The Pharmaceutical Journal
Vol 270 No 7234 p142
1 February 2003

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Too much vitamin A leads to increase in fracture risk

A direct link between high serum levels of vitamin A and the risk of fracture has been found in a long-term, prospective study involving 2,322 Swedish men.

At enrolment into the trial, levels of serum retinol (vitamin A) were measured. Subjects were followed for 30 years and fractures documented in 266 men. The risk of fracture was highest among men with the highest levels of serum retinol. Men with retinol levels higher than 103.12µg/dL had an overall risk of fracture that was seven times greater than that for men with lower levels.

Fracture rates were 1.64 times higher in men with retinol levels greater than 75.62µg/dL than in men whose retinol levels fell in the range 62.16–67.60µg/dL. For hip fractures the rate was 2.47. The researchers also compared the fracture risk of men who consumed more than 1.5mg retinol per day with those taking less than 0.5mg. The risk was increased by a factor of two among those in the higher category.

The authors of this study (New England Journal of Medicine 2003;348:287) say their findings are consistent with previous animal and dietary studies. "Our findings ... suggest that current levels of vitamin A supplementation and food fortification in many Western countries may need to be reassessed," they add.

Dr Pamela Mason, a pharmacist with a special interest in nutrition, said that on current evidence of fracture risks, she would not advise elderly people against taking multivitamin products containing vitamin A (providing they contained no more than 100 per cent of the recommended daily amount). However, patients with well-established osteoporosis could be warned about the latest findings. She added that many older people take cod liver oil in addition to multivitamin supplements and suggested that fish body oil, containing little or no vitamin A, could be taken instead of fish liver oil.