The American Journal of Medicine
Volume 117, Issue 3 , Pages 169-174, 1 August 2004

Serum vitamin A concentration and the risk of hip fracture among women 50 to 74 years old in the United States: A prospective analysis of the NHANES I follow-up study

  • Alexander R Opotowsky, MD, MPH

      Affiliations

    • Department of Medicine (ARO, JPB), College of Physicians and Surgeons, Columbia University, New York, New York, USA
    • ,
  • John P Bilezikian, MD

      Affiliations

    • Department of Medicine (ARO, JPB), College of Physicians and Surgeons, Columbia University, New York, New York, USA
    • Department of Pharmacology (JPB), College of Physicians and Surgeons, Columbia University, New York, New York, USA
    • Corresponding Author InformationRequests for reprints should be addressed to John P. Bilezikian, MD, Department of Medicine, Division of Endocrinology, College of Physicians and Surgeons, 630 W. 168th Street, New York, New York 10032, USA

Received 2 July 2003; received in revised form 26 February 2004; accepted 26 February 2004.

Abstract 

Background

Recent studies on the association between vitamin A and fracture risk have focused on samples with high vitamin A intake. We analyzed a cohort that was more representative of the overall U.S. population to test the hypothesis that both high and low serum vitamin A concentrations increase the risk of hip fracture.

Methods

We utilized data on 2799 women who were 50 to 74 years of age from the first National Health and Nutrition Examination Survey Epidemiologic Follow-up Study. There were 172 incident hip fractures during the 22-year follow-up period. Using Cox regression analysis, we analyzed the relation between baseline serum vitamin A (retinol and retinyl esters) concentration, as a continuous variable and by quintiles, and hip fracture risk.

Results

While there was no linear relation between serum vitamin A concentration and the risk of hip fracture in the multivariate analysis (hazard ratio [HR] per SD increase = 1.0; 95% confidence interval [CI]: 0.9 to 1.2), analysis by quintiles revealed a U-shaped relation between serum vitamin A concentration and hip fracture. Fracture risk was significantly higher among subjects in the lowest (HR = 1.9; 95% CI: 1.1 to 3.3) and highest (HR = 2.1; 95% CI: 1.2 to 3.6) quintiles compared with those in the middle quintiles.

Conclusion

Both low and high serum vitamin A concentrations may be associated with an increased risk of hip fracture.

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PII: S0002-9343(04)00275-X

doi:10.1016/j.amjmed.2004.02.045

The American Journal of Medicine
Volume 117, Issue 3 , Pages 169-174, 1 August 2004

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