Circulating 25-hydroxyvitamin D Levels and Frailty Status in Older Women

Overview

Journal J Clin Endocrinol Metab

Publisher Oxford University Press

Specialty Endocrinology

Date 2010 Dec 7

PMID 21131545

Citations 55

Authors

Kristine E Ensrud

Susan K Ewing

Lisa Fredman

Marc C Hochberg

Jane A Cauley

Teresa A Hillier

Steven R Cummings

Kristine Yaffe

Peggy M Cawthon

Affiliations

Soon will be listed here.

Abstract

Context: Vitamin D deficiency and frailty are common with aging, but the association between these conditions is uncertain.

Objective: To determine the association between 25-hydroxyvitamin D (25(OH)D) levels and prevalent and incident frailty status among older women.

Design: Cross-sectional and longitudinal analyses of a prospective cohort study.

Setting: Four U.S. centers.

Participants: 6307 women aged≥69 years.

Main Outcome Measures: Frailty status classified as robust, intermediate stage, or frail at baseline; and robust, intermediate stage, frail, or dead (all-cause mortality) at follow-up an average of 4.5 years later.

Results: At baseline, there was a U-shaped association between 25(OH)D level and odds of frailty with the lowest risk among women with levels 20.0-29.9 ng/ml (referent group). Compared with this group, the odds of frailty were higher among those with levels<15.0 ng/ml [multivariable odds ratio (MOR) 1.47, 95% confidence interval (CI), 1.19-1.82], those with levels 15.0-19.9 ng/ml (MOR 1.24, 95% CI 0.99-1.54), and those with levels≥30 ng/ml (MOR 1.32, 95% CI 1.06-1.63). Among 4551 nonfrail women at baseline, the odds of frailty/death (vs. robust/intermediate) at follow-up appeared higher among those with levels 15.0-19.9 ng/ml (MOR 1.21, 95% CI 0.99-1.49), but the CI overlapped 1.0. The odds of death (vs. robust/intermediate/frail at follow-up) was higher among those with levels<15.0 ng/ml (MOR 1.40, 95% CI 1.04-1.88) and those with levels 15.0-19.9 ng/ml (MOR 1.30, 95% CI 0.97-1.75), although the latter association did not quite reach significance.

Conclusion: Lower (<20 ng/ml) and higher (≥30 ng/ml) levels of 25(OH)D among older women were moderately associated with a higher odds of frailty at baseline. Among nonfrail women at baseline, lower levels (<20 ng/ml) were modestly associated with an increased risk of incident frailty or death at follow-up.

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References

Ensrud K, Ewing S, Taylor B, Fink H, Stone K, Cauley J . Frailty and risk of falls, fracture, and mortality in older women: the study of osteoporotic fractures. J Gerontol A Biol Sci Med Sci. 2007; 62(7):744-51. DOI: 10.1093/gerona/62.7.744. View

Puts M, Visser M, Twisk J, Deeg D, Lips P . Endocrine and inflammatory markers as predictors of frailty. Clin Endocrinol (Oxf). 2005; 63(4):403-11. DOI: 10.1111/j.1365-2265.2005.02355.x. View

Semba R, Bartali B, Zhou J, Blaum C, Ko C, Fried L . Low serum micronutrient concentrations predict frailty among older women living in the community. J Gerontol A Biol Sci Med Sci. 2006; 61(6):594-9. DOI: 10.1093/gerona/61.6.594. View

Folstein M, ROBINS L, Helzer J . The Mini-Mental State Examination. Arch Gen Psychiatry. 1983; 40(7):812. DOI: 10.1001/archpsyc.1983.01790060110016. View

Michelon E, Blaum C, Semba R, Xue Q, Ricks M, Fried L . Vitamin and carotenoid status in older women: associations with the frailty syndrome. J Gerontol A Biol Sci Med Sci. 2006; 61(6):600-7. DOI: 10.1093/gerona/61.6.600. View

Shardell M, Hicks G, Miller R, Kritchevsky S, Andersen D, Bandinelli S . Association of low vitamin D levels with the frailty syndrome in men and women. J Gerontol A Biol Sci Med Sci. 2009; 64(1):69-75. PMC: 2691187. DOI: 10.1093/gerona/gln007. View

Block G, Hartman A, Dresser C, CARROLL M, Gannon J, Gardner L . A data-based approach to diet questionnaire design and testing. Am J Epidemiol. 1986; 124(3):453-69. DOI: 10.1093/oxfordjournals.aje.a114416. View

Ensrud K, Lui L, Taylor B, Schousboe J, Donaldson M, Fink H . A comparison of prediction models for fractures in older women: is more better?. Arch Intern Med. 2009; 169(22):2087-94. PMC: 2811407. DOI: 10.1001/archinternmed.2009.404. View

Cummings S, Black D, Nevitt M, Browner W, Cauley J, Genant H . Appendicular bone density and age predict hip fracture in women. The Study of Osteoporotic Fractures Research Group. JAMA. 1990; 263(5):665-8. View

10.

Singh R, Taylor R, Reddy G, Grebe S . C-3 epimers can account for a significant proportion of total circulating 25-hydroxyvitamin D in infants, complicating accurate measurement and interpretation of vitamin D status. J Clin Endocrinol Metab. 2006; 91(8):3055-61. DOI: 10.1210/jc.2006-0710. View

11.

Cummings S, Block G, McHenry K, Baron R . Evaluation of two food frequency methods of measuring dietary calcium intake. Am J Epidemiol. 1987; 126(5):796-802. DOI: 10.1093/oxfordjournals.aje.a114716. View

12.

Paffenbarger Jr R, Wing A, HYDE R . Physical activity as an index of heart attack risk in college alumni. Am J Epidemiol. 1978; 108(3):161-75. DOI: 10.1093/oxfordjournals.aje.a112608. View

13.

Scott S, Goldberg M, Mayo N . Statistical assessment of ordinal outcomes in comparative studies. J Clin Epidemiol. 1997; 50(1):45-55. DOI: 10.1016/s0895-4356(96)00312-5. View

14.

Gregg E, Cauley J, Stone K, Thompson T, Bauer D, Cummings S . Relationship of changes in physical activity and mortality among older women. JAMA. 2003; 289(18):2379-86. DOI: 10.1001/jama.289.18.2379. View

15.

Cherniack E, Florez H, Troen B . Emerging therapies to treat frailty syndrome in the elderly. Altern Med Rev. 2007; 12(3):246-58. View

16.

Durrleman S, Simon R . Flexible regression models with cubic splines. Stat Med. 1989; 8(5):551-61. DOI: 10.1002/sim.4780080504. View

17.

Fried L, Tangen C, Walston J, Newman A, Hirsch C, Gottdiener J . Frailty in older adults: evidence for a phenotype. J Gerontol A Biol Sci Med Sci. 2001; 56(3):M146-56. DOI: 10.1093/gerona/56.3.m146. View

18.

Cawthon P, Marshall L, Michael Y, Dam T, Ensrud K, Barrett-Connor E . Frailty in older men: prevalence, progression, and relationship with mortality. J Am Geriatr Soc. 2007; 55(8):1216-23. DOI: 10.1111/j.1532-5415.2007.01259.x. View

19.

Rockwood K, Howlett S, MacKnight C, Beattie B, Bergman H, Hebert R . Prevalence, attributes, and outcomes of fitness and frailty in community-dwelling older adults: report from the Canadian study of health and aging. J Gerontol A Biol Sci Med Sci. 2005; 59(12):1310-7. DOI: 10.1093/gerona/59.12.1310. View