Citation

Bischoff-Ferrari H. Best Pract. Res. Clin. Rheumatol. 2009; 23(6): 789-795.

Affiliation

Centre on Aging and Mobility, University of Zurich, Zurich, Switzerland; Department of Rheumatology and Institute of Physical Medicine, University Hospital Zurich, Zurich, Switzerland.

Copyright

(Copyright © 2009, Elsevier Publishing)

DOI

10.1016/j.berh.2009.09.005

PMID

19945690

Abstract

Strong evidence indicates that many or most adults in the United States and Europe would benefit from vitamin D supplements with respect to fracture and fall prevention, and possibly other public health targets, such as cardiovascular health, diabetes and cancer. This review discusses the amount of vitamin D supplementation needed and a desirable 25-hydroxyvitamin D level to be achieved for optimal musculoskeletal health. Vitamin D modulates fracture risk in two ways: by decreasing falls and increasing bone density. Two most recent meta-analyses of double-blind randomised controlled trials came to the conclusion that vitamin D reduces the risk of falls by 19%, the risk of hip fracture by 18% and the risk of any non-vertebral fracture by 20%; however, this benefit was dose dependent. Fall prevention was only observed in a trial of at least 700IU vitamin D per day, and fracture prevention required a received dose (treatment dose*adherence) of more than 400IU vitamin D per day. Anti-fall efficacy started with achieved 25-hydroxyvitamin D levels of at least 60nmoll(-1) (24 ngml(-1)) and anti-fracture efficacy started with achieved 25-hydroxyvitamin D levels of at least 75nmoll(-1) (30ng ml(-1)) and both endpoints improved further with higher achieved 25-hydroxyvitamin D levels. Founded on these evidence-based data derived from the general older population, vitamin D supplementation should be at least 700-1000IU per day and taken with good adherence to cover the needs for both fall and fracture prevention. Ideally, the target range for 25-hydroxyvitamin D should be at least 75nmoll(-1), which may need more than 700-1000IU vitamin D in individuals with severe vitamin D deficiency or those overweight.

Language: en