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Osteoporosis International
Published in: Osteoporosis International 7/2017

01-07-2017 | Original Article

The relationship between cumulative lifetime ultraviolet radiation exposure, bone mineral density, falls risk and fractures in older adults

Authors: M. J. W. Thompson, D. A. Aitken, P. Otahal, J. Cicolini, T. M. Winzenberg, G. Jones

Published in: Osteoporosis International | Issue 7/2017

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Abstract

Summary

Data linking cumulative lifetime vitamin D status with skeletal outcomes are lacking. We show that increasing cumulative sun exposure was associated with higher bone mineral density in younger males and protective against fractures in females independent of current vitamin D. This supports the concept that cumulative sun exposure is an important contributor to skeletal health.

Introduction

While low 25-hydroxyvitamin D levels are associated with increased fracture risk, this reflects only recent sun exposure. The Beagley-Gibson (BG) method utilises microtopographical skin changes to quantify cumulative lifetime ultraviolet radiation (sun) exposure. This study aimed to describe the relationship between BG grade, BMD, falls risk and fractures in older adults.

Methods

Eight hundred thirty-five community-dwelling adults aged 53–83 years had silicone casts from the dorsum of both hands graded by the BG method. BMD was measured using DXA and falls risk using the short form of the Physiological Profile Assessment. Vertebral deformities and symptomatic fractures were assessed by DXA and questionnaire, respectively.

Results

The relationship between BG grade, spine BMD and vertebral fracture varied depending upon sex. In females, increasing grade was associated with lower vertebral fracture prevalence (OR = 0.44/grade, p = 0.018) and fewer fractures (OR = 0.82/grade, p = 0.021), particularly major fractures (OR = 0.75/grade, p = 0.03). In males, increasing grade was associated with more DXA-detected vertebral deformities (RR = 1.28/grade, p = 0.001), but not symptomatic fractures. These relationships were independent of BMD, falls risk, smoking and current 25-hydroxyvitamin D. BG grade was not associated with falls risk. For BMD, there were interactions between BG grade and both age and sex and a positive trend with hip BMD in younger males.

Conclusions

BG grade demonstrated beneficial associations with fracture outcomes in females and BMD in younger males independent of current 25-hydroxyvitamin D. These data support the concept that cumulative ultraviolet radiation exposure is an important determinant of skeletal health. The association with vertebral deformities in males may reflect outdoor physical trauma in younger life.
Literature
1.
Bischoff-Ferrari HA, Dietrich T, Orav EJ, Dawson-Hughes B (2004) Positive association between 25-hydroxy vitamin D levels and bone mineral density: a population-based study of younger and older adults. Am J Med 116:634–639CrossRefPubMed
2.
Bischoff-Ferrari HA, Kiel DP, Dawson-Hughes B, Orav JE, Li R, Spiegelman D et al (2009) Dietary calcium and serum 25-hydroxyvitamin D status in relation to BMD among U.S. adults. J Bone Miner Res 24:935–942CrossRefPubMed
3.
Kuchuk NO, Pluijm SM, van Schoor NM, Looman CW, Smit JH, Lips P (2009a) Relationships of serum 25-hydroxyvitamin D to bone mineral density and serum parathyroid hormone and markers of bone turnover in older persons. J Clin Endocrinol Metab 94:1244–1250CrossRefPubMed
4.
Kuchuk NO, van Schoor NM, Pluijm SM, Chines A, Lips P (2009b) Vitamin D status, parathyroid function, bone turnover, and BMD in postmenopausal women with osteoporosis: global perspective. J Bone Miner Res 24:693–701CrossRefPubMed
5.
Ooms ME, Lips P, Van Lingen A, Valkenburg HA (1993) Determinants of bone mineral density and risk factors for osteoporosis in healthy elderly women. J Bone Miner Res 8:669–675CrossRefPubMed
6.
Visser M, Deeg DJ, Lips P (2003) Low vitamin D and high parathyroid hormone levels as determinants of loss of muscle strength and muscle mass (sarcopenia): the Longitudinal Aging Study Amsterdam. Clin Endocrinol Metab 88:5766–5772CrossRef
7.
Bischoff-Ferrari HA, Giovannucci E, Willett WC, Dietrich T, Dawson-Hughes B (2006) Estimation of optimal serum concentrations of 25-hydroxyvitamin D for multiple health outcomes. Am J Clin Nutr 84(1):18–28CrossRefPubMed
8.
Mowe M, Haug E, Bohmer T (1999) Low serum calcidiol concentration in older adults with reduced muscular function. J Am Geriatr Soc 47:220–226CrossRefPubMed
9.
Stein MS, Wark JD, Scherer SC, Walton SL, Chick P, Di Carlantonio M et al (1999) Falls relate to vitamin D and parathyroid hormone in an Australian nursing home and hostel. J Am Geriatr Soc 47:1195–1201CrossRefPubMed
10.
Nguyen T, Sambrook P, Kelly P, Jones G, Lord S, Freund J et al (1993) Prediction of osteoporotic fractures by postural instability and bone density. BMJ 307(6912):1111–1115CrossRefPubMedPubMedCentral
11.
Kanis JA, Oden A, Johnell O, Johansson H, De Laet C, Brown J et al (2007) The use of clinical risk factors enhances the performance of BMD in the prediction of hip and osteoporotic fractures in men and women. Osteoporosis Int 18:1033–1046CrossRef
12.
Gillespie LD, Robertson MC, Gillespie WJ, Sherrington C, Gates S, Clemson LM et al (2012) Interventions for preventing falls in older people living in the community. Cochrane Database Syst Rev 9:CD007146
13.
Muir SW, Montero-Odasso M (2011) Effect of vitamin D supplementation on muscle strength, gait and balance in older adults: a systematic review and meta-analysis. J Am Geriatr Soc 59:2291–2300CrossRefPubMed
14.
Dawson-Hughes B, Harris SS, Krall EA, Dallal GE (1997) Effect of calcium and vitamin D supplementation on bone density in men and women 65 years of age or older. N Engl J Med 337:670–676CrossRefPubMed
15.
Tang BM, Eslick GD, Nowson C, Smith C, Bensoussan A (2007) Use of calcium or calcium in combination with vitamin D supplementation to prevent fractures and bone loss in people aged 50 years and older: a meta-analysis. Lancet 370(9588):657–666CrossRefPubMed
16.
Vieth R (1999) Vitamin D supplementation, 25-hydroxyvitamin D concentrations, and safety. Am J Clin Nutr 69:842–856CrossRefPubMed
17.
Srikanth V, Fryer J, Venn A, Blizzard L, Newman L, Cooley H et al (2007) The association between non-melanoma skin cancer and osteoporotic fractures—a population-based record linkage study. Osteoporosis Int 18:687–692CrossRef
18.
English DR, Armstrong BK, Kricker A, Winter MG, Heenan PJ, Randell PL (1998) Case-control study of sun exposure and squamous cell carcinoma of the skin. Int J Cancer 77:347–353CrossRefPubMed
19.
Holman CD, Armstrong BK, Evans PR, Lumsden GJ, Dallimore KJ, Meehan CJ et al (1984a) Relationship of solar keratosis and history of skin cancer to objective measures of actinic skin damage. Br J Dermatol 110:129–138CrossRefPubMed
20.
Battistutta D, Pandeya N, Strutton GM, Fourtanier A, Tison S, Green AC (2006) Skin surface topography grading is a valid measure of skin photoaging. Photodermatol Photoimmunol Photomed 22:39–45CrossRefPubMed
21.
Lucas RM, Ponsonby AL, Dear K, Taylor BV, Dwyer T, McMichael AJ et al (2009) Associations between silicone skin cast score, cumulative sun exposure, and other factors in the Ausimmune study: a multicenter Australian study. Cancer Epidemiol Biomark Prev 18:2887–2894CrossRef
22.
23.
Ding C, Cicuttini F, Parameswaran V, Burgess J, Quinn S, Jones G (2009) Serum levels of vitamin D, sunlight exposure, and knee cartilage loss in older adults: the Tasmanian Older Adult Cohort Study. Arthritis Rheum 60:1381–1389CrossRefPubMed
24.
Lord SR, Menz HB, Tiedemann A (2003) A physiological profile approach to falls risk assessment and prevention. Phys Ther 83:237–252PubMed
25.
Laslett LL, Just Nee Foley SJ, Quinn SJ, Winzenberg TM, Jones G (2012) Excess body fat is associated with higher risk of vertebral deformities in older women but not in men: a cross-sectional study. Osteoporosis Int 23:67–74CrossRef
26.
Genant H, Wu C, Kuijk C, Nevitt M (1993) Vertebral fracture assessment using a semiquantitative technique. J Bone Miner Res 8:1137–1148CrossRefPubMed
27.
Ismail AA, O'Neill TW, Cooper C, Silman AJ (2000) Risk factors for vertebral deformities in men: relationship to number of vertebral deformities. European Vertebral Osteoporosis Study Group. J Bone Miner Res 15:278–283CrossRefPubMed
28.
Silman AJ, O'Neill TW, Cooper C, Kanis J, Felsenberg D (1997) Influence of physical activity on vertebral deformity in men and women: results from the European Vertebral Osteoporosis Study. J Bone Miner Res 12:813–819CrossRefPubMed
29.
Kleerekoper M, Villanueva AR, Stanciu J, Rao DS, Parfitt AM (1985) The role of three-dimensional trabecular microstructure in the pathogenesis of vertebral compression fractures. Calcif Tissue Int 37:594–597CrossRefPubMed
30.
Gardiner EM, Baldock PA, Thomas GP, Sims NA, Henderson NK, Hollis B et al (2000) Increased formation and decreased resorption of bone in mice with elevated vitamin D receptor in mature cells of the osteoblastic lineage. FASEB J 14:1908–1916CrossRefPubMed
31.
Reeve J, Meunier PJ, Parsons JA, Bernat M, Bijvoet OL, Courpron P et al (1980) Anabolic effect of human parathyroid hormone fragment on trabecular bone in involutional osteoporosis: a multicentre trial. BMJ 280:1340–1344CrossRefPubMed
32.
Holman CD, Evans PR, Lumsden GJ, Armstrong BK (1984b) The determinants of actinic skin damage: problems of confounding among environmental and constitutional variables. Am J Epidemiol 120:414–422CrossRefPubMed
33.
Denda M, Koyama J, Hori J, Horii I, Takahashi M, Hara M et al (1993) Age- and sex-dependent change in stratum corneum sphingolipids. Arch Dermatol Res 285:415–417CrossRefPubMed
34.
Verdier-Sevrain S, Bonte F, Gilchrest B (2006) Biology of estrogens in skin: implications for skin aging. Exp Dermatol 15:83–94CrossRefPubMed
35.
36.
Johnell O, Gullberg B, Kanis JA, Allander E, Elffors L, Dequeker J et al (1995) Risk factors for hip fracture in European women: the MEDOS Study. Mediterranean Osteoporosis Study. J Bone Miner Res 10:1802–1815CrossRefPubMed
37.
Kanis J, Johnell O, Gullberg B, Allander E, Elffors L, Ranstam J et al (1999) Risk factors for hip fracture in men from southern Europe: the Mediterranean Osteoporosis Study. Osteoporosis Int 9:45–54CrossRef
Metadata
Title
The relationship between cumulative lifetime ultraviolet radiation exposure, bone mineral density, falls risk and fractures in older adults
Authors
M. J. W. Thompson
D. A. Aitken
P. Otahal
J. Cicolini
T. M. Winzenberg
G. Jones
Publication date
01-07-2017
Publisher
Springer London
Published in
Osteoporosis International / Issue 7/2017
Print ISSN: 0937-941X
Electronic ISSN: 1433-2965
DOI
https://doi.org/10.1007/s00198-017-4001-8

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