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Authors

Zhu, Kun; Lewis, Joshua R.; Sim, Marc; Prince, Richard L.

Publication Year

2019

Abstract Note

The vitamin D debate relates in part to ideal public health population levels of circulating 25-hydroxyvitamin D (25OHD) to maintain bone structure and reduce fracture. In a secondary analysis of 1,348 women aged 70-85 years at baseline (1998) from the Perth Longitudinal Study of Aging in Women (PLSAW, a five-year calcium supplementation trial followed by two five-year extensions), we examined the dose-response relations of baseline plasma 25OHD with hip DXA BMD at year 1, lumbar spine BMD and trabecular bone score (TBS) at year 5, and fracture-related hospitalizations over 14.5 years obtained by health record linkage. Mean baseline plasma 25OHD was 66.9±28.2 nmol/L and 28.5%, 36.4% and 35.1% of women had levels <50, 50-74.9 and ≥75 nmol/L, respectively. Generalized additive models showed that total hip and femoral neck BMD and TBS, but not spine BMD, were higher with increasing plasma 25OHD up to 100 nmol/L. Compared with those with 25OHD <50 nmol/L, women with 25OHD ≥75 nmol/L had significantly higher total hip and femoral neck BMD at year 1 (3.3-3.9%) and TBS at year 5 (2.0%), all P<0.05. During the follow-up 27.6% of women experienced any fracture-related, and 10.6% hip fracture-related hospitalization. Penalized spline regression models showed a decrease in risk with increased 25OHD levels up to 65 and 75 nmol/L for hip fracture and any fracture-related hospitalization, respectively. Cox regression grouped analyses showed that, compared with women with 25OHD <50 nmol/L, those with 25OHD levels 50-74.9 and ≥75 nmol/L had significantly lower risk for hip fracture (hazard ratio [95% CI]: 0.60 [0.40-0.91] and 0.61 [0.40-0.92], respectively), and any fracture-related hospitalization (hazard ratio [95% CI]: 0.77 [0.59-0.99] and 0.70 [0.54-0.91], respectively). In older Caucasian women 25OHD levels >50 nmol/L are a minimum public health target and 25OHD levels beyond 75 nmol/L may not have additional benefit to reduce fracture risk. This article is protected by copyright. All rights reserved.

Journal

Journal of Bone and Mineral Research

Volume

Pages

Pubmed Link

Tags

Australia     Hologic     Longitudinal     Osteoporosis     Vitamin D    
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