Excessive dietary intake of vitamin A is associated with reduced bone mineral density and increased risk for hip fracture

Ann Intern Med. 1998 Nov 15;129(10):770-8. doi: 10.7326/0003-4819-129-10-199811150-00003.


Background: The highest incidence of osteoporotic fractures is found in northern Europe, where dietary intake of vitamin A (retinol) is unusually high. In animals, the most common adverse effect of toxic doses of retinol is spontaneous fracture.

Objective: To investigate whether excessive dietary intake of vitamin A is associated with decreased bone mineral density and increased risk for hip fracture.

Design: A cross-sectional study and a nested case-control study.

Setting: Two counties in central Sweden.

Participants: For the cross-sectional study, 175 women 28 to 74 years of age were randomly selected. For the nested case-control study, 247 women who had a first hip fracture within 2 to 64 months after enrollment and 873 age-matched controls were selected from a mammography study cohort of 66,651 women 40 to 76 years of age.

Measurements: Retinol intake was estimated from dietary records and a food-frequency questionnaire. Bone mineral density was measured with dual-energy x-ray absorptiometry. Hip fracture was identified by using hospital discharge records and was confirmed by record review.

Results: In multivariate analysis, retinol intake was negatively associated with bone mineral density. For every 1-mg increase in daily intake of retinol, risk for hip fracture increased by 68% (95% CI, 18% to 140%; P for trend, 0.006). For intake greater than 1.5 mg/d compared with intake less than 0.5 mg/d, bone mineral density was reduced by 10% at the femoral neck (P = 0.05), 14% at the lumbar spine (P = 0.001), and 6% for the total body (P = 0.009) and risk for hip fracture was doubled (odds ratio, 2.1 [CI, 1.1 to 4.0]).

Conclusion: High dietary intake of retinol seems to be associated with osteoporosis.

MeSH terms

  • Adult
  • Aged
  • Bone Density / drug effects*
  • Case-Control Studies
  • Confounding Factors, Epidemiologic
  • Cross-Sectional Studies
  • Diet*
  • Feeding Behavior
  • Female
  • Hip Fractures / etiology*
  • Humans
  • Linear Models
  • Middle Aged
  • Multivariate Analysis
  • Osteoporosis / complications*
  • Osteoporosis / physiopathology
  • Surveys and Questionnaires
  • Vitamin A / adverse effects*


  • Vitamin A