Bone Abstracts (2015) 4 OC22 | DOI: 10.1530/boneabs.4.OC22

Extra vitamin D from food fortification and bone fractures in adolescents: results from the D-tect study

Mina Nicole Händel1,2, Kyle Raymond2, Cyrus Cooper3, Berit Lilienthal Heitmann2,5 & Bo Abrahamsen1,4


1Institute of Clinical Research, Odense Patient Explorative Network, University of Southern Denmark, Odense, Denmark; 2Research Unit for Dietary Studies, IPM, Bispebjerg and Frederiksberg Hospital, Frederiksberg, Denmark; 3MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton, UK; 4Research Centre for Ageing and Osteoporosis, Dept of Medicine M, Glostrup Hospital, Glostrup, Denmark; 5National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark.


Background: Improving the general population’s vitamin D status through food fortification is part of an ongoing international debate. Vitamin D status during pregnancy may influence the long-term bone health of the offspring; yet conflicting results have been reported and none of the studies have examined paediatric fracture as outcome.

Method: The influence of extra vitamin D exposure during prenatal life and risk of fracture during adolescence was determined by comparing those who were born before and after the termination of a mandatory vitamin D fortification program, applied in Denmark from 1961 to 1985, the effect of which has never been evaluated. For individuals born in 1983–1988, civil registration numbers were linked to the Danish National Patient Registry for incident and recurrent fractures at ages 12–18 years. Semi-parametric multiplicative models for mean functions were used to assess the association between vitamin D exposure and occurrence of fractures, while accounting for season of birth.

Results: A total of 103.569 exposed and 114.210 unexposed individuals were identified. Among those 11.693 exposed and 11.427 unexposed individuals sustained a fracture. Within each season of birth, the wrist/forearm and ankle fracture rates in the exposed individuals were significantly greater than the rate for the unexposed group, e.g. the estimated rate ratio for wrist/forearm fracture comparing exposed to unexposed individuals born November–January: RR=1.20; 95% CI: 1.12, 1.28. There was no significant association between exposure and the rate of clavicle fractures.

Table 1 Fracture rate per 1000 person-years by gender and exposure status.
GirlsBoys
Fracture TypeD+D-D+D-
Clavicle0.90.92.52.5
Wrist/forearm10.08.816.415.0
Ankle2.52.13.32.9
Total13.411.822.220.4

Conclusion: Among adolescents exposure to extra vitamin D from food fortification during prenatal life, seems related to an increased risk of fractures, in particular wrist/forearm and ankle.

Funding: The Danish Council for Strategic Research (11-116213) and University of Southern Denmark.

Disclosure: The authors declared no competing interests.

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