Different types of hip fragility fractures have different values of 25-hydroxyvitamin D and parathyroid hormone

Published:November 24, 2022DOI:



      Vitamin D insufficiency/deficiency is related to fragility fracture. In most previous studies, there was no assessment of vitamin D deficiency status separately for hip fracture types. The first aim is to evaluate vitamin D and parathyroid hormone (PTH) status in patients with hip fracture. The second objective is to determine whether there are differences in vitamin D and PTH between the femoral neck fracture and the femoral metaphyseal fracture group.


      62 men and 248 women with fragility hip fractures were enrolled. 25-hydroxyviamin D [25(OH)D] and intact PTH (iPTH) values were evaluated, and femoral neck bone mineral density (BMD) was measured on the uninjured side. Vertebral fractures (VFs) were assessed using radiographs of the thoracic and lumbar spine. We examined the relationships of 25(OH)D value with the number of prevalent VFs, T-score of femoral neck, and iPTH level. These analyses were also performed, neck fracture and trochanteric fracture separately.


      Mean age was 85 years. The mean 25(OH)D was 11.2 (range, 4.0–26.1) ng/ml, whereas the mean iPTH value was 48.9 pg/ml (range, 9–429 pg/ml). The mean number of VFs was 1.5 (range, 0–11), and the mean T-score was −3.3 (range, −5.2 to −0.5). There was a weak correlation between the 25(OH)D value and the number of VFs. There was a weak but significant correlation between 25(OH)D and iPTH values. In the patients with trochanteric fractures, 25(OH)D value was significantly lower and iPTH value was significantly higher than those with neck fractures. There was a significant correlation between the 25(OH)D value and number of the VFs, 25(OH)D, and iPTH values only in trochanteric fractures.


      Vitamin D deficiency was severe and PTH levels were higher in the trochanteric fractures. Both vitamin D deficiency and high PTH levels were suggested to have association with bone fragility.


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        • Siris E.S.
        • Adler R.
        • Bilezikian J.
        • Bolognese M.
        • Dawson-Hughes B.
        • Favus M.J.
        • et al.
        The clinical diagnosis of osteoporosis: a position statement from the national bone health alliance working group.
        Osteoporos Int. 2014 May; 25: 1439-1443
        • Salkeld G.
        • Cameron I.D.
        • Cumming R.G.
        • Easter S.
        • Seymour J.
        • Kurrle S.E.
        • et al.
        Quality of life related to fear of falling and hip fracture in older women: a time trade off study.
        BMJ. 2000 Feb 5; 320: 341-346
        • Holick M.F.
        • Binkley N.C.
        • Bischoff-Ferrari H.A.
        • Gordon C.M.
        • Hanley D.A.
        • Hassan Murad H.M.
        • et al.
        Evaluation, treatment, and prevention of vitamin D deficiency: an endocrine society clinical practice guideline.
        J Clin Endocrinol Metab. 2011 Jul; 96: 1911-1930
        • Julian C.
        • Lentjes M.A.
        • Huybrechts I.
        • Luben R.
        • Wareham N.
        • Moreno L.A.
        • et al.
        Fracture risk in relation to serum 25-hydroxyvitamin D and physical activity: results from the EPIC-Norfolk cohort study.
        PLoS One. 2016 Oct; 11e0164160
        • Tamaki J.
        • Iki M.
        • Sato Y.
        • Kajita E.
        • Nishino H.
        • Akiba T.
        • et al.
        Total 25-hydroxyvitamin D levels predict fracture risk: results from the 15-year follow-up of the Japanese population-based osteoporosis (JPOS) cohort study.
        Osteoporos Int. 2017 Jun; 28: 1903-1913
        • Yoshimura N.
        • Muraki S.
        • Oka H.
        • Morita M.
        • Yamada H.
        • Tanaka S.
        • et al.
        Profiles of vitamin D insufficiency and deficiency in Japanese men and women: association with biological, environmental, and nutritional factors and coexisting disorders: the ROAD study.
        Osteoporos Int. 2013 Nov; 24: 2775-2787
        • Man R.E.
        • Li L.J.
        • Cheng C.Y.
        • Wong T.Y.
        • Lamoureux E.
        • Sabanayagam C.
        Prevalence and determinants of suboptimal vitamin D levels in a multiethnic Asian population.
        Nutrients. 2017; 9: 313
        • Saito H.
        • Kishimoto K.N.
        • Mori Y.
        • Okuno H.
        • Tanaka M.
        • Itoi E.
        A vitamin D analogue, eldecalcitol, enhances expression of fast myosin heavy chain subtypes in differentiated C2C12 myoblasts.
        J Orthop Res. 2017 Mar; 22: 345-350
        • Saito T.
        • Mori Y.
        • Irei O.
        • Baba K.
        • Nakajo S.
        • Itoi E.
        Effect of eldecalcitol on muscle function and fall prevention in Japanese postmenopausal women: a randomized controlled trial.
        J Orthop Res. 2021 Jan; 26: 173-178
        • Sakuma M.
        • Endo N.
        • Oinuma T.
        • Hayami T.
        • Endo E.
        • Yazawa T.
        • et al.
        Vitamin D and intact PTH status in patients with hip fracture.
        Osteoporos Int. 2006; 17: 1608-1614
        • Nakano T.
        • Tsugawa N.
        • Kuwabara A.
        • Kamao M.
        • Tanaka K.
        • Okano T.
        High prevalence of hypovitaminosis D and K in patients with hip fracture.
        Asia Pac J Clin Nutr. 2011; 20: 56-61
        • Fisher A.
        • Srikusalanukul W.
        • Davis M.
        • Smith P.
        Hip fracture type: important role of parathyroid hormone (PTH) response to hypovitaminosis D.
        Bone. 2010 Aug; 47: 400-407
        • Soen S.
        • Fukunaga M.
        • Sugimito T.
        • Sone T.
        • Fujiwara S.
        • Endo N.
        • et al.
        • Japanese Society for Bone and Mineral Research and Japanese Osteoporosis Society Joint Review Committee for the Revision of the Diagnostic Criteria for Primary Osteoporosis
        Diagnostic Criteria for primary osteoporosis: year 2012 revision.
        J Bone Miner Metab. 2013 May; 31: 247-257
        • Fink H.A.
        • Milavetz D.L.
        • Palermo L.
        • Nevitt M.C.
        • Cauley J.A.
        • Genant H.K.
        • et al.
        What proportion of incident radiographic vertebral deformities is clinical diagnosed and vice versa?.
        J Bone Miner Res. 2005 Jul; 20: 1216-1222
      1. Japanese Society of Nephrology eds. Evidence-based clinical practice guideline for CKD 2018. Tokyo-Igakusha, Tokyo, Japan (in Japanese) p.2.

        • Genant H.K.
        • Wu C.Y.
        • van Kuijk C.
        • Nevitt M.C.
        Vertebral fracture assessment using a semiquantitative technique.
        J Bone Miner Res. 1993 Sep; 8: 1137-1148
        • Nuti R.
        • Martini G.
        • Valenti R.
        • Gambera D.
        • Gennari L.
        • Salcadori S.
        • et al.
        Vitamin D status and bone turnover in women with acute hip fracture.
        Clin Orthop Relat Res. 2004 May; 422: 208-213
        • El Maghraoui A.
        • Ouzzif Z.
        • Mounach A.
        • Rezqi A.
        • Achemlal L.
        • Bezza A.
        • et al.
        Hypovitaminosis D and prevalent asymptomatic vertebral fractures in Moroccan postmenopausal women.
        BMC Woman’s Health. 2012 Apr 24; 12: 11
        • Jiajue R.
        • Jiang Y.
        • Qi X.
        • Wang Q.
        • Wang W.
        • Pei Y.
        • et al.
        Calciotropic hormones and the prevalence of vertebral fractures in Chinese postmenopausal women with vitamin D insufficiency: peking vertebral fracture study.
        Calcif Tissue Int. 2019 Jun; 104: 622-630
        • Lentle B.C.
        • Berger C.
        • Probyn L.
        • Brown J.P.
        • Langsetmo L.
        • Fine B.
        • et al.
        Comparative analysis of the radiology of osteoporotic vertebral fractures in women and men: cross-sectional and longitudinal observations from the Canadian Multicentre Osteoporosis Study (CaMos).
        J Bone Miner Res. 2018 Apr; 33: 569-579
        • van Ballegooigen A.J.
        • Robinson-Cohen C.
        • Katz R.
        • Criqui M.
        • Budoff M.
        • Siscovick D.
        • et al.
        Vitamin D metabolites and bone mineral density: the multi-ethnic study of atherosclerosis.
        Bone. 2015 Sep; 78: 186-193
        • Di Monaco M.
        • Castiglioni C.
        • Tappero R.
        Parathyroid hormone response to severe vitamin D deficiency is associated with femoral neck bone mineral density: an observational study of 405 women with hip fracture.
        Hormones (Basel). 2016; 15: 527-533
        • Gonnelli S.
        • Caffarelli C.
        • Maggi S.
        • Rossi S.
        • Siviero P.
        • Gandolini G.
        • et al.
        • BREAK Study Group
        The assessment of vertebral fractures in elderly women with recent hip fractures: the BREAK study.
        Osteoporos Int. 2013 Apr; 24: 1151-1159
        • Cho Y.
        • Lee I.
        • Ha S.H.
        • Park J.H.
        • Park J.H.
        Comparison of hip subregion bone mineral density to the type of proximal femur fracture.
        Arch Osteoporos. 2020 Aug 5; 15: 122
        • Zhao J.
        • Cai Q.
        • Jiang D.
        • Wang L.
        • Chen S.
        • Jia W.
        The associations of serum vitamin D and bone turnover markers with the type and severity of hip fracture in older women.
        Clin Interv Aging. 2020; 15: 1971-1978
        • Zhang L.
        • Chan C.
        • Yang Y.
        • Liu B.
        • Zhu Y.
        • Chen R.
        • et al.
        Vitamin D deficiency/insufficiency is associated with risk of osteoporotic thoracolumbar junction vertebral fractures.
        Med Sci Monit. 2019; 25: 8260-8268
        • Dretakis K.
        • Igoumenou V.G.
        The role of parathyroid hormone (PTH) and vitamin D in falls and hip fracture type.
        Aging Clin Exp Res. 2019 Oct; 31: 1501-1507
        • Rejnmark L.
        • Ejlsmark-Svensson H.
        Effects of PTH and PTH hypersecretion on bone: a clinical perspective.
        Curr Osteoporos. 2020 Jun; 18: 103-114
        • Osima M.
        • Borgen T.T.
        • Lukic M.
        • Grimnes G.
        • Joakimsen R.M.
        • Eriksen E.F.
        • et al.
        Serum parathyroid hormone is associated with increased cortical porosity of the inner transitional zone at the proximal femur in postmenopausal women: the Tromsø study.
        Osteoporos Int. 2018 Feb; 29: 421-431
        • Zhuang H.
        • Li Y.
        • Lin J.
        • Cai D.
        • Yan L.
        • Yao X.
        Cortical thickness in the intertrochanteric region may be relevant to hip fracture type.
        BMC Muscoskelet Disord. 2017 Jul 18; 18: 305