Nutr Res Pract.  2019 Apr;13(2):115-125. 10.4162/nrp.2019.13.2.115.

Association between vitamin D intake and bone mineral density in Koreans aged ≥ 50 years: analysis of the 2009 Korea National Health and Nutrition Examination Survey using a newly established vitamin D database

  • 1Food and Nutrition Major, Woosong University, Daejeon 34606, Korea.
  • 2Department of Food and Nutrition, Daejeon Institute of Science and Technology, Daejeon 35408, Korea.
  • 3Department of Food and Nutrition, Chungnam National University, 99 Daehak-ro, Yuseong-gu, Daejeon 34134, Korea.


Vitamin D plays an important role in skeletal growth and maintenance and in the prevention of various diseases. We investigated the relationship between vitamin D intake and bone mineral density (BMD) in Korean adults aged ≥ 50 years using the 2009 Korea National Health and Nutrition Examination Survey data.
This study was conducted in 1,808 subjects aged ≥ 50 years with BMD data in Korea. Dietary vitamin D levels were assessed by the 24-hour recall method. BMD was measured using dual-energy X-ray absorptiometry. We investigated general characteristics and the association between these characteristics, vitamin D status, and BMD.
Vitamin D intake was significantly lower in the osteoporosis group among women (P < 0.05). Among all subjects, the higher the serum 25(OH)D concentration, the higher the whole-body total BMD (WBT-BMD), femoral total hip BMD, and femoral neck BMD (P < 0.01). In the serum vitamin D-deficient group of both the total population and women, serum 25(OH)D concentration was associated with WBT-BMD (P < 0.05). Among women with a calcium intake < 537.74 mg/day, BMD of those with a vitamin D intake > 2.51 µg/day (average intake of women) was higher than that of women with a vitamin D intake ≤ 2.51 µg/day (P < 0.001).
Korean adults should increase their BMD by increasing serum 25(OH)D concentration. Furthermore, increasing vitamin D intake could improve BMD, especially in Korean women who consume less calcium than the estimated average requirement.


Vitamin D intake; bone mineral density; osteoporosis; 25(OH)D

MeSH Terms

Absorptiometry, Photon
Bone Density*
Femur Neck
Nutrition Surveys*
Vitamin D*
Vitamin D


  • Fig. 1 Differences in whole-body total bone mineral density (WBT-BMD) of subjects with a higher- and lower-than-average daily vitamin D intake by calcium intake quartiles. Average daily vitamin D intake: total subjects (3.47 µg/day), men (3.88 µg/day), women (2.51 µg/day). Calcium intake levels: total subjects [Q1: < 278 mg (n = 452), Q2: 278 ~ < 416 mg (n = 452), Q3: 416 ~ < 628 mg (n = 452), and Q4; ≥ 628 mg (n = 452)]. men [Q1: < 327 mg (n = 225), Q2: 327 ~ < 484 mg (n = 225), Q3: 484 ~ < 699 mg (n = 225), and Q4; ≥ 699 mg (n = 225)]. women [Q1: < 237 mg (n = 227), Q2: 237 ~ < 367 mg (n = 229), Q3: 367 ~ < 538 mg (n = 226), and Q4; ≥ 538 mg (n = 226)]. WBT-BMD values are presented as Mean ± SE. F-values were obtained based on the results of the complex samples general linear model. ***P < 0.001.


1. Consensus development conference: prophylaxis and treatment of osteoporosis. Am J Med. 1991; 90:107–110.
2. World Health Organization. Assessment of fracture risk and its application to screening for postmenopausal osteoporosis. Report of a WHO Study Group. World Health Organ Tech Rep Ser. 1994; 843:1–129.
3. Dhanwal DK, Dennison EM, Harvey NC, Cooper C. Epidemiology of hip fracture: Worldwide geographic variation. Indian J Orthop. 2011; 45:15–22.
4. Odén A, McCloskey EV, Kanis JA, Harvey NC, Johansson H. Burden of high fracture probability worldwide: secular increases 2010-2040. Osteoporos Int. 2015; 26:2243–2248.
5. Cauley JA. Osteoporosis: fracture epidemiology update 2016. Curr Opin Rheumatol. 2017; 29:150–156.
6. Ministry of Health and Welfare. Korea Centers for Disease Control and Prevention. Korea Health Statistics 2009: Korea National Health and Nutrition Examination Survey (KNHANES IV-3). Cheongwon: Korea Centers for Disease Control and Prevention;2009.
7. Wade SW, Strader C, Fitzpatrick LA, Anthony MS, O'Malley CD. Estimating prevalence of osteoporosis: examples from industrialized countries. Arch Osteoporos. 2014; 9:182.
8. Weaver CM, Alexander DD, Boushey CJ, Dawson-Hughes B, Lappe JM, LeBoff MS, Liu S, Looker AC, Wallace TC, Wang DD. Calcium plus vitamin D supplementation and risk of fractures: an updated meta-analysis from the National Osteoporosis Foundation. Osteoporos Int. 2016; 27:367–376.
9. DeLuca HF. Overview of general physiologic features and functions of vitamin D. Am J Clin Nutr. 2004; 80:1689S–1696S.
10. Holick MF. The influence of vitamin D on bone health across the life cycle. J Nutr. 2005; 135:2726S–2727S.
11. Institute of Medicine (US) Committee to Review Dietary Reference Intakes for Vitamin D and Calcium. Ross AC, Taylor CL, Yaktine AL, Del Valle HB. Dietary Reference Intakes for Calcium and Vitamin D. Washington, D.C.: National Academies Press;2011.
12. Yoo K, Cho J, Ly S. Vitamin D intake and serum 25-Hydroxyvitamin D levels in Korean adults: analysis of the 2009 Korea national health and nutrition examination survey (KNHANES IV-3) Using a newly established vitamin D database. Nutrients. 2016; 8:610.
13. Armas LA, Dowell S, Akhter M, Duthuluru S, Huerter C, Hollis BW, Lund R, Heaney RP. Ultraviolet-B radiation increases serum 25-hydroxyvitamin D levels: the effect of UVB dose and skin color. J Am Acad Dermatol. 2007; 57:588–593.
14. Holick MF. Sunlight "D"ilemma: risk of skin cancer or bone disease and muscle weakness. Lancet. 2001; 357:4–6.
15. Kim M, Yoon C. The research on the ultraviolet protector recognition of the adult and propensity to consume. J Beauty Ind. 2014; 8:63–84.
16. Holick MF, Chen TC. Vitamin D deficiency: a worldwide problem with health consequences. Am J Clin Nutr. 2008; 87:1080S–1086S.
17. van Schoor NM, Lips P. Worldwide vitamin D status. Best Pract Res Clin Endocrinol Metab. 2011; 25:671–680.
18. Nanri A, Foo LH, Nakamura K, Hori A, Poudel-Tandukar K, Matsushita Y, Mizoue T. Serum 25-hydroxyvitamin d concentrations and season-specific correlates in Japanese adults. J Epidemiol. 2011; 21:346–353.
19. Sadat-Ali M, Al Elq AH, Al-Turki HA, Al-Mulhim FA, Al-Ali AK. Influence of vitamin D levels on bone mineral density and osteoporosis. Ann Saudi Med. 2011; 31:602–608.
20. Flicker L, Mead K, MacInnis RJ, Nowson C, Scherer S, Stein MS, Thomasx J, Hopper JL, Wark JD. Serum vitamin D and falls in older women in residential care in Australia. J Am Geriatr Soc. 2003; 51:1533–1538.
21. Khazai N, Judd SE, Tangpricha V. Calcium and vitamin D: skeletal and extraskeletal health. Curr Rheumatol Rep. 2008; 10:110–117.
22. Trivedi DP, Doll R, Khaw KT. Effect of four monthly oral vitamin D3 (cholecalciferol) supplementation on fractures and mortality in men and women living in the community: randomised double blind controlled trial. BMJ. 2003; 326:469.
23. Cranney A, Horsley T, O'Donnell S, Weiler H, Puil L, Ooi D, Atkinson S, Ward L, Moher D, Hanley D, Fang M, Yazdi F, Garritty C, Sampson M, Barrowman N, Tsertsvadze A, Mamaladze V. Effectiveness and safety of vitamin D in relation to bone health. Evid Rep Technol Assess (Full Rep). 2007; 1–235.
24. Dawson-Hughes B, Heaney RP, Holick MF, Lips P, Meunier PJ, Vieth R. Estimates of optimal vitamin D status. Osteoporos Int. 2005; 16:713–716.
25. Kim SH, Han JH, Kim WY. Health functional food use and related variables among the middle-aged in Korea. Korean J Nutr. 2010; 43:294–303.
26. Rho HK, Park MM. Perception level of vitamin D and calcium on osteoporosis treatment. J Korean Soc Menopause. 2008; 14:115–129.
27. Berg KM, Kunins HV, Jackson JL, Nahvi S, Chaudhry A, Harris KA Jr, Malik R, Arnsten JH. Association between alcohol consumption and both osteoporotic fracture and bone density. Am J Med. 2008; 121:406–418.
28. Gaddini GW, Turner RT, Grant KA, Iwaniec UT. Alcohol: a simple nutrient with complex actions on bone in the adult skeleton. Alcohol Clin Exp Res. 2016; 40:657–671.
29. DeSimone DP, Stevens J, Edwards J, Shary J, Gordon L, Bell NH. Influence of body habitus and race on bone mineral density of the midradius, hip, and spine in aging women. J Bone Miner Res. 1989; 4:827–830.
30. Yoo JI, Ha YC, Kwon HB, Lee YK, Koo KH, Yoo MJ. High Prevalence of sarcopenia in Korean patients after hip fracture: a case-control study. J Korean Med Sci. 2016; 31:1479–1484.
31. Ogata N, Chikazu D, Kubota N, Terauchi Y, Tobe K, Azuma Y, Ohta T, Kadowaki T, Nakamura K, Kawaguchi H. Insulin receptor substrate-1 in osteoblast is indispensable for maintaining bone turnover. J Clin Invest. 2000; 105:935–943.
32. Krakauer JC, McKenna MJ, Rao DS, Whitehouse FW. Bone mineral density in diabetes. Diabetes Care. 1997; 20:1339–1340.
33. Piepkorn B, Kann P, Forst T, Andreas J, Pfützner A, Beyer J. Bone mineral density and bone metabolism in diabetes mellitus. Horm Metab Res. 1997; 29:584–591.
34. Srikanthan P, Crandall CJ, Miller-Martinez D, Seeman TE, Greendale GA, Binkley N, Karlamangla AS. Insulin resistance and bone strength: findings from the study of midlife in the United States. J Bone Miner Res. 2014; 29:796–803.
35. Laktasic-Zerjavic N, Korsic M, Crncevic-Orlic Z, Kovac Z, Polasek O, Soldo-Juresa D. Vitamin D status, dependence on age, and seasonal variations in the concentration of vitamin D in Croatian postmenopausal women initially screened for osteoporosis. Clin Rheumatol. 2010; 29:861–867.
36. Gao C, Qiao J, Li SS, Yu WJ, He JW, Fu WZ, Zhang ZL. The levels of bone turnover markers 25(OH)D and PTH and their relationship with bone mineral density in postmenopausal women in a suburban district in China. Osteoporos Int. 2017; 28:211–218.
37. Henry HL, Bouillon R, Norman AW, Gallagher JC, Lips P, Heaney RP, Vieth R, Pettifor JM, Dawson-Hughes B, Lamberg-Allardt CJ, Ebeling PR. 14th Vitamin D Workshop consensus on vitamin D nutritional guidelines. J Steroid Biochem Mol Biol. 2010; 121:4–6.
38. Hwang YC, Ahn HY, Jeong IK, Ahn KJ, Chung HY. Optimal serum concentration of 25-hydroxyvitamin D for bone health in older Korean adults. Calcif Tissue Int. 2013; 92:68–74.
39. Dawson-Hughes B, Dallal GE, Krall EA, Harris S, Sokoll LJ, Falconer G. Effect of vitamin D supplementation on wintertime and overall bone loss in healthy postmenopausal women. Ann Intern Med. 1991; 115:505–512.
40. Larsen ER, Mosekilde L, Foldspang A. Vitamin D and calcium supplementation prevents osteoporotic fractures in elderly community dwelling residents: a pragmatic population-based 3-year intervention study. J Bone Miner Res. 2004; 19:370–378.
41. Jackson RD, LaCroix AZ, Gass M, Wallace RB, Robbins J, Lewis CE, Bassford T, Beresford SA, Black HR, Blanchette P, Bonds DE, Brunner RL, Brzyski RG, Caan B, Cauley JA, Chlebowski RT, Cummings SR, Granek I, Hays J, Heiss G, Hendrix SL, Howard BV, Hsia J, Hubbell FA, Johnson KC, Judd H, Kotchen JM, Kuller LH, Langer RD, Lasser NL, Limacher MC, Ludlam S, Manson JE, Margolis KL, McGowan J, Ockene JK, O'Sullivan MJ, Phillips L, Prentice RL, Sarto GE, Stefanick ML, Van Horn L, Wactawski-Wende J, Whitlock E, Anderson GL, Assaf AR, Barad D. Calcium plus vitamin D supplementation and the risk of fractures. N Engl J Med. 2006; 354:669–683.
42. Chapuy MC, Arlot ME, Duboeuf F, Brun J, Crouzet B, Arnaud S, Delmas PD, Meunier PJ. Vitamin D3 and calcium to prevent hip fractures in elderly women. N Engl J Med. 1992; 327:1637–1642.
43. Chapuy MC, Pamphile R, Paris E, Kempf C, Schlichting M, Arnaud S, Garnero P, Meunier PJ. Combined calcium and vitamin D3 supplementation in elderly women: confirmation of reversal of secondary hyperparathyroidism and hip fracture risk: the Decalyos II study. Osteoporos Int. 2002; 13:257–264.
44. Black LJ, Seamans KM, Cashman KD, Kiely M. An updated systematic review and meta-analysis of the efficacy of vitamin D food fortification. J Nutr. 2012; 142:1102–1108.
45. Bischoff-Ferrari HA, Kiel DP, Dawson-Hughes B, Orav JE, Li R, Spiegelman D, Dietrich T, Willett WC. Dietary calcium and serum 25-hydroxyvitamin D status in relation to BMD among U.S. adults. J Bone Miner Res. 2009; 24:935–942.
46. Lee SW, Lee SH, Kweon YR, Lee HJ. Factors relating to bone mineral density of adult man in Korea. J Korean Acad Fam Med. 2003; 24:158–165.
47. National Institute for Health and Care Excellence. Vitamin D: supplement use in specific population groups. Public health guideline [Internet]. London: National Institute for Health and Care Excellence;2014. cited 2014 November 26. Available from:
48. National Osteoporosis Foundation. Clinician's Guide to Prevention and Treatment of Osteoporosis. Washington, D.C.: National Osteoporosis Foundation;2008.
Full Text Links
  • NRP
export Copy
  • Twitter
  • Facebook
Similar articles
Copyright © 2022 by Korean Association of Medical Journal Editors. All rights reserved.     E-mail: