Low serum vitamin D is associated with higher cortical porosity in elderly men

Background Bone loss at peripheral sites in the elderly is mainly cortical and involves increased cortical porosity. However, an association between bone loss at these sites and 25‐hydroxyvitamin D has not been reported. Objective To investigate the association between serum levels of 25‐hydroxyvitamin D, bone microstructure and areal bone mineral density (BMD) in elderly men. Methods A population‐based cohort of 444 elderly men (mean ± SD age 80.2 ± 3.5 years) was investigated. Bone microstructure was measured by high‐resolution peripheral quantitative computed tomography, areal BMD by dual‐energy X‐ray absorptiometry and serum 25‐hydroxyvitamin D and parathyroid hormone levels by immunoassay. Results Mean cortical porosity at the distal tibia was 14.7% higher (12.5 ± 4.3% vs. 10.9 ± 4.1%, P < 0.05) whilst cortical volumetric BMD, area, trabecular bone volume fraction and femoral neck areal BMD were lower in men in the lowest quartile of vitamin D levels compared to the highest. In men with vitamin D deficiency (<25 nmol L −1 ) or insufficiency [25–49 nmol L −1 , in combination with an elevated serum level of parathyroid hormone (>6.8 pmol L −1 )], cortical porosity was 17.2% higher than in vitamin D‐sufficient men ( P < 0.01). A linear regression model including age, weight, height, daily calcium intake, physical activity, smoking vitamin D supplementation and parathyroid hormone showed that 25‐hydroxyvitamin D independently predicted cortical porosity (standardized β = −0.110, R 2 = 1.1%, P = 0.024), area (β = 0.123, R 2 = 1.4%, P = 0.007) and cortical volumetric BMD (β = 0.125, R 2 = 1.4%, P = 0.007) of the tibia as well as areal BMD of the femoral neck (β = 0.102, R 2 = 0.9%, P = 0.04). Conclusion Serum vitamin D is associated with cortical porosity, area and density, indicating that bone fragility as a result of low vitamin D could be due to changes in cortical bone microstructure and geometry.