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Bone strength (more accurate than BMD) is inversely associated with vitamin D level – May 2015

The Association of Vitamin D with Femoral Neck Strength: an Additional Evidence of Vitamin D on Bone Health

J Clin Endocrinol Metab doi: 10.1210/jc.2014-4320
Hyeonmok Kim, Seung Hun Lee, JinJu Kim, Kyeong-Hye Lim, Seong Hee Ahn, Beom-Jun Kim, Jung-Min Koh
Division of Endocrinology and Metabolism, Asan Medical Center, University of Ulsan College of Medicine, 138-736, Seoul, Korea

Context: Although bone mineral density (BMD) is a strong predictor of fracture risk, additional parameters, such as bone strength, are needed to predict future fracture risk because of the low sensitivity of BMD for predicting the fracture risk.

Objective: The association of vitamin D with femoral neck (FN) strength.

Designs and Setting: A population-based, cross-sectional study from Korea National Health and Nutrition Examination Surveys.

Participants: 1,209 Koreans (586 men and 623 women) aged > 50 years.
Main Outcome Measures: We calculated composite indices of FN strength, such as indices of compression strength (CSI), bending strength (BSI), and impact strength (ISI), by combining BMD, body weight, and height with the femoral axis length and width which were measured by dualenergy X-ray absorptiometry.

Results: Multiple regression analysis demonstrated that serum 25-hydroxyvitamin D 25(OH)D levels were associated with CSI, BSI, and ISI in both genders. When women were categorized into four quartiles of 25(OH)D, FN BMD and composite indices, except for BSI, significantly increased from the lowest (Q1) to the highest quartile (Q4) (P for trend = 0.001-0.004). In contrast, there is no significant association of quartiles with composite indices in men. When women were divided into two groups according to their serum 25(OH)D levels, the composite indices as well as the FN BMD were markedly higher in subjects with higher 25(OH)D levels (>51.5 nmol/L).

Conclusion: These findings provide the first clinical evidence that high serum 25(OH)D levels exhibit higher composite indices of FN strength in a dose-dependent manner, especially in women.

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