Purpose: To examine the association between circulating 25(OH)D concentrations and incidence of total hip replacement for osteoarthritis in a prospective cohort study.

Methods: This study examined a random sample of 2768 participants in the Melbourne Collaborative Cohort Study who had 25(OH)D concentrations measured from dried blood spots collected in 1990-1994. Participants who underwent total hip replacement for osteoarthritis between January 2001 and December 2018 were identified by linking the cohort records to the Australian Orthopaedic Association National Joint Replacement Registry. Participants with self-reported hip replacement before January 2001 were identified as having severe hip osteoarthritis. Logistic regression was used to estimate odds ratios (OR) and 95% confidence intervals (CI) of total hip replacement in relation to 25(OH)D concentrations.

Results: 97 men and 94 women had a total hip replacement for osteoarthritis. Compared with men in the lowest (1st) quartile of 25(OH)D concentration, the OR for total hip replacement was 1.61 (95% CI 0.84-3.09) for those in the 2nd quartile, 2.15 (95% CI 1.15-4.01) for those in the 3rd quartile, and 1.32 (95% CI 0.67-2.61) for those in the highest quartile of 25(OH)D concentrations (p for trend 0.047). There was little evidence of an association in women.

Conclusions: Higher circulating 25(OH)D concentrations were associated with an increased risk of hip replacement for osteoarthritis in men but not in women. Although the underlying mechanism warrants further investigation, our findings highlight the need to determine the optimal levels of circulating 25(OH)D to prevent osteoporotic fractures and reduce the risk of hip osteoarthritis.