Vitamin D insufficiency and health outcomes over 5 y in older women.

BACKGROUND Vitamin D insufficiency was shown to be associated with adverse musculoskeletal and nonskeletal outcomes in numerous observational studies. However, some studies did not control for confounding factors such as age or seasonal variation of 25-hydroxyvitamin D [25(OH)D]. OBJECTIVE We sought to determine the effect of vitamin D status on health outcomes. DESIGN Healthy community-dwelling women (n = 1471) with a mean age of 74 y were followed in a 5-y trial of calcium supplementation. 25(OH)D was measured at baseline in all women. Skeletal and nonskeletal outcomes were evaluated according to seasonally adjusted vitamin D status at baseline. RESULTS Fifty percent of women had a seasonally adjusted 25(OH)D concentration <50 nmol/L. These women were significantly older, heavier, and less physically active and had more comorbidities than women with a seasonally adjusted 25(OH)D concentration > or =50 nmol/L. Women with a seasonally adjusted 25(OH)D concentration <50 nmol/L had an increased incidence of stroke and cardiovascular events that did not persist after adjustment for between-group differences in age or comorbidities. Women with a seasonally adjusted 25(OH)D concentration <50 nmol/L were not at increased risk of adverse consequences for any musculoskeletal outcome, including fracture, falls, bone density, or grip strength or any nonskeletal outcomes, including death, myocardial infarction, cancer, heart failure, diabetes, or adverse changes in blood pressure, weight, body composition, cholesterol, or glucose. CONCLUSIONS Vitamin D insufficiency is more common in older, frailer women. Community-dwelling older women with a seasonally adjusted 25(OH)D concentration <50 nmol/L were not at risk of adverse outcomes over 5 y after control for comorbidities. Randomized placebo-controlled trials are needed to determine whether vitamin D supplementation in individuals with vitamin D insufficiency influences health outcomes. This trial was registered at www.anzctr.org.au as ACTRN 012605000242628.

[1]  A. Avenell,et al.  Vitamin D and vitamin D analogues for preventing fractures associated with involutional and post-menopausal osteoporosis. , 2009, The Cochrane database of systematic reviews.

[2]  E John Orav,et al.  Prevention of nonvertebral fractures with oral vitamin D and dose dependency: a meta-analysis of randomized controlled trials. , 2009, Archives of internal medicine.

[3]  B. Cunha,et al.  A randomized controlled trial of vitamin D3 supplementation for the prevention of symptomatic upper respiratory tract infections , 2009, Epidemiology and Infection.

[4]  R. Jorde,et al.  Supplementation with cholecalciferol does not result in weight reduction in overweight and obese subjects. , 2008, European journal of endocrinology.

[5]  I. Reid,et al.  The effects of seasonal variation of 25-hydroxyvitamin D on diagnosis of vitamin D insufficiency. , 2008, The New Zealand medical journal.

[6]  M. Horowitz,et al.  Glucose tolerance and vitamin D: effects of treating vitamin D deficiency. , 2008, Nutrition.

[7]  B. Astor,et al.  25-hydroxyvitamin D levels and the risk of mortality in the general population. , 2008, Archives of internal medicine.

[8]  B. Boehm,et al.  Independent association of low serum 25-hydroxyvitamin d and 1,25-dihydroxyvitamin d levels with all-cause and cardiovascular mortality. , 2008, Archives of internal medicine.

[9]  E. Rimm,et al.  25-hydroxyvitamin D and risk of myocardial infarction in men: a prospective study. , 2008, Archives of internal medicine.

[10]  Garrett Fitzmaurice,et al.  Laboratory-based versus non-laboratory-based method for assessment of cardiovascular disease risk: the NHANES I Follow-up Study cohort , 2008, The Lancet.

[11]  Michael J. Pencina,et al.  Vitamin D Deficiency and Risk of Cardiovascular Disease , 2008, Circulation.

[12]  R. Doughty,et al.  Vascular events in healthy older women receiving calcium supplementation: randomised controlled trial , 2008, BMJ : British Medical Journal.

[13]  I. Reid,et al.  The effects of seasonal variation of 25-hydroxyvitamin D and fat mass on a diagnosis of vitamin D sufficiency. , 2007, The American journal of clinical nutrition.

[14]  Sara Gandini,et al.  Vitamin D supplementation and total mortality: a meta-analysis of randomized controlled trials. , 2007, Archives of internal medicine.

[15]  A. Avenell,et al.  Vitamin D supplementation to prevent infections: a sub-study of a randomised placebo-controlled trial in older people (RECORD trial, ISRCTN 51647438). , 2007, Age and ageing.

[16]  T. Hangartner,et al.  Detection of Aortic Calcification during Vertebral Fracture Assessment (VFA) Compared to Digital Radiography , 2007, PloS one.

[17]  M. Holick.  Vitamin D deficiency. , 2007, The New England journal of medicine.

[18]  S. Boonen,et al.  Need for additional calcium to reduce the risk of hip fracture with vitamin d supplementation: evidence from a comparative metaanalysis of randomized controlled trials. , 2007, The Journal of clinical endocrinology and metabolism.

[19]  P. Delmas,et al.  Associations of vitamin D status with bone mineral density, bone turnover, bone loss and fracture risk in healthy postmenopausal women. The OFELY study. , 2007, Bone.

[20]  I. Reid,et al.  Randomized controlled trial of calcium in healthy older women. , 2006, The American journal of medicine.

[21]  W. Willett,et al.  Estimation of optimal serum concentrations of 25-hydroxyvitamin D for multiple health outcomes. , 2006, The American journal of clinical nutrition.

[22]  J. Manson,et al.  Calcium plus vitamin D supplementation and the risk of fractures. , 2006, The New England journal of medicine.

[23]  I. Reid,et al.  Determinants of vitamin D status in older women living in a subtropical climate , 2005, Osteoporosis International.

[24]  I. Reid,et al.  Effects of calcium supplementation on body weight and blood pressure in normal older women: a randomized controlled trial. , 2005, The Journal of clinical endocrinology and metabolism.

[25]  M. Visser,et al.  Adiposity in relation to vitamin D status and parathyroid hormone levels: a population-based study in older men and women. , 2005, The Journal of clinical endocrinology and metabolism.

[26]  C. Cooper,et al.  Oral vitamin D3 and calcium for secondary prevention of low-trauma fractures in elderly people (Randomised Evaluation of Calcium Or vitamin D, RECORD): a randomised placebo-controlled trial , 2005, The Lancet.

[27]  P. Lips,et al.  Estimates of optimal vitamin D status , 2005, Osteoporosis International.

[28]  E. Gunter,et al.  Measurement of Vitamin D metabolites: an international perspective on methodology and clinical interpretation , 2004, The Journal of Steroid Biochemistry and Molecular Biology.

[29]  Bess Dawson-Hughes,et al.  Effect of Vitamin D on falls: a meta-analysis. , 2004, JAMA.

[30]  I. Reid,et al.  Effects of Vitamin D Supplementation on Strength, Physical Performance, and Falls in Older Persons: A Systematic Review , 2003, Journal of the American Geriatrics Society.

[31]  M. Schlichting,et al.  Combined Calcium and Vitamin D3 Supplementation in Elderly Women: Confirmation of Reversal of Secondary Hyperparathyroidism and Hip Fracture Risk: The Decalyos II Study , 2002, Osteoporosis International.

[32]  I. Reid,et al.  Effects of calcium supplementation on serum lipid concentrations in normal older women: a randomized controlled trial. , 2002, The American journal of medicine.

[33]  P. Lips,et al.  Vitamin D deficiency and secondary hyperparathyroidism in the elderly: consequences for bone loss and fractures and therapeutic implications. , 2001, Endocrine reviews.

[34]  S. Cummings,et al.  Endogenous hormones and the risk of hip and vertebral fractures among older women. Study of Osteoporotic Fractures Research Group. , 1998, The New England journal of medicine.

[35]  P. Wilson,et al.  Plasma 25-hydroxyvitamin D and its determinants in an elderly population sample. , 1997, The American journal of clinical nutrition.

[36]  M. Horowitz,et al.  Effects of skin thickness, age, body fat, and sunlight on serum 25-hydroxyvitamin D. , 1993, The American journal of clinical nutrition.

[37]  F Duboeuf,et al.  Vitamin D3 and calcium to prevent hip fractures in elderly women. , 1992, The New England journal of medicine.

[38]  J N Morris,et al.  Assessment methods for physical activity and physical fitness in population studies: report of a NHLBI workshop. , 1986, American heart journal.

[39]  B. Dawson-Hughes,et al.  Plasma calcidiol, season, and serum parathyroid hormone concentrations in healthy elderly men and women. , 1997, The American journal of clinical nutrition.