ECTS2013 Oral Communications Osteoporosis epidemiology and long term treatment complications (6 abstracts)
Hip fractures and bone mineral density of the elderly: importance of serum 25-hydroxy vitamin D
Laufey Steingrimsdottir 1, , Thorhallur Halldorsson 1, , Kristin Siggeirsdottir 2 , Mary Frances Cotch 3 , Gudny Eiriksdottir 2 , Sigurdur Sigurdsson 2 , Tamara Harris 3 , Vilmundur Gudnason 2, & Gunnar Sigurdsson 2,
1Unit for Nutrition Research, University of Iceland and Landspitali Hospital, Reykjavik, Iceland; 2Icelandic Heart Association Research Institute, Kopavogur, Iceland; 3Intramural Research Program, Laboratory of Epidemiology, Demography, and Biometry, National Institute on Aging, Bethesda, Maryland, USA; 4University of Iceland, Reykjavik, Iceland.
Introduction: Vitamin D is known to be important for bone health. Still, the significance of serum 25-hydroxy vitamin D concentrations (s-25OHD) for hip fracture risk of the elderly is uncertain. Discordant findings may in part be explained by difficulties of RCTs or large cohort studies to reach both the frail and the healthy elderly. The objectives of this study were to determine the risk of hip fractures of the elderly related to s-25OHD, including both the frail and the healthy.
Methods/participants: The AGES-Reykjavik Study is a prospective study of 5764 elderly, age 66–96 years, based on a random sample of the population of Reykjavik, participation 71.8%. Incident hip fractures were related to s-25OHD at baseline, average time to event 3.4 years. BMD was measured by quantitative computed topography.
Results: Compared with referent values (50–75 nmol/l), hazard ratios for hip fractures were 2.24 (95% CI 1.63, 3.09) for s-25OHD <30 nmol/l, adjusting for age, sex, BMI, smoking, alcohol intake and season of blood sampling, and 2.08 (95% CI 1.51, 2.87) adjusting additionally for maximal knee extension, time up and go and physical activity. No difference in risk was associated with 30–50 nmol/l, nor with ≥75 nmol/l in either model compared with referent. Hazard ratios were 2.61 (95% CI 1.47, 4.65) in men and 1.92 (95% CI 1.30, 2.82) in women. Values <30 nmol/l compared with 50–75 nmol/l were associated with slightly lower BMD of femoral neck, reported as z-score, or −0.18 (95% CI −0.31, 0.04) in men and −0.13 (95% CI −0.23, −0.03) in women.
Conclusions: Our study lends support to the prime importance of keeping s-25OHD above 30–40 nmol/l for lowering hip fracture risk of the elderly. While higher levels may be of some benefit for other health outcomes, the main emphasis should be to ensure sufficient vitamin D to maintain adequate status.
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