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Open AccessArticle

Elevated Serum 25-Hydroxyvitamin D Levels Are Associated with Improved Bone Formation and Micro-Structural Measures in Elderly Hip Fracture Patients

1
Health and Biomedical Innovation, School of Pharmacy and Medical Sciences, University of South Australia, Adelaide 5001, Australia
2
Royal Adelaide Hospital, Adelaide 5001, Australia
3
Centre for Orthopaedic and Trauma Research, The University of Adelaide, Adelaide 5001, Australia
*
Author to whom correspondence should be addressed.
H.A.M. is deceased.
Co-senior author.
J. Clin. Med. 2019, 8(11), 1988; https://doi.org/10.3390/jcm8111988
Received: 14 October 2019 / Revised: 11 November 2019 / Accepted: 13 November 2019 / Published: 15 November 2019
(This article belongs to the Special Issue Orthopaedics: Medicine and Mechanisms)
Vitamin D, along with calcium, is generally considered necessary for bone health and reduction of fractures. However, he effects of improving vitamin D status have not always been observed to improve bone mineral density (BMD). We have investigated whether varying vitamin D status in humans, as measured by serum 25(OH)D levels, relate to micro-structural and histomorphetric measures of bone quality and quantity, rather than density. Intertrochanteric trabecular bone biopsies and serum samples were collected from patients undergoing hip arthroplasty (65 females, 38 males, mean age 84.8 ± 8.3 years) at Royal Adelaide Hospital. Estimated GFR, serum ionized calcium, alkaline phosphatase, albumin, supplement and medication intake prior to surgery were taken from patient case records. Serum 25(OH)D, 1,25(OH)2D, and parathyroid hormone (PTH) levels were measured by immunoassays. Trabecular bone structural indices were determined by high-resolution micro-CT. Mean wall thickness (MWT) was measured on toluidine blue-stained histological sections. Bone mRNA levels for vitamin D metabolising enzymes CYP27B1 and CYP24A1 were measured by qRT-PCR. While serum 25(OH)D levels did not associate with bone volume/tissue volume (BV/TV%), serum 25(OH)D levels were strongly and independently associated with MWT (r = 0.81 p < 0.0001) with values significantly greater in patients with higher serum 25(OH)D levels. Furthermore, serum 25(OH)D levels were negatively associated with Bone Surface/Bone Volume (BS/BV) (r = −0.206, p < 0.05) and together with bone CYP27B1 and CYP24A1 mRNA accounted for 10% of the variability of BS/BV (p = 0.001). These data demonstrate that serum 25(OH)D is an independent positive predictor of micro-structural and bone formation measures and may be dependent, in part, on its metabolism within the bone. View Full-Text
Keywords: 25-hydroxyvitamin D; bone surface/bone volume ratio; plate-like trabecular structure; mean wall thickness; CYP27B1; CYP24A1 25-hydroxyvitamin D; bone surface/bone volume ratio; plate-like trabecular structure; mean wall thickness; CYP27B1; CYP24A1
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Sharma, D.K.; Sawyer, R.K.; Robertson, T.S.; Stamenkov, R.; Solomon, L.B.; Atkins, G.J.; Clifton, P.M.; Morris, H.A.; Anderson, P.H. Elevated Serum 25-Hydroxyvitamin D Levels Are Associated with Improved Bone Formation and Micro-Structural Measures in Elderly Hip Fracture Patients. J. Clin. Med. 2019, 8, 1988.

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