Calciotropic hormones and the risk of hip and nonspine fractures in older adults:

the Health ABC Study.

J Bone Miner Res. 2012 May;27(5):1177-85. doi: 10.1002/jbmr.1545.
Barbour KE, Houston DK, Cummings SR, Boudreau R, Prasad T, Sheu Y, Bauer DC, Tooze JA, Kritchevsky SB, Tylavsky FA, Harris TB, Cauley JA; Health ABC Study.
Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA 15213, USA. barbourk at edc.pitt.edu

The effects of vitamin D and parathyroid hormone (PTH) levels on incident fracture remain uncertain.

To test the hypothesis that increasing serum 25-hydroxyvitamin D [25(OH)D] and decreasing PTH levels are associated with decreased risk of hip and any nonspine fracture, we conducted a prospective cohort study among 2614 community-dwelling white and black participants, aged ?70 years, from the Health, Aging and Body Composition (Health ABC) Study.

Serum and plasma samples were drawn at year 2, which formed the baseline for this analysis. Serum 25(OH)D and intact PTH (1-84) were measured using radioimmunoassay with DiaSorin reagents and EDTA plasma with a two-site immunoradiometric assay kit, respectively. Incident fractures (hip and any nonspine) were assessed after year 2, every 6 months, by self-report and validated by radiology reports.

The median (interquartile range) follow-up times for hip and any nonspine fractures were 6.4 (6.1-6.5) and 6.4 (5.5-6.5) years, respectively. Cox proportional hazards regression was used to estimate the hazard ratios (HR) with 95% confidence intervals (CI) for fracture.

There were 84 hip and 247 nonspine fractures that occurred over the follow-up period.

The multivariable adjusted HRs (95% CIs) of hip fracture for participants in the lowest (?17.78?ng/mL), second (17.79 to 24.36?ng/mL), and third quartiles (24.37 to 31.94?ng/mL) of 25(OH)D were 1.92 (0.97 to 3.83), 0.75 (0.32 to 1.72) and 1.86 (1.00 to 3.45), respectively, compared with participants in the highest 25(OH)D quartile (>31.94?ng/mL) (p trend?=?0.217).

Additional adjustment for IL-6 (p?=?0.107), PTH (p?=?0.124), and hip areal bone mineral density (p?=?0.137) attenuated HRs of hip fracture in the lowest quartile by 16.3%, 17.4%, and 26.1%, respectively.

There was no evidence of an association between 25(OH)D and any nonspine fractures, or between PTH and hip or any nonspine fractures. We found limited evidence to support an association between calciotropic hormones and hip and nonspine fractures in older men and women.

Copyright © 2012 American Society for Bone and Mineral Research.

PMID: 22228250
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Summary of risk of HIP FRACTURE

• <18 ng 1.92
• 18 – 24 ng 0.75
• 24 – 32 ng 1.9
• <32 ng 1.0
  Note: Vitamin D testing was done only once
  Many things could have caused vitamin D levels to significantly drop after the test, such as:
  +Surgery
  +started taking Bisphosphonates to avoid bone fracture
  +Move into senior home
  Strange: less likely to get hip fracture if 18-24 ng

See also Vitamin D Life

• Hip fractures reduced 30 % with 800 IU of vitamin D – meta-analysis July 2012
• Mobility Disability 1.9X more likely if had low level of vitamin D – May 2012 another paper based on the same study