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Information on the latest vitamin D news and research.

Find out more information on deficiency, supplementation, sun exposure, and how vitamin D relates to your health.

Hip fracture patients have lower levels of vitamins D and K1

According to new research published in the journal Clinical Nutrition, low levels of vitamin D and vitamin K1 are both independently and synergistically associated with hip fracture.

Vitamin D deficiency has long been associated with increased risk of hip fracture. Maintaining good levels of vitamin D helps improve balance and decreases the risk of falling and getting fractures from falls. Vitamin D may also help bone mass density, by slowing the process of losing bone mass as we age, which would also have an effect on the risk of hip fracture.

Vitamin K describes two vitamins, both vitamin K1 (found in leafy greens) and vitamin K2 (found in nattō and in small quantities in hard cheeses and meats). Research in vitamin K is very young, and so far studies have been mixed at how effective it is in decreasing risk of fracture. In a large 4,000-person trial, vitamin K2 supplementation reduced vertebral fractures in patients with severe osteoporosis but showed no effect on hip fractures.

Still, mechanistic studies suggest vitamin K is important for bone density and that it might work with vitamin D synergistically. Bone density depends on the amount of calcium retained in the bone, among other things. A protein called osteocalcin binds calcium to bone. Vitamin D upregulates the production of an inactive form of osteocalcin. Vitamin K then acts as a catalyst to take this inactive type of osteocalcin and make an active form of osteocalcin. Thus vitamin D and vitamin K work together to keep calcium retained in bones.

In the present study, researchers from Oslo University Hospital in Norway examined patients that suffered hip fracture and matched them with controls. They enrolled 116 patients with hip fracture who were admitted to their hospital. They pulled 73 controls from a national census survey who had never had a hip fracture. The researchers took blood samples of all participants.

The researchers wanted to know, do blood levels of vitamin D and vitamin K1 correlate at all with risk of hip fracture? Here’s what they found:

  • The hip fracture patients had significantly lower vitamin D levels, with a mean level of 20 ng/ml, compared to the controls (mean level 32.4 ng/ml).
  • The hip fracture patients had significantly lower vitamin K1 levels, with a mean level of 0.24 ng/ml, compared to the controls (mean level 0.55 ng/ml).
  • If you had a vitamin D level less than the mean and a vitamin K1 level less than the mean, you had a greater than 7 times higher associated risk of hip fracture compared to having a vitamin K1 level above the mean [OR=7.61 (2.26-26.67)]. This relationship wasn’t as strong if you had a vitamin D level above the mean, but still had a vitamin K1 level less than the mean [OR=2.28 (0.39-13.26)].
  • Total osteocalcin was highest in those with both high vitamin K1 and vitamin D levels.

The researchers concluded,

“Low serum levels of vitamin K1 and 25(OH)D are independently associated with an increased risk of hip fracture. There is a significant synergistic effect between the two nutrients, possibly mediated through osteocalcin. Vitamin K1 and 25(OH)D may be important in preventing development of osteoporosis and in treatment of hip fracture patients to reduce the risk of subsequent fracture.”

Limitations of this study include its observational design, so it’s not intended to see if there’s a causal relationship between vitamins K1 and D and hip fracture. However, this research shows a clear relationship that hip fracture patients have both low vitamin D and vitamin K1 levels. It’s not fully understood if fracture trauma depletes the body of these nutrients, so the researchers did their best to mitigate this problem, by drawing blood samples as soon as possible upon hospital admission.

Future trials should look to see if vitamin D and vitamin K supplementation can work together to reduce risk of fracture and increase bone mass density.


Torbergsen A et al. Vitamin K1 and 25(OH)D are independently and synergistically associated with a risk for hip fracture in an elderly population: A case control study. Clinical Nutrition, 2014.

  About: Brant Cebulla

Brant Cebulla was a staff member for the Vitamin D Council from May 2011 to April 2014. He has keen interests in nutrition and exercise.
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7 Responses to Hip fracture patients have lower levels of vitamins D and K1

  1. Jim Larsen says:

    Researchers by definition try to isolate a single variable to figure out how it works.

    The communication problem is that single variable focus creates confusion in the non-researchers who start thinking that one thing will fix their health.

    Bone strength, for example, varies as a function of 20+ variables (macronutrients, micronutrients, impact exercise, sleep, diet acidity, etc.). I wish researchers would put a context statement in their papers.

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  2. Rebecca Oshiro says:

    This is an excellent point. I bet having a high K1 status is indicative of a higher leafy green intake which includes all of the other vitamins and minerals that go along with that. It’s probably a marker of an overall better diet too.

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  3. Rita and Misty says:

    It’s really simpler than the modern world makes it out to be.

    Here’s what I do:

    Eat minimally processed, organically produced foods
    Ensure that my daily diet is 70% veggies and fruits–following the colors of the rainbow.
    Choose high-quality sources of protein.
    Avoid all simple carbs.
    Avoid sugar like the plague.
    Sleep 8 hours nightly.
    Run 1 hour daily.
    Take my D3, Iodine, Selenium, Boron, Magnesium, Zinc, K2, vitamin C and high-quality multi-B daily.
    I really should sunlamp daily, but I do not–someone please cyberspace whack me on this item. :)

    My bones are very strong.

    Some of this is also hereditary. However, those of you who know me, and some here do know me, I am slight of frame, light of weight, and skin level 2. One would think I would be a candidate for osteoporosis. But, I do not have this condition.


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  4. Hi Rita, do I understand? … you eat 70E% veggies? how much protein? fat?
    that means very little fat, as I see. Too little fat. What kind of fats do you eat?
    Best Elisabeth

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  5. Rita and Misty says:

    :) organic first pressed extra virgin oilve oil, fresh coconut, organically and humanely raised cattle and chicken (I apologize for those I have offended), venison, fresh whole eggs, organic dairy products like greek yogurt and some cheeses. Once in a great while I treat myself to whole milk and whole cream–organic of course, and in glass bottles. :)

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  6. Rita and Misty says:

    Also sardines and wild salmon :)

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  7. Rita and Misty says:

    And all sorts of nuts and seeds….

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