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This version published online on January 21, 2009
Journal of Clinical Endocrinology & Metabolism , doi:10.1210/jc.2008-1832
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Submitted on August 20, 2008
Accepted on January 12, 2009

Relationships of serum 25-hydroxyvitamin D to bone mineral density and serum parathyroid hormone and markers of bone turnover in older persons

Natalia O. Kuchuk, Saskia M.F. Pluijm, Natasja M. van Schoor, Caspar W.N. Looman, Johannes H. Smit, and Paul Lips*

Department of Endocrinology, VU University Medical Center, Amsterdam, The Netherlands; Department of Public Health, Erasmus MC, Rotterdam, The Netherlands; EMGO Institute, VU University Medical Center, Amsterdam, The Netherlands; Department of Sociology and Social Gerontology, VU University, Amsterdam, The Netherlands

* To whom correspondence should be addressed. E-mail: p.lips{at}vumc.nl.

Context: Serum 25-hydroxyvitamin D (25(OH)D) may influence serum parathyroid hormone (PTH) and other parameters of bone health up to a threshold concentration, which may be between 25 and 80 nmol/l.

Objective: To assess the threshold serum 25(OH)D with regard to PTH, bone turnover markers, and bone mineral density (BMD).

Design and setting: Longitudinal Aging Study Amsterdam, an ongoing cohort study.

Participants: 1319 men (n=643) and women (n=676), aged 65–88 years.

Main Outcome Measures: Serum 25(OH)D, PTH, osteocalcin (OC), urinary deoxypyridinoline (DPD/Cr), quantitative ultrasound (QUS) of the heel, BMD of lumbar spine and hip, total body bone mineral content (BMC) and physical performance. The relationship between the variables was explored by Analysis of Covariance (ANCOVA) and the locally weighted regression (LOESS) plots.

Results: Serum 25(OH)D was < 25 nmol/l in 11.5%, < 50 nmol/l in 48.4%, < 75 nmol/l in 82.4% and > 75 nmol/l in 17.6% of the respondents. Mean serum PTH decreased gradually from 5.1 pmol/l when serum 25(OH)D < 25 nmol/l to 3.1 pmol/l when serum 25(OH)D >75 nmol/l (p<0.001) without reaching a plateau. All bone mineral density values were higher in the higher serum 25(OH)D groups, although only significantly for total hip (p=0.01), trochanter (p=0.001) and total body BMC (p=0.005). A threshold of about 40 nmol/l existed for OC and DPD/Cr, 50 nmol/l for BMD and 60 nmol/l for physical performance.

Conclusions: Low serum 25(OH)D concentrations are common in the elderly. Bone health and physical performance in older persons are likely to improve when serum 25(OH)D is raised over 50–60 nmol/l.
Key words: vitamin D • PTH • bone markers • bone mineral density • threshold




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