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Previous Volume 348:287-294 January 23, 2003 Number 4 Next

	Full Text PDF PDA Full Text PowerPoint Slide Set Editorial by Lips, P. Letters Add to Personal Archive Add to Citation Manager Notify a Friend E-mail When Cited E-mail When Letters Appear PubMed Citation

ABSTRACT

Background Although studies in animals and epidemiologic studies have indicated that a high vitamin A intake is associated with increased bone fragility, no biologic marker of vitamin A status has thus far been used to assess the risk of fractures in humans.

Methods We enrolled 2322 men, 49 to 51 years of age, in a population-based, longitudinal cohort study. Serum retinol and beta carotene were analyzed in samples obtained at enrollment. Fractures were documented in 266 men during 30 years of follow-up. Cox regression analysis was used to determine the risk of fracture according to the serum retinol level.

Results The risk of fracture was highest among men with the highest levels of serum retinol. Multivariate analysis of the risk of fracture in the highest quintile for serum retinol (>75.62 µg per deciliter [2.64 µmol per liter]) as compared with the middle quintile (62.16 to 67.60 µg per deciliter [2.17 to 2.36 µmol per liter]) showed that the rate ratio was 1.64 (95 percent confidence interval, 1.12 to 2.41) for any fracture and 2.47 (95 percent confidence interval, 1.15 to 5.28) for hip fracture. The risk of fracture was further increased within the highest quintile for serum retinol. Men with retinol levels in the 99th percentile (>103.12 µg per deciliter [3.60 µmol per liter]) had an overall risk of fracture that exceeded the risk among men with lower levels by a factor of seven (P<0.001). The level of serum beta carotene was not associated with the risk of fracture.

Conclusions Our findings, which are consistent with the results of studies in animals, as well as in vitro and epidemiologic dietary studies, suggest that current levels of vitamin A supplementation and food fortification in many Western countries may need to be reassessed.

Source Information

From the Department of Surgical Sciences, Section of Orthopedics (K.M.), the Department of Public Health and Caring Sciences, Sections of Geriatrics (H.L.) and Clinical Nutrition Research (B.V.), and the Department of Medical Sciences, Section of Clinical Pharmacology (H.M.), University Hospital, Uppsala, Sweden.

Address reprint requests to Dr. Michaëlsson at the Department of Surgical Sciences, Section of Orthopedics, University Hospital, S-751 85 Uppsala, Sweden, or at karl.michaelsson{at}surgsci.uu.se.

Full Text of this Article

Related Letters:

Serum Retinol Levels and Fracture Risk
Boucher B. J., Chandra R. K., Melhus H., Michaëlsson K.
Extract | Full Text | PDF  
N Engl J Med 2003; 348:1927-1928, May 8, 2003. Correspondence

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