Active vitamin D (1,25-dihydroxyvitamin D) and bone health in middle-aged and elderly men: The European Male Aging Study (EMAS)

Dirk Vanderschueren, Stephen R. Pye, Terence W. O'Neill, David M. Lee, Ivo Jans, Jaak Billen, Evelien Gielen, Michaël Laurent, Frank Claessens, Judith E. Adams, Kate A. Ward, Gyorgy Bartfai, Felipe F. Casanueva, Joseph D. Finn, Gianni Forti, Aleksander Giwercman, Thang S. Han, Ilpo T. Huhtaniemi, Krzysztof Kula, Michael E J LeanNeil Pendleton, Margus Punab, Frederick C W Wu, Steven Boonen

Research output: Contribution to journalArticlepeer-review


Context: There is little information on the potential impact of serum 1,25-dihydroxyvitamin D [1,25(OH)2D] on bone health including turnover. Objective: The objective of the study was to determine the influence of 1,25(OH)2D and 25-hydroxyvitamin D [25(OH)D] on bone health in middle-aged and older European men. Design, Setting, and Participants: Men aged 40-79 years were recruited from population registers in 8 European centers. Subjects completed questionnaires that included questions concerning lifestyle and were invited to attend for quantitative ultrasound (QUS) of the heel, assessment of height and weight, and a fasting blood sample from which 1,25(OH)2D, 25(OH)D, and PTH were measured. 1,25(OH)2D was measured using liquid chromatography tandem mass spectrometry. Bone markers serum N-terminal propeptide of type 1 procollagen (P1NP) and crosslinks (β-cTX) were also measured. Dual-energy x-ray absorptiometry (DXA) of the hip and lumbar spine was performed in 2 centers. Main Outcome Measure(s):QUSof the heel, bone markers P1NP and β-cTX, and DXA of the hip and lumbar spine were measured. Results: A total of 2783 men, mean age 60.0 years (SD 11.0) were included in the analysis. After adjustment for age and center, 1,25(OH) 2D was positively associated with 25(OH)D but not with PTH. 25(OH)D was negatively associated with PTH. After adjustment for age, center, height, weight, lifestyle factors, and season, 1,25(OH)2D was associated negatively with QUS and DXA parameters and associated positively with β-cTX. 1,25(OH)2D was not correlated with P1NP. 25(OH)D was positively associated with the QUS and DXA parameters but not related to eitherbone turnover marker. Subjects with both high 1,25(OH)2D (upper tertile) and low 25(OH)D (lower tertile) had the lowest QUS and DXA parameters and the highest β-cTX levels. Conclusions: Serum 1,25(OH)2D is associated with higher bone turnover and poorer bone health despite being positively related to 25(OH)D. A combination of high 1,25(OH)2D and low 25(OH)D is associated with the poorest bone health. Copyright © 2013 by The Endocrine Society.
Original languageEnglish
Pages (from-to)995-1005
Number of pages10
JournalJournal of Clinical Endocrinology and Metabolism
Issue number3
Publication statusPublished - Mar 2013


  • serum 25-hydroxyvitamin d
  • parathyroid-hormone
  • mineral density
  • fracture risk
  • older-adults
  • population
  • association
  • calcium
  • markers
  • season


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