title: Associations of 25-Hydroxyvitamin D and 1,25-Dihydroxyvitamin D With Bone Mineral Density, Bone Mineral Density Change, and Incident Nonvertebral Fracture.
abstract: Relationships between 1,25-dihydroxyvitamin D (1,25(OH)2 D) and skeletal outcomes are uncertain. We examined the associations of 1,25(OH)2 D with bone mineral density (BMD), BMD change, and incident non-vertebral fractures in a cohort of older men and compared them with those of 25-hydroxyvitamin D (25OHD). The study population included 1000 men (aged 74.6 ± 6.2 years) in the Osteoporotic Fractures in Men (MrOS) study, of which 537 men had longitudinal dual-energy X-ray absorptiometry (DXA) data (4.5 years of follow-up). A case-cohort design and Cox proportional hazards models were used to test the association between vitamin D metabolite levels and incident nonvertebral and hip fractures. Linear regression models were used to estimate the association between vitamin D measures and baseline BMD and BMD change. Interactions between 25OHD and 1,25(OH)2 D were tested for each outcome. Over an average follow-up of 5.1 years, 432 men experienced incident nonvertebral fractures, including 81 hip fractures. Higher 25OHD was associated with higher baseline BMD, slower BMD loss, and lower hip fracture risk. Conversely, men with higher 1,25(OH)2 D had lower baseline BMD. 1,25(OH)2 D was not associated with BMD loss or nonvertebral fracture. Compared with higher levels of calcitriol, the risk of hip fracture was higher in men with the lowest 1,25(OH)2 D levels (8.70 to 51.60 pg/mL) after adjustment for baseline hip BMD (hazard ratio [HR] = 1.99, 95% confidence interval [CI] 1.19-3.33). Adjustment of 1,25(OH)2 D data for 25OHD (and vice versa) had little effect on the associations observed but did attenuate the hip fracture association of both vitamin D metabolites. In older men, higher 1,25(OH)2 D was associated with lower baseline BMD but was not related to the rate of bone loss or nonvertebral fracture risk. However, with BMD adjustment, a protective association for hip fracture was found with higher 1,25(OH)2 D. The associations of 25OHD with skeletal outcomes were generally stronger than those for 1,25(OH)2 D. These results do not support the hypothesis that measures of 1,25(OH)2 D improve the ability to predict adverse skeletal outcomes when 25OHD measures are available. © 2015 American Society for Bone and Mineral Research.
authors.affiliation: Division of Endocrinology, Oregon Health & Science University, Portland, OR, USA.|Bone and Mineral Unit, Oregon Health & Science University, Portland, OR, USA.
authors.forename: Christine M
authors.initials: CM
authors.lastname: Swanson
authors.affiliation: Department of Public Health and Preventive Medicine, Oregon Health & Science University, Portland, OR, USA.
authors.forename: Priya
authors.initials: P
authors.lastname: Srikanth
authors.affiliation: Division of Endocrinology, Oregon Health & Science University, Portland, OR, USA.|Bone and Mineral Unit, Oregon Health & Science University, Portland, OR, USA.|Research Service, Portland Veterans Affairs Medical Center, Portland, OR, USA.
authors.forename: Christine G
authors.initials: CG
authors.lastname: Lee
authors.affiliation: California Pacific Medical Research Institute, San Francisco, CA, USA.
authors.forename: Steven R
authors.initials: SR
authors.lastname: Cummings
authors.affiliation: Laboratory of Diagnostic Medicine, KU Leuven, University Hospitals Leuven, Leuven, Belgium.
authors.forename: Ivo
authors.initials: I
authors.lastname: Jans
authors.affiliation: Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA.
authors.forename: Jane A
authors.initials: JA
authors.lastname: Cauley
authors.affiliation: Laboratory of Clinical and Experimental Endocrinology, KU Leuven, University Hospitals Leuven, Leuven, Belgium.
authors.forename: Roger
authors.initials: R
authors.lastname: Bouillon
authors.affiliation: Laboratory of Diagnostic Medicine, KU Leuven, University Hospitals Leuven, Leuven, Belgium.|Laboratory of Clinical and Experimental Endocrinology, KU Leuven, University Hospitals Leuven, Leuven, Belgium.
authors.forename: Dirk
authors.initials: D
authors.lastname: Vanderschueren
authors.affiliation: Division of Endocrinology, Oregon Health & Science University, Portland, OR, USA.|Bone and Mineral Unit, Oregon Health & Science University, Portland, OR, USA.
authors.forename: Eric S
authors.initials: ES
authors.lastname: Orwoll
authors.affiliation: Bone and Mineral Unit, Oregon Health & Science University, Portland, OR, USA.|Department of Public Health and Preventive Medicine, Oregon Health & Science University, Portland, OR, USA.
authors.forename: Carrie M
authors.initials: CM
authors.lastname: Nielson
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D015519:Bone Density; D005500:Follow-Up Studies; D006620:Hip Fractures / Q000097:blood* / Q000000981:diagnostic imaging / Q000453:epidemiology*; D006801:Humans; D015994:Incidence; D008297:Male; D011859:Radiography; D012307:Risk Factors; D014807:Vitamin D / Q000031:analogs & derivatives* / Q000097:blood
chemical_list: D014807:Vitamin D; C097949:1,25-dihydroxyvitamin D; C104450:25-hydroxyvitamin D
keywords: 1,25-DIHYDROXYVITAMIN D; 25-HYDROXYVITAMIN D; BONE MINERAL DENSITY (BMD); CALCITRIOL; FRACTURE