CLINICAL INVESTIGATIONS Associations Between Serum 25-Hydroxyvitamin D Concentrations and Multiple Health Conditions, Physical Performance Measures, Disability, and All-Cause Mortality: The Concord Health and Ageing in Men Project Vasant Hirani, PhD, a,b Robert G. Cumming, PhD, a,b Vasi Naganathan, PhD, a Fiona Blyth, PhD, a David G. Le Couteur, PhD, a,c David J. Handelsman, PhD, d,e Louise M. Waite, PhD, a and Markus J. Seibel, PhD f,g OBJECTIVES: To explore associations between serum 25-hydroxyvitamin D (25(OH)D) levels and a wide range of health conditions, physical performance measures, dis- ability, and mortality in a large epidemiological study to identify an optimum range for 25(OH)D concentrations. DESIGN: Cross-sectional study, with additional prospec- tive data on falls and mortality. SETTING: Concord Health and Ageing in Men Project, Sydney, Australia. PARTICIPANTS: Community-dwelling men aged 70 and older (N = 1,659). MEASUREMENTS: Serum 25(OH)D levels, general health status, self-reported diseases, physical performance measures, disability (activities of daily living and instru- mental activities of daily living) and falls. RESULTS: Fair, poor, and very poor health; self-reported diabetes mellitus; hyperglycemia; depression; muscle weak- ness; poor balance; and all-cause mortality were all associ- ated with serum 25(OH)D levels less than 50 nmol/L, even after adjustment for confounding. The findings also suggest that, in older men, for a wide range of health conditions, physical performance measures, disability, falls, and mor- tality, the optimum range of 25(OH)D is between 50.0 and 74.9 nmol/L, with no additional benefit for 25(OH)D levels of 75.0 nmol/L or greater. CONCLUSION: Programs aimed at achieving an opti- mum range of serum 25(OH)D at levels between 50.0 and 74.9 nmol/L may have overall health benefits and such levels are adequate for older men. J Am Geriatr Soc 2014. Key words: vitamin D levels; older men; health out- comes; Sydney; Australia; population study I nadequate vitamin levels D (25-hydroxyvitamin D (25(OH)D) concentrations <50 nmol/L) are a wide- spread and emerging major public health problem glob- ally. 1–3 The importance of vitamin D for bone health is well known, but there is increasing interest in the link between vitamin D deficiency and a wide range of non- communicable diseases. 4,5 There is no clear consensus on optimal 25(OH)D levels for overall health. 3 The Institute of Medicine and others have proposed a serum 25(OH)D level of less than 50.0 nmol/L as the definition of vitamin D insufficiency, 4,6 whereas other evidence suggests that levels of 75.0 nmol/L or greater are desirable. 7,8 A recent position statement 3 states that 25(OH)D levels of 50 nmol/L or greater at the end of winter and 50 to 80 nmol/L at the end of summer are adequate. Most of the recommendations for optimal 25(OH)D levels have been derived from studies that have bone-related outcomes. The target levels for other health outcomes may not be the same. A recent study has found associations between 25 (OH)D levels of less than 50 nmol/L and clinical out- comes such as hip fracture, myocardial infarction, inci- dent cancer, and mortality in individuals aged 65 and older. 9 Another study of adults aged 25 and older (mean age 51) who participated in the Australian Diabetes, Obesity and Lifestyle Study 10 reported on 25(OH)D levels From the a Centre for Education and Research on Ageing, Concord Hospital, University of Sydney, b School of Public Health, University of Sydney, c Charles Perkins Centre, University of Sydney, d Department of Andrology, Concord Hospital, University of Sydney, e ANZAC Research Institute, University of Sydney, f Department of Endocrinology and Metabolism, Concord Hospital, University of Sydney, and g Bone Research Program, University of Sydney, Sydney, New South Wales, Australia. Address correspondence to Dr. Vasant Hirani, Centre for Education and Research on Ageing, Concord Hospital, Hospital Road, Concord, NSW 2139, Australia. E-mail: vasant.hirani@sydney.edu.au DOI: 10.1111/jgs.12693 JAGS 2014 © 2014, Copyright the Authors Journal compilation © 2014, The American Geriatrics Society 0002-8614/14/$15.00