We developed an externally validated simple prediction model to predict serum 25(OH)D levels < 30, < 40, < 50 and 60 nmol/L in older women with risk factors for fractures. The benefit of the model reduces when a higher 25(OH)D threshold is chosen.
Vitamin D deficiency is associated with increased fracture risk in older persons. General supplementation of all older women with vitamin D could cause medicalization and costs. We developed a clinical model to identify insufficient serum 25-hydroxyvitamin D (25(OH)D) status in older women at risk for fractures.
In a sample of 2689 women ≥ 65 years selected from general practices, with at least one risk factor for fractures, a questionnaire was administered and serum 25(OH)D was measured. Multivariable logistic regression models with backward selection were developed to select predictors for insufficient serum 25(OH)D status, using separate thresholds 30, 40, 50 and 60 nmol/L. Internal and external model validations were performed.
Predictors in the models were as follows: age, BMI, vitamin D supplementation, multivitamin supplementation, calcium supplementation, daily use of margarine, fatty fish ≥ 2×/week, ≥ 1 hours/day outdoors in summer, season of blood sampling, the use of a walking aid and smoking. The AUC was 0.77 for the model using a 30 nmol/L threshold and decreased in the models with higher thresholds to 0.72 for 60 nmol/L. We demonstrate that the model can help to distinguish patients with or without insufficient serum 25(OH)D levels at thresholds of 30 and 40 nmol/L, but not when a threshold of 50 nmol/L is demanded.
This externally validated model can predict the presence of vitamin D insufficiency in women at risk for fractures. The potential clinical benefit of this tool is highly dependent of the chosen 25(OH)D threshold and decreases when a higher threshold is used.
Wood CL, Cheetham TD (2016) Vitamin D: increasing use among at-risk groups (NICE guideline PH56). Arch Dis Child Educ Ed 101(1):43–45. https://doi.org/10.1136/archdischild-2015-308299 CrossRef
Health Council of the Netherlands (2012) Evaluation of the dietary reference values for vitamin D. Health Council of the Netherlands, The Hague
Reid IR, Bolland MJ, Grey A (2014) Effects of vitamin D supplements on bone mineral density: a systematic review and meta-analysis. Lancet 383(9912):146–155. https://doi.org/10.1016/S0140-6736(13)61647-5 CrossRefPubMed
Bischoff-Ferrari HA, Willett WC, Orav EJ, Lips P, Meunier PJ, Lyons RA, Flicker L et al (2012) A pooled analysis of vitamin D dose requirements for fracture prevention. N Engl J Med 367:481 CrossRef
Weaver CM, Alexander DD, Boushey CJ, Dawson-Hughes B, Lappe JM, LeBoff MS, Liu S, Looker AC, Wallace TC, Wang DD (2016) Calcium plus vitamin D supplementation and risk of fractures: an updated meta-analysis from the National Osteoporosis Foundation. Osteoporos Int 27(1):367–376. https://doi.org/10.1007/s00198-015-3386-5 CrossRefPubMed
Avenell A, Mak JC, O’Conell D (2014) Vitamin D and vitamin D analogues for preventing fractures in post-menopausal women and older men. Cochrane Database Syst Rev 4:CD000227
Gillespie LD, Robertson MC, Gillespie WJ, Sherrington C, Gates S, Clemson LM et al (2012) Interventions for preventing falls in older people living in the community Cochrane Database Syst Rev CD007146
Bischoff-Ferrari HA, Dawson-Hughes B, Staehelin HB, Orav JE, Stuck AE, Theiler R, Wong JB, Egli A, Kiel DP, Henschkowski J (2009) Fall prevention with supplemental and active forms of vitamin D: a meta-analysis of randomized controlled trials. BMJ 339(oct01 1):b3692. https://doi.org/10.1136/bmj.b3692 CrossRefPubMedPubMedCentral
Bischoff-Ferrari HA (2010) Vitamin D and fracture prevention. Endocrinol Metab Clin N Am 39(2):347–353. https://doi.org/10.1016/j.ecl.2010.02.009 CrossRef
Van Schoor NM, Visser M, Pluijm SM, Kuchuk N, Smit JH, Lips P (2008) Vitamin D deficiency as a risk factor for osteoporotic fractures. Bone 42(2):260–266. https://doi.org/10.1016/j.bone.2007.11.002 CrossRefPubMed
Janssen HCJP, Emmelot-Vonk MH, Verhaar HJJ, van der Schouw YT (2013) Determinants of vitamin D status in healthy men and women aged 40-80 years. Maturitas 74(1):79–83. https://doi.org/10.1016/j.maturitas.2012.10.008 CrossRefPubMed
Annweiler C, Kabeshova A, Legeay M, Fantino B, Beauchet O (2015) Derivation and validation of a clinical diagnostic tool for the identification of older community-dwellers with hypovitaminosis D. J Am Med Dir Assoc 16:536.e8–536.19 CrossRef
Elders PJM, Merlijn T, Swart KMA, van Hout W, Van der Zwaard BC, Niemeijer C et al (2017) Design of the SALT osteoporosis study, a randomised pragmatic trial, to study a primary care screening and treatment program for the prevention of fractures in women aged 65 years or older. BMC Musculoskelet Disord 18(1):424. https://doi.org/10.1186/s12891-017-1783-y CrossRefPubMedPubMedCentral
Lips P (2012) Interaction between vitamin D and calcium. Scand J Clin Lab Invest 243:S60–S64
Brot C, Vestergaard P, Kolthoff N, Gram J, Hermann AP, Sorensen OH (2001) Vitamin D status and its adequacy in healthy Danish perimenopausal women: relationships to dietary intake, sun exposure and serum para-thyroid hormone. Br J Nutr 86(S1):S97–103. https://doi.org/10.1079/BJN2001345 CrossRefPubMed
Farrel C, Soldo J, Williams P, Herrmann M (2012) 25-Hydroxyvitamin D-testing: challenging the performance of current automated immunoassays. Clin Chem Lab Med 50:1953–1963
- Prediction of insufficient serum vitamin D status in older women: a validated model
K. M. A. Swart
M. W. Heymans
N. M. Van Schoor
C. J. Netelenbos
P. J. M. Elders
- Springer London
Neu im Fachgebiet Orthopädie und Unfallchirurgie
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