Osteoporosis and hip fractures are linked to vitamin deficiencies
Strong bones require minerals such as calcium and magnesium. It is also known that vitamin D plays a role in calcium absorption, and deficiencies are common among the elderly. Furthermore, deficiencies in vitamin A, folic acid, and vitamin K appear to be much more widespread among elderly patients with bone fractures compared to healthy control groups. This is highlighted in a new study published in Frontiers in Nutrition, where the researchers take a closer look at the importance of vitamins for bone health.
As the global population ages, more and more people develop osteoporosis and sustain bone fractures, especially fractures of the hip. A hip fracture, which affects the femoral neck, often occurs due to a fall. After surgery, many patients are no longer able to care for themselves and often end up in nursing homes. Hip fractures are associated with numerous severe complications, and 20-30% of individuals die within the first year due to infections, heart disease, blood clots in the legs, or other complications.
Given the significant human and economic costs of hip fractures, it is relevant to focus more on prevention. Elderly people are usually advised to take supplements of calcium and vitamin D, as vitamin D is important for calcium absorption into the bloodstream. However, magnesium is also required, as it helps embed nearly all (99%) of the body’s calcium in bones and teeth. Studies have shown that vitamins A, B, E, and K play a role in bone metabolism, and deficiencies increase the risk of osteoporosis. The new study aimed to investigate this further, as it could contribute to better prevention of osteoporosis and hip fractures.
Patients with bone fractures lack several vitamins
The new study included 210 patients who had suffered hip fractures and a control group of 402 healthy individuals. All participants were 65 years or older.
Blood tests were drawn to measure the participants' levels of vitamin A, various B vitamins, vitamin D, vitamin E, and vitamin K. The researchers also examined the participants’ nutritional status by looking at other markers.
The study revealed that levels of vitamins A, B9 (folic acid), K, D, and E were lower in the hip fracture group compared to the healthy controls. Furthermore, vitamin D deficiency was widespread in more than 80% of both groups.
The study provides a deeper understanding of how various vitamins contribute to bone health, as outlined below.
Vitamin A
While the role of vitamin A in bone health is controversial, studies do show that nutrient is involved in bone metabolism. Additionally, vitamin A serves as a powerful antioxidant that protects cells from damage caused by free radicals and oxidative stress. The link between vitamin A deficiency and fragile bones also appears to be more pronounced in overweight individuals and those who lack vitamin D to begin with. This supports the hypothesis that vitamin A and vitamin D interact in bone metabolism. Therefore, the researchers recommend that elderly people have their vitamin A levels measured, especially if they are also deficient in vitamin D.
In general, it seems that vitamin A is important for the absorption and utilization of the three other fat-soluble vitamins (D, E, and K).
Pure vitamin A (retinol) is found in animal sources such as cod liver oil, liver, butter, cheese, egg yolks, and oily fish.
Beta-carotene, a precursor, is found in plant sources such as carrots, bell peppers, cabbage, spinach, tomatoes, and parsley.
It is relatively easy to get enough vitamin A from a healthy and varied diet, provided it includes animal fats and plant sources.
Vitamin D
Vitamin D increases the intestinal absorption of calcium, which is then transported through the bloodstream to the bones. The parathyroid glands’ production of PTH (parathyroid hormone) regulates calcium levels in the blood. As noted, vitamin D deficiency is widespread, and it has been found to affect bone mineral density, the parathyroid glands' production of PTH, and a marker for bone changes called BTM (Bone Turnover Markers).
The strong summer sun is our primary source of vitamin D, which we synthesize in our skin. Vitamin D is also found in cod liver oil, oily fish, cod roe, and egg yolks, but diet only delivers modest amounts.
Factors such as lack of sun exposure during the summer, long winter months, aging processes, overweight, and diabetes increase the risk of vitamin D deficiency.
Vitamin K
There are two forms of vitamin K, K1 and K2, with K2 being especially important for bones and calcium metabolism. Vitamin K2 is essential for the formation of a protein named matrix GLA (MGP), which removes calcium from the bloodstream. Additionally, vitamin K2 is important for the protein osteocalcin, which embeds calcium in bones.
A deficiency in vitamin K2 thus increases the risk of arteriosclerosis and osteoporosis because the body’s distribution of calcium does not function properly.
Vitamin D also works synergistically with vitamin K, as vitamin D can upregulate MGP.
Vitamin K2 is primarily found in fermented products such as butter, aged cheese, and sauerkraut, where it is produced by bacteria. K2 is also present in egg yolks and fatty cuts of meat from grass-fed animals.
A well-functioning gut microbiota can also produce vitamin K2 from K1.
Vitamin K1 is primarily found in cabbage, spinach, parsley, and other leafy greens.
A deficiency in vitamin K2 may be due to an imbalanced diet, poor gut flora, or cholesterol-lowering medications (statins), which block the synthesis of vitamin K2 and activation of MGP.
Vitamin B9 (folate)
Several studies have explored the relationship between blood levels of vitamin B9 and bone health. First, vitamin B9 is important for blood formation, which is crucial for energy levels. Secondly, vitamin B9 plays a role in the breakdown of an amino acid called homocysteine. If homocysteine levels become too high, homocysteine can act as a toxin, damaging cells and circulation. Several studies have already shown that elevated homocysteine levels increase the risk of dementia, Alzheimer’s disease, and strokes, which in turn may increase the risk of falls and hip fractures.
It also appears that a combination of vitamin B9 and vitamin D can improve cognitive functions and alertness in patients with mild cognitive impairment and Alzheimer’s disease. This could simultaneously help prevent falls and hip fractures.
Vitamin B9 is found in liver, eggs, legumes, cabbage, and other vegetables, nuts, and dairy products.
Deficiencies may be due to an imbalanced diet, alcohol, intestinal diseases, and antacid medications.
Conclusion and new guidelines for bone health
The study revealed that elderly patients who had sustained hip fractures lacked several vitamins compared to a healthy, age-matched control group. The patients with hip fractures were particularly low in vitamins A, K, and B9. Vitamin D deficiency was widespread in both groups.
According to the researchers, the results of the study could contribute to a better understanding of the importance of vitamins for bone health and how these vitamins interact. It would also be advisable to conduct blood tests to reveal additional deficiencies.
It should be noted that there are interactions between calcium, magnesium, and vitamin D, and that any calcium supplements should always be combined with magnesium.
References
Qifei He et al. Association between vitamin levels and geriatric hip fractures: A cross-sectional study. Frontiers in Nutrition 2025
Niamh Aspell et al. Vitamin D Deficiency Is Associated With Impaired Muscle Strength And Physical Performance in Community-Dwelling Older Adults: Findings From The English Longitudinal Study Of Ageing. Clinical Interventions in Aging. 2019
Harumi Okuyama et al. Statins stimulates atherosclerosis and Heart failure: pharmacological mechanism. Expert Rev Clin Pharmacol. 2015
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