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Background : 25-hydroxyvitamin-D (25[OH]D) and Dual-energy x-ray absorptiometry (DEXA) are routinely evaluated in bone health clinics, but existing literature is conflicting with regard to whether these factors predict fragility fractures. We hypothesized that both serum 25(OH)D levels and bone density are lower in patients who have sustained fragility fracture(s) prior to initial presentation compared to those patients who have not. Methods : We reviewed the charts of 102 consecutive patients presenting to a single-center Bone Health Clinic, comprising 11 males and 91 females with a mean age of 68 and range of 50 to 92. Demographic data, serum 25(OH)D levels, fracture history, and DEXA scans were obtained at the initial visit. Results : 64 patients had previously sustained a fragility fracture, and 38 patients had not. 25(OH)D levels were similar in the fracture and non-fracture groups (37.12±17.02 ng/mL versus 38.55±16.42, p=0.676). DEXA T-scores were similar between fracture and non-fracture groups (-2.28±1.33 versus -1.82±1.1, p=0.075). Patients with rheumatoid arthritis (RA) (n=7) had lower 25(OH)D levels upon presentation (mean 22.57±8.46 versus 38.77±16.67, p=0.001). BMI was inversely correlated with 25(OH)D level (Pearson correlation [R] =-0.211, p=0.033). Age was inversely correlated with DEXA T-score (R=-0.269, p-0.009), whereas BMI was positively correlated with DEXA T-score (R=0.259, p=0.013). The other demographic variables and risk factors studied were not significantly associated with either 25(OH)D levels or DEXA T-scores. Within the fracture group, DEXA T-scores were lower for patients who had sustained a hip fracture (n=15) compared to those who had sustained a fragility fracture elsewhere (-3.12±1.02 versus -2.03±1.32, p=0.004), but their 25(OH)D levels did not differ (34.33±25.49 versus 37.98±13.69, p=0.602). Conclusions : In this cohort of patients referred to a Bone Health Clinic, serum 25(OH)D levels and DEXA T-scores did not differ between those patients who had sustained a fragility fracture from those who had not.

The utility of serum 25-Hydroxyvitamin-D and body mass index in the work-up of patients presenting to a bone health clinic