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March 20, 2002

Does High Intake of Vitamin A Pose a Risk for Osteoporotic Fracture?—Reply

Author Affiliations

Stephen J.LurieMD, PhD, Senior EditorIndividualAuthor

JAMA. 2002;287(11):1396-1397. doi:10.1001/jama.287.11.1395

In Reply: We agree with Dr Hathcock that dietary guidance must be based on collected evidence from various scientific sources. With this in mind, we analyzed data from the Nurses' Health Study after a Swedish study reported that retinol intake was positively associated with risk of hip fracture and inversely associated with femoral bone mineral density in women.1 Our finding of a significant increase in risk of hip fracture with higher retinol intakes in postmenopausal women was very similar to that observed in the Swedish study. Although we recognize the inherent limitations of observational research, laboratory data come with their own strengths and weaknesses. An analysis of data from NHANES III showed no association between serum retinyl esters and bone mineral density,2 although this finding is difficult to interpret because there was a single measurement of blood retinyl esters without evidence that this reflects long-term retinol intake. Also, although bone mineral density is a major factor in osteoporotic fracture, it is not synonymous with fracture, which is the outcome of public health concern. The small Icelandic study that Hathcock cites3 also assessed bone mineral density rather than fracture and did not control for vitamin D intake, which confounds the observed effects of retinol.

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