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Vitamin D levels and the risk of fracture

Key clinical point: Serum 25-hydroxyvitamin D (25[OH]D) levels are not associated with an increased risk of fractures overall, but severely low levels may increase the risk of osteoporotic fracture, particularly of the wrist.

Major finding: 25(OH)D levels <12, 12-19, and >50 ng/mL were not associated with overall fracture risk compared with 25(OH)D levels 20-50 ng/mL (reference group). Compared with the reference group, the risk of any osteoporotic fracture (adjusted hazard ratio [aHR], 1.41; 95% confidence interval [CI], 1.05-1.89) and wrist fracture (aHR, 2.11; 95% CI, 1.27-3.48) was higher in only individuals with 25(OH)D levels Ë‚12 ng/mL after adjustment for a prior diagnosis of osteoporosis/osteopenia.

Study details: This retrospective study evaluated the association between serum 25(OH)D levels and fracture risk (n = 11,002).

Disclosures: This study was funded by a CTSA grant from the National Center for Advancing Translational Sciences. The authors declared no conflicts of interest.


"Vitamin D contributed to bone mineralization and skeletal muscle strength. The purpose of this study was to determine whether serum 25-hydroxyvitamin D (25[OH]D) levels are associated with higher risk of fractures. This was a retrospective study that involved 11,002 adults living in Olmsted County, Minnesota, who had at least one 25(OH)D measurement between 2005 and 2011. Participants’ 25(OH)D vitamin D levels were categorized as <12, 12-19, 20-50 (referent) and >50 ng/mL. A 25(OH)D vitamin D levels were categorized as <12 ng/ml was associated with 40% increased odds of osteoporotic fractures (e.g. vertebral, hip, wrist, femur, radius and ulna). Individuals in the lowest vitamin D category were twice as likely to have a wrist fracture in multivariable models adjusting for previous diagnosis of osteoporosis/osteopenia. These findings are consistent with previous reports of increased risk of fracture in vitamin D deficient individuals. "

Maria I. Danila, MD, MSc, MSPH
University of Alabama at Birmingham


Aul AJ et al. Osteoporos Int. 2020 May 6. doi: 10.1007/s00198-020-05436-7.