Ginsberg C, Hoofnagle AN, Katz R, et al. - When compared with 25(OH)D ₃, a lower vitamin D metabolite ratio (VMR) was more strongly related to both loss of BMD and fracture risk in a diverse cohort of community-dwelling older adults.

• It was a retrospective cohort study.

• The sample consisted of 786 community-dwelling adults aged 70 to 79 years who partook in the Health Aging and Body Composition Study.

• Annual changes in bone density and incident fracture were the primary outcomes.

• The participants' average age was 75 ±  3 years, 49% were female, 42% were Black, and 23% had an eGFR < 60ml/ml/1.73m ².

• A 50% lower VMR was associated with a 0.3% faster decline in total hip BMD in fully adjusted models.

• Similar relationships were discovered with thoracic and lumbar spine BMD.

• 25(OH)D ₃ concentrations, on the other hand, were not linked to the longitudinal change in BMD.

• During a 10-year follow-up, there were 178 fractures.

• Lower 25(OH)D ₃ concentrations were not significantly connected with fracture risk, despite a 50% lower VMR being linked to a 49% higher risk of fracture.