Serum vitamin A concentration and the risk of hip fracture among women 50 to 74 years old in the United States: a prospective analysis of the NHANES I follow-up study

Am J Med. 2004 Aug 1;117(3):169-74. doi: 10.1016/j.amjmed.2004.02.045.


Background: Recent studies on the association between vitamin A and fracture risk have focused on samples with high vitamin A intake. We analyzed a cohort that was more representative of the overall U.S. population to test the hypothesis that both high and low serum vitamin A concentrations increase the risk of hip fracture.

Methods: We utilized data on 2799 women who were 50 to 74 years of age from the first National Health and Nutrition Examination Survey Epidemiologic Follow-up Study. There were 172 incident hip fractures during the 22-year follow-up period. Using Cox regression analysis, we analyzed the relation between baseline serum vitamin A (retinol and retinyl esters) concentration, as a continuous variable and by quintiles, and hip fracture risk.

Results: While there was no linear relation between serum vitamin A concentration and the risk of hip fracture in the multivariate analysis (hazard ratio [HR] per SD increase = 1.0; 95% confidence interval [CI]: 0.9 to 1.2), analysis by quintiles revealed a U-shaped relation between serum vitamin A concentration and hip fracture. Fracture risk was significantly higher among subjects in the lowest (HR = 1.9; 95% CI: 1.1 to 3.3) and highest (HR = 2.1; 95% CI: 1.2 to 3.6) quintiles compared with those in the middle quintiles.

Conclusion: Both low and high serum vitamin A concentrations may be associated with an increased risk of hip fracture.

MeSH terms

  • Aged
  • Female
  • Follow-Up Studies
  • Hip Fractures / blood*
  • Humans
  • Middle Aged
  • Prospective Studies
  • Regression Analysis
  • Risk
  • Vitamin A / administration & dosage
  • Vitamin A / blood*


  • Vitamin A