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Low serum vitamin D is associated with higher cortical porosity in elderly men

Sundh, D.; Mellström, D.; Ljunggren, ; Karlsson, M. K. LU ; Ohlsson, C.; Nilsson, M.; Nilsson, A. G. and Lorentzon, M. (2016) In Journal of Internal Medicine 280(5). p.496-508
Abstract

Background: Bone loss at peripheral sites in the elderly is mainly cortical and involves increased cortical porosity. However, an association between bone loss at these sites and 25-hydroxyvitamin D has not been reported. Objective: To investigate the association between serum levels of 25-hydroxyvitamin D, bone microstructure and areal bone mineral density (BMD) in elderly men. Methods: A population-based cohort of 444 elderly men (mean ± SD age 80.2 ± 3.5 years) was investigated. Bone microstructure was measured by high-resolution peripheral quantitative computed tomography, areal BMD by dual-energy X-ray absorptiometry and serum 25-hydroxyvitamin D and parathyroid hormone levels by immunoassay. Results: Mean cortical porosity at the... (More)

Background: Bone loss at peripheral sites in the elderly is mainly cortical and involves increased cortical porosity. However, an association between bone loss at these sites and 25-hydroxyvitamin D has not been reported. Objective: To investigate the association between serum levels of 25-hydroxyvitamin D, bone microstructure and areal bone mineral density (BMD) in elderly men. Methods: A population-based cohort of 444 elderly men (mean ± SD age 80.2 ± 3.5 years) was investigated. Bone microstructure was measured by high-resolution peripheral quantitative computed tomography, areal BMD by dual-energy X-ray absorptiometry and serum 25-hydroxyvitamin D and parathyroid hormone levels by immunoassay. Results: Mean cortical porosity at the distal tibia was 14.7% higher (12.5 ± 4.3% vs. 10.9 ± 4.1%, P < 0.05) whilst cortical volumetric BMD, area, trabecular bone volume fraction and femoral neck areal BMD were lower in men in the lowest quartile of vitamin D levels compared to the highest. In men with vitamin D deficiency (<25 nmol L−1) or insufficiency [25–49 nmol L−1, in combination with an elevated serum level of parathyroid hormone (>6.8 pmol L−1)], cortical porosity was 17.2% higher than in vitamin D-sufficient men (P < 0.01). A linear regression model including age, weight, height, daily calcium intake, physical activity, smoking vitamin D supplementation and parathyroid hormone showed that 25-hydroxyvitamin D independently predicted cortical porosity (standardized β = −0.110, R2 = 1.1%, P = 0.024), area (β = 0.123, R2 = 1.4%, P = 0.007) and cortical volumetric BMD (β = 0.125, R2 = 1.4%, P = 0.007) of the tibia as well as areal BMD of the femoral neck (β = 0.102, R2 = 0.9%, P = 0.04). Conclusion: Serum vitamin D is associated with cortical porosity, area and density, indicating that bone fragility as a result of low vitamin D could be due to changes in cortical bone microstructure and geometry.

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organization
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type
Contribution to journal
publication status
published
subject
keywords
cortical porosity, high-resolution peripheral computed tomography, vitamin D
in
Journal of Internal Medicine
volume
280
issue
5
pages
13 pages
publisher
Wiley-Blackwell Publishing Ltd
external identifiers
  • scopus:84992053152
  • wos:000386917400008
ISSN
0954-6820
DOI
10.1111/joim.12514
language
English
LU publication?
yes
id
acff9bfc-a21c-4110-bb97-ea8e8d0e3cf4
date added to LUP
2016-11-04 10:53:31
date last changed
2017-01-01 08:38:36
@article{acff9bfc-a21c-4110-bb97-ea8e8d0e3cf4,
  abstract     = {<p>Background: Bone loss at peripheral sites in the elderly is mainly cortical and involves increased cortical porosity. However, an association between bone loss at these sites and 25-hydroxyvitamin D has not been reported. Objective: To investigate the association between serum levels of 25-hydroxyvitamin D, bone microstructure and areal bone mineral density (BMD) in elderly men. Methods: A population-based cohort of 444 elderly men (mean ± SD age 80.2 ± 3.5 years) was investigated. Bone microstructure was measured by high-resolution peripheral quantitative computed tomography, areal BMD by dual-energy X-ray absorptiometry and serum 25-hydroxyvitamin D and parathyroid hormone levels by immunoassay. Results: Mean cortical porosity at the distal tibia was 14.7% higher (12.5 ± 4.3% vs. 10.9 ± 4.1%, P &lt; 0.05) whilst cortical volumetric BMD, area, trabecular bone volume fraction and femoral neck areal BMD were lower in men in the lowest quartile of vitamin D levels compared to the highest. In men with vitamin D deficiency (&lt;25 nmol L<sup>−1</sup>) or insufficiency [25–49 nmol L<sup>−1</sup>, in combination with an elevated serum level of parathyroid hormone (&gt;6.8 pmol L<sup>−1</sup>)], cortical porosity was 17.2% higher than in vitamin D-sufficient men (P &lt; 0.01). A linear regression model including age, weight, height, daily calcium intake, physical activity, smoking vitamin D supplementation and parathyroid hormone showed that 25-hydroxyvitamin D independently predicted cortical porosity (standardized β = −0.110, R<sup>2</sup> = 1.1%, P = 0.024), area (β = 0.123, R<sup>2</sup> = 1.4%, P = 0.007) and cortical volumetric BMD (β = 0.125, R<sup>2</sup> = 1.4%, P = 0.007) of the tibia as well as areal BMD of the femoral neck (β = 0.102, R<sup>2</sup> = 0.9%, P = 0.04). Conclusion: Serum vitamin D is associated with cortical porosity, area and density, indicating that bone fragility as a result of low vitamin D could be due to changes in cortical bone microstructure and geometry.</p>},
  author       = {Sundh, D. and Mellström, D. and Ljunggren,  and Karlsson, M. K. and Ohlsson, C. and Nilsson, M. and Nilsson, A. G. and Lorentzon, M.},
  issn         = {0954-6820},
  keyword      = {cortical porosity,high-resolution peripheral computed tomography,vitamin D},
  language     = {eng},
  month        = {11},
  number       = {5},
  pages        = {496--508},
  publisher    = {Wiley-Blackwell Publishing Ltd},
  series       = {Journal of Internal Medicine},
  title        = {Low serum vitamin D is associated with higher cortical porosity in elderly men},
  url          = {http://dx.doi.org/10.1111/joim.12514},
  volume       = {280},
  year         = {2016},
}