uu.seUppsala University Publications
Change search
ReferencesLink to record
Permanent link

Direct link
Serum 25-hydroxyvitamin D in relation to BMD and fractures in a Swedish cohort of women and men
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Orthopaedics.
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, UCR-Uppsala Clinical Research Center.
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Internal Medicine.
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Clinical pharmacogenomics and osteoporosis.
Show others and affiliations
(English)Manuscript (preprint) (Other academic)
Abstract [en]


Vitamin D insufficiency has been suggested to be common and to cause osteoporotic fractures. Results from previous studies are inconsistent. The aim of our study was to assess if circulating vitamin D is associated with incident fractures and bone mineral density (BMD) among elderly Swedish men and women.


A population-based cohort consisting of 1002 Swedish men and women, aged 70-years at baseline with a setting at latitude 60o north, was followed for 7 years. Serum vitamin D (25(OH)D) at baseline was analysed by an immunoassay. Fractures during follow-up were identified from registry data and BMD was measured with DXA. Association between 25(OH)D levels and time to fracture was our primary endpoint and BMD our secondary outcome.


Mean S-25(OH)Dlevel was 58 (SD 20) nmol/L and 38% of the participants had levels <50 nmol/L. After multivariable adjustment, S-25(OH)D was only associated with total body BMD among men (P=0.03) but the relation was weak. Each SD increase in S-25(OH)D (approximately 20 nmol/L) conferred a 1% increase in total body BMD. Low vitamin D levels were not associated with lower BMD at the total hip or the lumbar spine in men or women. During follow-up, 155 (15%) of the participants sustained a fracture. No association between 25(OH)D and the rate of fracture was evident. The lowest quintile compared to highest quintile of 25(OH)D conferred a HR of 1.13 (95% CI 0.65-1.94).


In a general population of elderly Swedish men and women, serum vitamin D is not a strong determinant of fractures or of low bone mineral density.

Keyword [en]
Vitamin D, fracture, BMD, observational study
National Category
Research subject
Epidemiology; Orthopaedics
URN: urn:nbn:se:uu:diva-159837OAI: oai:DiVA.org:uu-159837DiVA: diva2:447119
Available from: 2011-10-10 Created: 2011-10-10 Last updated: 2012-08-24Bibliographically approved
In thesis
1. Boning up on Vitamin D: Observational Studies on Bone and Health
Open this publication in new window or tab >>Boning up on Vitamin D: Observational Studies on Bone and Health
2011 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

The primary function of vitamin D in humans is to maintain sufficient circulating calcium concentrations. Low vitamin D levels could result in excessive calcium resorption from bone. Vitamin deficiency may therefore decrease bone mineral density (BMD), resulting in an increased risk of fracture. This thesis sought to determine the association between vitamin D intake and bone health and to estimate circulating levels of vitamin D optimal for bone health without increasing the risk for non-bone disease. Furthermore, the thesis assessed the difference in performance between common serum vitamin D assays and the genetic influence of vitamin D status.

In prospective population-based cohorts, blood concentrations <40 nmol/L (lowest 5%) increased the risk of fracture in elderly men. Low levels were further associated with a slight decrease in lumbar spine BMD. Both high (>98 nmol/L) and low (<46 nmol/L) vitamin D levels were associated with higher cancer and overall mortality. In another cohort, also of older men and women, no association was found between vitamin D levels and fracture. Low vitamin D levels were weakly associated with decreased total body BMD in men but not in women.

Dietary intake of vitamin D over a 20-year period in more than 60,000 Swedish women was not associated with osteoporosis or fracture, regardless of calcium intake. During summer, dietary vitamin D intake and other life style habits are of minor importance for the variation in vitamin D levels relative to sun exposure and genes. In summer time, genes explain about half  of the variation in vitamin D levels, but none of the variance in winter time. The variability between vitamin D assays was substantial. Three assays classified 8, 22 and 43% of the same study population as vitamin D insufficient if <50 nmol/L was set as the insufficiency level.

Based on the results in this thesis, low 25(OH)D levels and low dietary vitamin D intake are not a major cause of fractures in community-dwelling elderly Swedish women and men. Differences in assay performance and potential negative health outcomes of high 25(OH)D levels need to be considered.

Place, publisher, year, edition, pages
Uppsala: Acta Universitatis Upsaliensis, 2011. 68 p.
Digital Comprehensive Summaries of Uppsala Dissertations from the Faculty of Medicine, ISSN 1651-6206 ; 711
Vitamin D, fracture, BMD, assays, genes, mortality, cohort studies
National Category
Research subject
urn:nbn:se:uu:diva-159873 (URN)978-91-554-8184-1 (ISBN)
Public defence
2011-11-25, Grönwallsalen, Ing. 70, Akademiska Sjukhuset, Uppsala, 09:00 (Swedish)
Available from: 2011-11-03 Created: 2011-10-11 Last updated: 2011-11-10Bibliographically approved

Open Access in DiVA

No full text

Search in DiVA

By author/editor
Snellman, GretaByberg, LiisaLind, LarsMelhus, HåkanGedeborg, RolfMallmin, HansMichaëlsson, Karl
By organisation
OrthopaedicsUCR-Uppsala Clinical Research CenterInternal MedicineClinical pharmacogenomics and osteoporosisAnaesthesiology and Intensive Care

Search outside of DiVA

GoogleGoogle Scholar
The number of downloads is the sum of all downloads of full texts. It may include eg previous versions that are now no longer available

Total: 229 hits
ReferencesLink to record
Permanent link

Direct link