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Vitamin A intake and hip fractures among postmenopausal women.
JAMA. 2002 Jan 02; 287(1):47-54.JAMA

Abstract

CONTEXT

Ingestion of toxic amounts of vitamin A affects bone remodeling and can have adverse skeletal effects in animals. The possibility has been raised that long-term high vitamin A intake could contribute to fracture risk in humans.

OBJECTIVE

To assess the relationship between high vitamin A intake from foods and supplements and risk of hip fracture among postmenopausal women.

DESIGN

Prospective analysis begun in 1980 with 18 years of follow-up within the Nurses' Health Study.

SETTING

General community of registered nurses within 11 US states.

PARTICIPANTS

A total of 72 337 postmenopausal women aged 34 to 77 years.

MAIN OUTCOME MEASURES

Incident hip fractures resulting from low or moderate trauma, analyzed by quintiles of vitamin A intake and by use of multivitamins and vitamin A supplements, assessed at baseline and updated during follow-up.

RESULTS

From 1980 to 1998, 603 incident hip fractures resulting from low or moderate trauma were identified. After controlling for confounding factors, women in the highest quintile of total vitamin A intake (>/=3000 microgram/d of retinol equivalents [RE]) had a significantly elevated relative risk (RR) of hip fracture (RR, 1.48; 95% confidence interval [CI], 1.05-2.07; P for trend =.003) compared with women in the lowest quintile of intake (<1250 microgram/d of RE). This increased risk was attributable primarily to retinol (RR, 1.89; 95% CI, 1.33-2.68; P for trend <.001 comparing >/=2000 microgram/d vs <500 microgram/d). The association of high retinol intake with hip fracture was attenuated among women using postmenopausal estrogens. Beta carotene did not contribute significantly to fracture risk (RR, 1.22; 95% CI, 0.90-1.66; P for trend =.10 comparing >/=6300 microgram/d vs <2550 microgram/d). Women currently taking a specific vitamin A supplement had a nonsignificant 40% increased risk of hip fracture (RR, 1.40; 95% CI, 0.99-1.99) compared with those not taking that supplement, and, among women not taking supplemental vitamin A, retinol from food was significantly associated with fracture risk (RR, 1.69; 95% CI, 1.05-2.74; P for trend =.05 comparing >/=1000 microgram/d vs <400 microgram/d).

CONCLUSIONS

Long-term intake of a diet high in retinol may promote the development of osteoporotic hip fractures in women. The amounts of retinol in fortified foods and vitamin supplements may need to be reassessed.

Authors+Show Affiliations

Channing Laboratory, 181 Longwood Ave, Boston, MA 02115. diane.feskanich@channing.harvard.eduNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Research Support, Non-U.S. Gov't
Research Support, U.S. Gov't, Non-P.H.S.
Research Support, U.S. Gov't, P.H.S.

Language

eng

PubMed ID

11754708

Citation

Feskanich, Diane, et al. "Vitamin a Intake and Hip Fractures Among Postmenopausal Women." JAMA, vol. 287, no. 1, 2002, pp. 47-54.
Feskanich D, Singh V, Willett WC, et al. Vitamin A intake and hip fractures among postmenopausal women. JAMA. 2002;287(1):47-54.
Feskanich, D., Singh, V., Willett, W. C., & Colditz, G. A. (2002). Vitamin A intake and hip fractures among postmenopausal women. JAMA, 287(1), 47-54.
Feskanich D, et al. Vitamin a Intake and Hip Fractures Among Postmenopausal Women. JAMA. 2002 Jan 2;287(1):47-54. PubMed PMID: 11754708.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Vitamin A intake and hip fractures among postmenopausal women. AU - Feskanich,Diane, AU - Singh,Vishwa, AU - Willett,Walter C, AU - Colditz,Graham A, PY - 2002/1/12/pubmed PY - 2002/1/19/medline PY - 2002/1/12/entrez SP - 47 EP - 54 JF - JAMA JO - JAMA VL - 287 IS - 1 N2 - CONTEXT: Ingestion of toxic amounts of vitamin A affects bone remodeling and can have adverse skeletal effects in animals. The possibility has been raised that long-term high vitamin A intake could contribute to fracture risk in humans. OBJECTIVE: To assess the relationship between high vitamin A intake from foods and supplements and risk of hip fracture among postmenopausal women. DESIGN: Prospective analysis begun in 1980 with 18 years of follow-up within the Nurses' Health Study. SETTING: General community of registered nurses within 11 US states. PARTICIPANTS: A total of 72 337 postmenopausal women aged 34 to 77 years. MAIN OUTCOME MEASURES: Incident hip fractures resulting from low or moderate trauma, analyzed by quintiles of vitamin A intake and by use of multivitamins and vitamin A supplements, assessed at baseline and updated during follow-up. RESULTS: From 1980 to 1998, 603 incident hip fractures resulting from low or moderate trauma were identified. After controlling for confounding factors, women in the highest quintile of total vitamin A intake (>/=3000 microgram/d of retinol equivalents [RE]) had a significantly elevated relative risk (RR) of hip fracture (RR, 1.48; 95% confidence interval [CI], 1.05-2.07; P for trend =.003) compared with women in the lowest quintile of intake (<1250 microgram/d of RE). This increased risk was attributable primarily to retinol (RR, 1.89; 95% CI, 1.33-2.68; P for trend <.001 comparing >/=2000 microgram/d vs <500 microgram/d). The association of high retinol intake with hip fracture was attenuated among women using postmenopausal estrogens. Beta carotene did not contribute significantly to fracture risk (RR, 1.22; 95% CI, 0.90-1.66; P for trend =.10 comparing >/=6300 microgram/d vs <2550 microgram/d). Women currently taking a specific vitamin A supplement had a nonsignificant 40% increased risk of hip fracture (RR, 1.40; 95% CI, 0.99-1.99) compared with those not taking that supplement, and, among women not taking supplemental vitamin A, retinol from food was significantly associated with fracture risk (RR, 1.69; 95% CI, 1.05-2.74; P for trend =.05 comparing >/=1000 microgram/d vs <400 microgram/d). CONCLUSIONS: Long-term intake of a diet high in retinol may promote the development of osteoporotic hip fractures in women. The amounts of retinol in fortified foods and vitamin supplements may need to be reassessed. SN - 0098-7484 UR - https://www.unboundmedicine.com/medline/citation/11754708/Vitamin_A_intake_and_hip_fractures_among_postmenopausal_women_ L2 - https://jamanetwork.com/journals/jama/fullarticle/vol/287/pg/47 DB - PRIME DP - Unbound Medicine ER -