Suboptimal Vitamin D Status: a Risk Factor for Osteoporosis?

Part of the Advances in Nutritional Research book series (ANUR, volume 9)


Severe vitamin D deficiency of long duration leads to osteomalacia, characterized by bone pain, muscle weakness, fractures and pseudofractures or Looser zones (Frame and Parfitt, 1978). Osteomalacia is relatively rare and occurs mainly in certain risk groups, e.g., patients with malabsorption and immigrants to Northwestern Europe from Asian and African countries. About 25 years ago it was recognized by Chalmers et al. (1967) that elderly women also were at risk for osteomalacia. They described 37 patients, 34 women and 3 men, mean age 72 years, of whom 19 had previously undergone gastric surgery. Looser zones, indicating gross osteomalacia, were present in 30 patients. Chalmers et al. (1969) found an association between osteomalacia and hip fractures. Later on, the measurement of vitamin D metabolites became feasible and low serum concentrations of 25-hydroxyvitamin D (25-OHD) were reported in institutionalized elderly and geriatric patients (Preece et al., 1975; Corless et al., 1975).


Bone Loss Elderly People Elderly Subject Femoral Neck Fracture Parathyroid Function 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.


  1. Aaron, J.E., Gallagher, J.C., Anderson J., Stasiak, L., Longton, E.B., Nordin, B.E.C., and Nicholson M., 1974, Frequency of osteomalacia and osteoporosis in fractures of the proximal femur, Lancet 1: 229.CrossRefGoogle Scholar
  2. Boland, R., 1986, Role of vitamin D in skeletal muscle function, Endocrinol. Rev. 7: 434.CrossRefGoogle Scholar
  3. Bouillon, R.A., Auwerx, J.H., Lissens, W.D., and Pelemans, W.K., 1987, Vitamin D status in the elderly; seasonal substrate deficiency causes 1,25-dihydroxycholecalciferol deficiency, Am. J. Clin. Nutr. 45: 755.Google Scholar
  4. Bouillon, R., Pelemans, W., and Quesada, J.M., 1991, “Vitamin D deficiency in the elderly,” in: Nutritional Aspects of Osteoporosis (P. I3uckhardt and R.P. Heaney, eds.), Serono Symposia 85, pp. 245–256, Raven Press, New York.Google Scholar
  5. Brown, I.R.E, Bakowska, A., and Millard, PH., 1976, Vitamin D status of patients with femoral neck fracture, Age Aging 5: 127.CrossRefGoogle Scholar
  6. Chalmers, J., Conacher, W.D.H., Gardner, D.L., and Scott, P.J., 1967, Osteomalacia, a common disease in elderly women, J. Bone Joint Surg. 49B: 403.Google Scholar
  7. Chalmers, J., Barclay, A., Davidson, A.M., Macleod, D.A.D., and Williams, D.A., 1969, Quantitative measurements of osteoid in health and disease. Clin. Orthop. 63: 196.Google Scholar
  8. Chapuy, M.C., Chapuy, E, and Meunier, P.J., 1987, Calcium and vitamin D supplements: effects on calcium metabolism in elderly people, Am. J. Clin. Nutr. 46: 324.Google Scholar
  9. Chapuy, M.C., Arlot, M.E., Duboeuf, E, Brun, J., Crouzet, B., Arnaud, S., Delmas, RD., and Meunier, P.J., 1992, Vitamin D3 and calcium to prevent hip fractures in elderly women, N. Engl. J. Med. 327: 1637.CrossRefGoogle Scholar
  10. Clements, M.R., Davies, M., Fraser, D.R., Lumb, G.A., Mawer, E.B., and Adams, P.H., 1987, Metabolic inactivation of vitamin D is enhanced in primary hyperparathyroidism, Clin. Sci. 73: 659.Google Scholar
  11. Corless, D., Beer, M., Boucher, B.J., Gupta, S.P., and Cohen, R.D., 1975, Vitamin D status in long-stay geriatric patients, Lancet 1: 140.Google Scholar
  12. Corless, D., Gupta, S.E, Switala, S., Boucher, B.J., Barragry, J.M., and Cohen, R.D., 1978, Response of plasma 25-hydroxyvitamin D to ultraviolet irradiation in long-stay geriatric patients, Lancet 2: 649.CrossRefGoogle Scholar
  13. Corless, D., Dawson, E., Fraser F., Ellis, M., Evans, S.J.W., Perry, J.D., Reisner, C., Silver, C.P., Beer, M., Boucher, B.J., and Cohen, R.D., 1985, Do vitamin D supplements improve the physical capabilities of elderly hospital patients? Age Aging 14: 76.CrossRefGoogle Scholar
  14. Davies, M., Mawer, E.B., Hann, J.T., Stephens, W.P., and Taylor, J.L., 1985, Vitamin D prophylaxis in the elderly: a simple effective method suitable for large populations, Age Ageing 14: 349.CrossRefGoogle Scholar
  15. Dawson-Hughes, B., Dallai, G.E., Krall, E.A., Harris, S., Sokoll, L.J., and Falconer, G., 1991, Effect of vitamin D supplementation on wintertime and overall bone loss in healthy postmenopausal women, Ann. Intern. Med. 115: 505.CrossRefGoogle Scholar
  16. DeLuca, H.F., 1990, Osteoporosis and the metabolites of vitamin D, Metabolism 39:Suppl. 1: 3.Google Scholar
  17. Duda, R.J., Kumar, R., Nelson, K.I., Zinsmeister, A.R., Mann, K.G., and Riggs, B.L., 1987, 1,25-Dihydroxyvitamin D stimulation test for osteoblast function in normal and osteoporotic postmenopausal women, J Clin. Invest. 79: 1249.Google Scholar
  18. Faccini, J.M., Exton-Smith, A.N., and Boyde, A., 1976, Disorders of bone and fracture of the femoral neck, Lancet I: 1089.CrossRefGoogle Scholar
  19. Fonseca, V., Agnew, J.E., Nag, D., and Dandona, R, 1988, Bone density and cortical thickness in nutritional vitamin D deficiency; effect of secondary hyperparathyroidism, Ann. Clin. Biochem. 25: 271.Google Scholar
  20. Frame, B., and Parfitt, A.M., 1978, Osteomalacia: current concepts, Ann. Intern. Med. 89: 966.CrossRefGoogle Scholar
  21. Gallagher, J.C., Riggs, B.L., Eisman, J., Hamstra, A., Arnaud, S.B., and DeLuca, H.F., 1979, Intestinal calcium absorption and serum vitamin D metabolites in normal subjects and osteoporotic patients, J. Clin. Invest. 64: 729.CrossRefGoogle Scholar
  22. Heaney, R.P., 1986, “Calcium, bone health and osteoporosis,” in: Bone and Mineral Research 4 ( W. Peck, ed.), pp. 255–301, Elsevier, Amsterdam and New York.Google Scholar
  23. Heikinheimo, R.J., Inkovaara, J.A., Harju, E.J., Haavisto, M.V., Kaarela, R.H., Kataja, J.M., Kokko, A.M.L., Kolho, L.A., and Rajala, S.A., 1992, Annual injection of vitamin D and fractures of aged bones, Calcif. Tissue Int. 51: 105.CrossRefGoogle Scholar
  24. Himmelstein, S., Clemens, T.L., Rubin, A., and Lindsay R., 1990, Vitamin D supplementation in elderly nursing home residents increases 25-OHD but not 1,25(OH)2D, Am. J Clin. Nutr. 52: 701.Google Scholar
  25. Hodkinson, H.M., 1971, Fracture of the femoral neck in the elderly: Assessment of the role of osteomalacia, Gerontol. Clin. 13: 153.CrossRefGoogle Scholar
  26. Hoikka, V., Althava, E.M., Savolaimen, K., and Parviamen, M., 1982, Osteomalacia in fractures of the proximal femur, Acta. Orthop. Scand. 53: 255.CrossRefGoogle Scholar
  27. Holick, M.F., 1990, “Vitamin D and the skin: photobiology, physiology and therapeutic efficacy for psoriasis,” in: Bone and Mineral Research 7, ( J.N.M. Heersche and J.A. Kanis, eds.), pp. 313–366, Elsevier, Amsterdam.Google Scholar
  28. Hordon, L.D., and Peacock, M., 1990, Osteomalacia and osteoporosis in femoral neck fracture, Bone Mineral 11: 147.Google Scholar
  29. Hosking, D.J., Kemm, J.R., Knight M.E., Campbell, G.A., Cotton, R.E., Berryman, R., and Boyd, R.V., 1983, Screening for subclinical osteomalacia in the elderly: normal ranges or pragmatism? Lancet 2: 1290.CrossRefGoogle Scholar
  30. Jenkins, D.H.R., Roberts, J.G., Webster, D., and Williams, E.O., 1973, Osteomalacia in elderly patients with fracture of the femoral neck, J. Bone Jt. Surg. (Br) 55: 575.Google Scholar
  31. Johnson, K.R., Jobber, J., and Stonawski, B.J., 1980, Prophylactic vitamin D in the elderly, Age Ageing 9: 121.CrossRefGoogle Scholar
  32. Johnston, C.C., Norton, J., Khairi, M.R., Kernek, C., Edouard, C., Arlot, M., and Meunier, P.J., 1985, Heterogeneity of fracture syndromes in postmenopausal women, J Clin. Endocrinol. Metab. 61: 551.CrossRefGoogle Scholar
  33. Khaw, K.T., Sneyd, M.J., and Compston, J., 1992, Bone density, parathyroid hormone and 25-hydroxyvitamin D concentrations in middle aged women, Br. Med. J. 305: 273.CrossRefGoogle Scholar
  34. Knorring, J. von, Slätis, P., Weber, T.H., and Helenius, T., 1982, Serum level of 25hydroxyvitamin D, 24,25-dihydroxyvitamin D and parathyroid hormone in patients with femoral neck fracture in Southern Finland, Clin. Endocrinol. 17: 189.CrossRefGoogle Scholar
  35. Krall, E.A., Sahyoun, N., Tannenbaum, S., Dallai, G.E., and Dawson-Hughes, B., 1989, Effect of vitamin D intake on seasonal variations in parathyroid hormone secretion in postmenopausal women, N. Engl. J. Med. 321: 1777.CrossRefGoogle Scholar
  36. Lips, P., 1991, “Vitamin D nutrition in the elderly; problems and recommendations,” in: Vitamin D: Gene Regulation, Structure-Function Analysis and Clinical Application, ( A.W. Norman, R. Bouillon, M. Thomasset, eds.), pp. 757–764, Walter de Gruyter, Berlin, New York.Google Scholar
  37. Lips, P., and Obrant, K., 1991, The pathogenesis and treatment of hip fractures, Osteoporosis Int. I: 218.CrossRefGoogle Scholar
  38. Lips, P., Netelenbos, J.C., Jongen, M.J.M., van Ginkel, F.C., Althuis, A.L., van Schaik, C.L., Van der Vijgh, W.J.F., Vermeiden, J.P.W., and Van der Meer, C., 1982, Histomorphometric profile and vitamin D status in patients with femoral neck fracture, Metab. Bone Dis. Rel. Res. 4: 85.CrossRefGoogle Scholar
  39. Lips, P., Hackeng, W.H.L., Jongen, M.J.M., van Ginkel, F.C., and Netelenbos, J.C., 1983, Seasonal variation in serum concentrations of parathyroid hormone in elderly people, J. Clin. Endocrinol. Metab. 57: 204.CrossRefGoogle Scholar
  40. Lips, P., Bouillon, R., Jongen, M.J.M., van Ginkel, F.C., van der Vijgh, W.J.F., and Netelenbos J.C., 1985, The effect of trauma on serum concentrations of vitamin D metabolites in patients with hip fracture, Bone 6: 63.CrossRefGoogle Scholar
  41. Lips, P., van Ginkel, F.C., Jongen, M.J.M., Rubertus, A., van der Vijgh, W.J.F., and Netelenbos, J.C., 1987, Determinants of vitamin D status in patients with hip fracture and elderly control subjects, Am. J. Clin. Nutr. 46: 1005.Google Scholar
  42. Lips, P, Wiersinga, A., van Ginkel, F.C., Jongen, M.J.M., Netelenbos, J.C., Hackeng, W.H.L., Delmas, P.D., and Van der Vijgh, W.J.E, 1988, The effect of vitamin D supplementation on vitamin D status and parathyroid function in elderly subjects, J Clin. Endocrinol. Metab. 67: 644.CrossRefGoogle Scholar
  43. Lips, P, van Ginkel, EC., Netelenbos, J.C., Wiersinga, A., and van der Vijgh, W.J.F., 1990a, Lower mobility and markers of bone resorption in the elderly, Bone and Mineral 9: 49.CrossRefGoogle Scholar
  44. Lips, P., Hesp, R., Reeve, J., Wootton, R., Green, J.R., and Klenerman, L., 1990b, High indices of remodelling in iliac trabecular bone predict reduced forearm cortical bone mass indices in patients with proximal femoral fractures, Bone and Mineral 11: 93.CrossRefGoogle Scholar
  45. Lund, B., Sorensen, O.H., and Christensen, A.B., 1975, 25-hydroxy-cholecalciferol and fractures of the proximal femur, Lancet 2: 300.Google Scholar
  46. MacLaughlin, J., and Holick, M.F., 1985, Aging decreases the capacity of human skin to produce vitamin D3, J. Clin. Invest. 76: 1536.CrossRefGoogle Scholar
  47. McKenna, M.J., Freaney, R., Meade, A., and Muldowney, EP., 1985, Hypovitaminosis D and elevated serum alkaline phosphatase in elderly Irish people, Am. J. Clin. Nutr. 41: 101.Google Scholar
  48. McLennan, W.J., and Hamilton, J.C., 1977, Vitamin D supplements and 25-hydroxyvitamin D concentrations in the elderly, Br. Med. J. 2: 859.CrossRefGoogle Scholar
  49. McLeod, C.C., Judge, T.G., and Caird, F.I., 1974, Nutrition of the elderly at home; II: Intake of vitamins, Age Aging 3: 209.CrossRefGoogle Scholar
  50. Meunier, R.I., Edouard, C., Richard, D., and Laurent, J., 1977, “Histomorphometry of osteoid tissue: the hyperosteoidoses,” in: Second International Workshop on Bone Histomorphometry, ( P.J. Meunier, ed.), pp. 249–262, Armour Montagu, Paris.Google Scholar
  51. Meunier, P.J., Chapuy, M.C., Arlot, M.E., Delmas, P.D., Duboeuf, E, Brun, J., Crouzet, B., and Arnaud, S., 1991, Effects of a calcium and vitamin D3 supplement on non-vertebral fracture rate, femoral bone density, and parathyroid function in elderly women, J. Bone Min. Res. 5: 135 (abstract).Google Scholar
  52. Netelenbos, J.C., Jongen, M.J.M., van der Vijgh, W.J.F., Lips, P., and van Ginkel, F.C., 1985, Vitamin D status in urinary calcium stone formation, Arch. Intern. Med. 145: 681.CrossRefGoogle Scholar
  53. Omdahl, J.L., Garry, P.J., Hunsaker, L.A., Hunt, W.C., and Goodwin, J.S., 1982, Nutritional status in a healthy elderly population, Am. J. Clin. Nutr. 36: 1225.Google Scholar
  54. Parfitt, A.M., 1980, Morphological basis of bone mineral measurements: transient and steady state effects of treatment in osteoporosis, Min. Electrolyte Metab. 4: 273.Google Scholar
  55. Parfitt, A.M., Matthews, C., Rao, D., Frame, B., Kleerekoper, M., and Villanueva, A.R., 1981, “Impaired osteoblast function in metabolic bone disease,” in: Osteoporosis, Recent Advances in Pathogenesis and Treatment, ( H.E DeLuca, H.M. Frost, W.S.S. Jee, C.C. Johnston and A.M. Parfitt, eds.), pp. 321–30, University Park Press, Baltimore.Google Scholar
  56. Parfitt, A.M., Gallagher, J.C., Heaney, R.P., Johnston, C.C., Neer, R., and Whedon, G.D., 1982, Vitamin D and bone health in the elderly, Am. J. Clin. Nutr. 36: 1014.Google Scholar
  57. Preece, M.A., Tomlinson,S., Ribot, C.A., Pietrek, J., Korn, H.T., Davies, D.M., Ford, J.A., Dunnigan, M.G., and O’Riordan, J.L.H., 1975, Studies of vitamin D deficiency in men, Quart. J. Med. 44: 575.Google Scholar
  58. Sherman, S.S., Hollis, B.W., and Tobin, J., 1990, Vitamin D status and related parameters in a healthy population: the effects of age, sex and season, J. Clin. Endocrinol. Metab. 71: 405.CrossRefGoogle Scholar
  59. Sokoloff, L., 1978, Occult osteomalacia in American (USA) patients with fracture of the hip, Am. J. Surg. Pathol. 2: 21.CrossRefGoogle Scholar
  60. Toss, G., Andersson, R., Diffey, B.L., Fall, P.A., Larks, O., and Larsson, L., 1982, Oral vitamin D and ultraviolet radiation for the prevention of vitamin D deficiency in the elderly, Acta Med. Scand. 212: 157.CrossRefGoogle Scholar
  61. Toss, G., Larsson, L., and Lindgren, S., 1983, Serum levels of 25-hydroxyvitamin D in adults and elderly humans after a prophylactic dose of vitamin D2, Scand. J. Clin. Lab. Invest. 43: 329.Google Scholar
  62. Tsai, K.S., Heath, H., Kumar, R., and Riggs, B.L., 1984, Impaired vitamin D metabolism with aging in women; possible role in pathogenesis of senile osteoporosis, J. Clin. Invest. 73: 1668.CrossRefGoogle Scholar
  63. Villareal, D.T., Civitelli, R., Chines, A., and Avioli, L.V., 1991, Subclinical vitamin D deficiency in postmenopausal women with low vertebral bone mass, J. Clin. Endocrinol. Metab. 72: 628.CrossRefGoogle Scholar
  64. Vir, S.C., and Love, A.H.G., 1978, Vitamin D status of elderly at home and institutionalized in hospital, Int. J. Vit. Nutt: Res. 48: 123.Google Scholar
  65. Wicks, M., Garrett, R., Vernon-Roberts, B., and Fazzalari, N., 1982, Absence of metabolic bone disease in the proximal femur in patients with fracture of the femoral neck, J. Bone Joint Surg. (Br) 64: 319.Google Scholar
  66. Wilton, T.J., Hosking, D.J., Pawley, F., Stevens, A., and Harvey, I., 1987, Osteomalacia and femoral neck fractures in the elderly, J. Bone Joint Surg. (Br) 69: 388.Google Scholar
  67. Wootton, R., Brereton, P.J., Clark M.B., Hesp. R., Hodkinson, H.M., Klenerman L., Reeve, J., Slavin, G., and Tellez-Judilevich, M., 1979, Fractured neck of femur in the elderly: an attempt to identify patients at risk, Clin. Sci. 57: 93.Google Scholar

Copyright information

© Springer Science+Business Media New York 1994

Authors and Affiliations

  • P. Lips
    • 1
  1. 1.Afdeling Endocrinologie, Academisch ZiekenhuisVrije UniversiteitAmsterdamNetherlands

Personalised recommendations