquinone concentration is associated with high incidence of vertebral fracture in Japanese women. J Bone Miner Metab. 2008;26:79–85.PubMedCrossRefGoogle Scholar

Copyright information

© The Japanese Orthopaedic Association 2011

Authors and Affiliations

  • Mayumi Sakuma
    • 2
    • 3
  • Naoto Endo
    • 1
    • 3
  • Hiroshi Hagino
    • 1
    • 5
  • Atsushi Harada
    • 1
    • 4
  • Yasumoto Matsui
    • 4
  • Tetsuo Nakano
    • 1
    • 6
  • Kozo Nakamura
    • 7
  1. 1.Committee on Osteoporosis of the Japan Orthopedic AssociationTokyoJapan
  2. 2.Department of Physical Therapy, Faculty of Medical TechnologyNiigata University of Health and WelfareNiigataJapan
  3. 3.Division of Orthopedic Surgery, Department of Regenerative and Transplant MedicineNiigata University Graduate School of Medical and Dental SciencesNiigataJapan
  4. 4.Department of Advanced MedicineNational Center for Geriatrics and GerontologyObuJapan
  5. 5.School of Health Science, Faculty of MedicineTottori UniversityYonagoJapan
  6. 6.Department of Orthopedic SurgeryTamana Central HospitalKumamotoJapan
  7. 7.Department of Orthopaedic Surgery, Sensory and Motor System Medicine, Surgical Sciences, Graduate School of MedicineThe University of TokyoTokyoJapan

Personalised recommendations