Bone is more susceptible to vitamin K deficiency than liver in the institutionalized elderly

Asia Pac J Clin Nutr. 2011;20(1):50-5.


In Japan, γ-carboxylation of blood coagulation factors is the basis for determining adequate intake (AI) for vitamin K in Dietary Reference Intakes (DRIs) issued in 2010. Recently, vitamin K is also known to be essential for preventing fracture. In this study, relative susceptibility of liver and bone to vitamin K deficiency was studied. Thirty-seven elderly institutionalized subjects were evaluated for vitamin K status by measuring serum PIVKA (protein induced by vitamin K absence) -II and ucOC (undercarboxylated osteocalcin) levels, as sensitive markers for hepatic and skeletal vitamin K deficiency, respectively. Serum PIVKA-II and ucOC levels, with their cut-off values in the parentheses, were 20.2±8.9 mAUmL (28 mAU/mL) and 4.7±3.0 ng/mL (4.5 ng/mL), respectively. Median vitamin K intake was approximately 200 μg/day, which is more than 3 times higher than the current Japanese AI. Vitamin K intake was significantly correlated with serum PIVKA-II and ucOC/OC levels, but not with serum ucOC level. Although serum ucOC level is generally a good indicator for vitamin K status, multiple regression analysis revealed that elevated bone turnover marker significantly contributed to serum ucOC level. All subjects had vitamin K intake exceeding AI for vitamin K. Nevertheless, serum PIVKA-II and ucOC concentrations exceeded the cut-off value in 14% and 43% of subjects, respectively. The present findings suggest that vitamin K intake greater than the current AI is required for the skeletal health in the institutionalized elderly.

MeSH terms

  • Aged
  • Aged, 80 and over
  • Biomarkers / blood
  • Bone and Bones / chemistry*
  • Diet
  • Elder Nutritional Physiological Phenomena
  • Energy Intake
  • Female
  • Fractures, Bone / etiology
  • Homes for the Aged
  • Humans
  • Liver / chemistry*
  • Liver Diseases / etiology
  • Male
  • Nursing Homes
  • Osteocalcin / blood
  • Protein Precursors / blood
  • Prothrombin
  • Vitamin K / administration & dosage
  • Vitamin K Deficiency / blood*
  • Vitamin K Deficiency / complications


  • Biomarkers
  • Protein Precursors
  • Osteocalcin
  • Vitamin K
  • acarboxyprothrombin
  • Prothrombin