title: The associations between serum 25-hydroxyvitamin D level and the risk of total fracture and hip fracture.
abstract: In this meta-analysis, we evaluated the association between serum 25-hydroxyvitamin D (25(OH) vitamin D) level and the risk of total fractures and hip fractures. Low serum 25(OH) vitamin D level is associated with an increased risk of total and hip fractures.
  
  
  
  Data on the association between serum 25(OH) vitamin D level and the risk of fractures are conflicting. This study aimed to provide a summary of prospective cohort or nested case-control studies on the association between serum 25(OH) vitamin D level and the risk of total fractures and hip fractures.
  
  
  
  We identified relevant studies by searching the PubMed, EMBASE, and OVID databases from their inception to June 1, 2016. We included published prospective cohort or nested case-control studies evaluating the associations of serum 25(OH) vitamin D level with the fracture risk. Two reviewers abstracted the data independently. Relative risks (RRs) with 95% confidence intervals (CIs) were derived throughout the whole analysis.
  
  
  
  Sixteen prospective cohort studies and three nested case-control studies were included. We found that low serum 25(OH) vitamin D level was significantly associated with the risk of total fractures (RR 1.25, 95% CI 1.06-1.43; I2= 31.3%, p for heterogeneity = 0.15) and hip fractures (RR 1.48, 95% CI 1.29-1.68; I2= 0%, p for heterogeneity = 0.51). The hip fracture risk was increased by 40% for each SD decrease in serum 25(OH) vitamin D level (RR 1.40, 95% CI 1.20-1.61; I2= 0%, p for heterogeneity = 0.51). The per SD decrease in serum 25(OH) vitamin D level was not associated with the increased risk of total fractures (RR 1.14, 95% CI 0.93-1.35; I2= 63.2%, p for heterogeneity = 0.04).
  
  
  
  Our study suggests that low serum 25(OH) vitamin D level is associated with increased risks of total and hip fractures. In the analyzed studies, the per SD decrease in serum 25(OH) vitamin D level was associated with the hip fracture risk but not with the total fracture risk.
authors.affiliation: Department of Orthopedics, Ren Ji Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, People's Republic of China.
authors.forename: Y
authors.initials: Y
authors.lastname: Feng
authors.affiliation: Department of Orthopedics, Ren Ji Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, People's Republic of China.
authors.forename: G
authors.initials: G
authors.lastname: Cheng
authors.affiliation: Department of Orthopedics, Ren Ji Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, People's Republic of China.
authors.forename: H
authors.initials: H
authors.lastname: Wang
authors.affiliation: Department of Orthopedics, Ren Ji Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, People's Republic of China. drbinchan@gmail.com.
authors.forename: B
authors.initials: B
authors.lastname: Chen
mesh_terms: D016022:Case-Control Studies; D006620:Hip Fractures / Q000097:blood / Q000209:etiology*; D006801:Humans; D058866:Osteoporotic Fractures / Q000097:blood / Q000209:etiology*; D018570:Risk Assessment / Q000379:methods; D014807:Vitamin D / Q000031:analogs & derivatives* / Q000097:blood; D014808:Vitamin D Deficiency / Q000097:blood / Q000150:complications*
chemical_list: D014807:Vitamin D; C104450:25-hydroxyvitamin D
keywords: Cohort; Fracture; Meta-analysis; Serum 25(OH) vitamin D