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Serum retinoids and beta-carotene as predictors of hip and other fractures in elderly women.

Abstract

There is debate about the possible deleterious effect of excessive vitamin A exposure on fracture risk. In this nested case control study in older women (312 cases and 934 controls), serum retinol, retinyl palmitate, and beta-carotene were not associated with fracture risk, and there was no evidence of excess risk with multivitamin or cod liver oil supplementation.

INTRODUCTION

Recent studies have suggested that higher vitamin A intake may account for a component of fracture risk within the general population and that supplemental vitamin A may be harmful even within recommended limits. No studies have examined the relationship between biochemical retinol status and fracture in older women.

MATERIALS AND METHODS

We examined serum retinol, retinyl palmitate, and beta-carotene as predictors of incident hip and other fractures in a large prospective study of British women over the age of 75 years (n = 2606, 312 incident osteoporotic fractures, 92 incident hip fractures; mean follow-up duration, 3.7 years). Fasting blood samples (9:00-11:00 a.m.) were collected at baseline. Using a case-control design (three controls per case), serum retinol, retinyl palmitate, and beta-carotene were assessed as univariate predictors of incident osteoporotic fracture or hip fracture. Baseline BMD at the total hip, age, 25(OH)D, serum beta Crosslaps, bone-specific alkaline phosphatase, weight, height, and smoking were considered as covariates in a multivariate model.

RESULTS

Serum retinol, retinyl palmitate, and beta-carotene were not significant univariate predictors of either hip fracture or any fracture (all p > 0.05; Cox proportional hazards regression). For all osteoporotic fractures, the hazard ratio (HR) was 0.92 (95% CI, 0.81-1.05) per 1 SD increase in serum retinol. Risk of any osteoporotic fracture was slightly less in the highest quartile of serum retinol compared with the lowest quartile (HR, 0.85; 95% CI, 0.69-1.05; p = 0.132) There was a tendency for increased serum retinol to predict benefit rather than harm in terms of BMD (r = 0.09, p = 0.002). Multivitamin or cod liver oil supplementation was associated with a significantly lower risk of any fracture (HR, 0.76; 95% CI, 0.60-0.96; p = 0.021). In multivariate analysis, only age, total hip BMD, and weight were associated with fracture risk (p < 0.05).

CONCLUSIONS

We found no evidence to support any skeletal harm associated with increased serum indices of retinol exposure or modest retinol supplementation in this population.

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  • Authors+Show Affiliations

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    Human Nutrition Unit, Division of Clinical Sciences (North), University of Sheffield, United Kingdom. m.e.barker@sheffield.ac.uk

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    Source

    MeSH

    Aged
    Alkaline Phosphatase
    Body Height
    Body Weight
    Bone Density
    Bone and Bones
    Case-Control Studies
    Dietary Supplements
    Female
    Hip Fractures
    Humans
    Multivariate Analysis
    Osteoporosis
    Proportional Hazards Models
    Regression Analysis
    Retinoids
    Risk Factors
    Time Factors
    Vitamin A
    beta Carotene

    Pub Type(s)

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

    Language

    eng

    PubMed ID

    15883630

    Citation

    Barker, Margo E., et al. "Serum Retinoids and Beta-carotene as Predictors of Hip and Other Fractures in Elderly Women." Journal of Bone and Mineral Research : the Official Journal of the American Society for Bone and Mineral Research, vol. 20, no. 6, 2005, pp. 913-20.
    Barker ME, McCloskey E, Saha S, et al. Serum retinoids and beta-carotene as predictors of hip and other fractures in elderly women. J Bone Miner Res. 2005;20(6):913-20.
    Barker, M. E., McCloskey, E., Saha, S., Gossiel, F., Charlesworth, D., Powers, H. J., & Blumsohn, A. (2005). Serum retinoids and beta-carotene as predictors of hip and other fractures in elderly women. Journal of Bone and Mineral Research : the Official Journal of the American Society for Bone and Mineral Research, 20(6), pp. 913-20.
    Barker ME, et al. Serum Retinoids and Beta-carotene as Predictors of Hip and Other Fractures in Elderly Women. J Bone Miner Res. 2005;20(6):913-20. PubMed PMID: 15883630.
    * Article titles in AMA citation format should be in sentence-case
    TY - JOUR T1 - Serum retinoids and beta-carotene as predictors of hip and other fractures in elderly women. AU - Barker,Margo E, AU - McCloskey,Eugene, AU - Saha,Shikha, AU - Gossiel,Fatma, AU - Charlesworth,Diane, AU - Powers,Hilary J, AU - Blumsohn,Aubrey, Y1 - 2005/01/24/ PY - 2004/08/04/received PY - 2004/11/11/revised PY - 2005/01/21/accepted PY - 2005/5/11/pubmed PY - 2005/10/4/medline PY - 2005/5/11/entrez SP - 913 EP - 20 JF - Journal of bone and mineral research : the official journal of the American Society for Bone and Mineral Research JO - J. Bone Miner. Res. VL - 20 IS - 6 N2 - UNLABELLED: There is debate about the possible deleterious effect of excessive vitamin A exposure on fracture risk. In this nested case control study in older women (312 cases and 934 controls), serum retinol, retinyl palmitate, and beta-carotene were not associated with fracture risk, and there was no evidence of excess risk with multivitamin or cod liver oil supplementation. INTRODUCTION: Recent studies have suggested that higher vitamin A intake may account for a component of fracture risk within the general population and that supplemental vitamin A may be harmful even within recommended limits. No studies have examined the relationship between biochemical retinol status and fracture in older women. MATERIALS AND METHODS: We examined serum retinol, retinyl palmitate, and beta-carotene as predictors of incident hip and other fractures in a large prospective study of British women over the age of 75 years (n = 2606, 312 incident osteoporotic fractures, 92 incident hip fractures; mean follow-up duration, 3.7 years). Fasting blood samples (9:00-11:00 a.m.) were collected at baseline. Using a case-control design (three controls per case), serum retinol, retinyl palmitate, and beta-carotene were assessed as univariate predictors of incident osteoporotic fracture or hip fracture. Baseline BMD at the total hip, age, 25(OH)D, serum beta Crosslaps, bone-specific alkaline phosphatase, weight, height, and smoking were considered as covariates in a multivariate model. RESULTS: Serum retinol, retinyl palmitate, and beta-carotene were not significant univariate predictors of either hip fracture or any fracture (all p > 0.05; Cox proportional hazards regression). For all osteoporotic fractures, the hazard ratio (HR) was 0.92 (95% CI, 0.81-1.05) per 1 SD increase in serum retinol. Risk of any osteoporotic fracture was slightly less in the highest quartile of serum retinol compared with the lowest quartile (HR, 0.85; 95% CI, 0.69-1.05; p = 0.132) There was a tendency for increased serum retinol to predict benefit rather than harm in terms of BMD (r = 0.09, p = 0.002). Multivitamin or cod liver oil supplementation was associated with a significantly lower risk of any fracture (HR, 0.76; 95% CI, 0.60-0.96; p = 0.021). In multivariate analysis, only age, total hip BMD, and weight were associated with fracture risk (p < 0.05). CONCLUSIONS: We found no evidence to support any skeletal harm associated with increased serum indices of retinol exposure or modest retinol supplementation in this population. SN - 0884-0431 UR - https://www.unboundmedicine.com/medline/citation/15883630/Serum_retinoids_and_beta_carotene_as_predictors_of_hip_and_other_fractures_in_elderly_women_ L2 - https://doi.org/10.1359/JBMR.050112 DB - PRIME DP - Unbound Medicine ER -