The role of vitamin D for bone health and fracture prevention
- Michael F. Holick PhD, MD
- … show all 1 hide
Purchase on Springer.com
$39.95 / €34.95 / £29.95*
Rent the article at a discountRent now
* Final gross prices may vary according to local VAT.
Vitamin D inadequacy is pandemic in adults. Vitamin D deficiency causes osteopenia, precipitates and exacerbates osteoporosis, causes the painful bone disease osteomalacia, and increases muscle weakness, which worsens the risk of falls and fractures. Vitamin D deficiency can be prevented by sensible sun exposure and adequate supplementation. Monitoring serum 25-hydroxyvitamin D is the only way to determine vitamin D status. Recent recommendations suggest that in the absence of sun exposure, adults should ingest 1000 IU of vitamin D3 per day. The ideal healthy blood level of 25-hydroxyvitamin D should be 30 to 60 ng/mL. Vitamin D intoxication occurs when 25-hydroxyvitamin D levels are greater than 150 ng/mL. Three recent reports suggesting that vitamin D and calcium supplementation does not decrease the risk of fracture will be put into perspective in light of the vast literature supporting increasing vitamin D and calcium intake as an effective method for decreasing risk of vertebral and nonvertebral fractures.
- Holick, MF: High prevalence of vitamin D inadequacy and implications for health. Mayo Clin Proc 2006, 81:353–373. This comprehensive review not only provides levels of evidence and documentation for the important role of vitamin D in maintaining bone health in adults, but also provides a comprehensive update on all the beneficial effects of vitamin D for decreasing risk of chronic diseases including cancer, autoimmune diseases, and cardiovascular disease. CrossRef
- Holick MF: Sunlight and vitamin D for bone health and prevention of autoimmune diseases, cancers, and cardiovascular disease. Am J Clin Nutr 2004, 80:1678S-1688S.
- Bouillon R: Vitamin D: from photosynthesis, metabolism, and action to clinical applications. In Endocrinology. Edited by DeGroot LJ, Jameson JL. Philadelphia: WB Saunders; 2001:1009–1028.
- Dawson-Hughes B, Heaney RP, Holick, MF, et al.: Estimates of optimal vitamin D status [editorial]. Osteoporos Int 2005, 16:713–716. CrossRef
- Christakos S, Dhawan P, Liu Y, et al.: New insights into the mechanisms of vitamin D action. J Cell Biochem 2003, 88:695–705. CrossRef
- Khosla S: The OPG/RANKL/RANK system. Endocrinology 2001, 142:5050–5055. CrossRef
- Rosen CJ: Clinical practice. Postmenopausal osteoporosis [review]. N Engl J Med 2005, 353:595–603. CrossRef
- Boonen S, Bischoff-Ferrari A, Cooper C, et al.: Addressing the musculoskeletal components of fracture risk with calcium and vitamin D: a review of the evidence. Calcif Tissue Int 2006, 78:257–270. CrossRef
- Chapuy MC, Preziosi P, Maaner M, et al.: Prevalence of vitamin D insufficiency in an adult normal population. Osteoporos Int 1997, 7:439–443. CrossRef
- Holick MF, Siris ES, Binkley N, et al.: Prevalence of vitamin D inadequacy among postmenopausal North American women receiving osteoporosis therapy. J Clin Endocrinol Metab 2005, 90:3215–3224. CrossRef
- Heaney RP, Dowell MS, Hale CA, et al.: Calcium absorption varies within the reference range for serum 25-hydroxyvitamin D. J Am Coll Nutr 2003, 22:142–146.
- Vieth R, Chan PCR, MacFarlane GD: Efficacy and safety of vitamin D intake exceeding the lowest observed adverse effect level. Am J Clin Nutr 2001, 73:288–294.
- Gaugris S, Heaney RP, Boonen S, et al.: Vitamin D inadequacy among post-menopausal women: a systemic review. Q J Med 2005, 98:667–676.
- Webb AR, Pilbeam C, Hanafin N, et al.: A one-year study to evaluate the roles of exposure to sunlight and diet on the circulating concentrations of 25-OH-D in an elderly population in Boston. Am J Clin Nutr 1990, 51:1075–1081.
- Barger-Lux MJ, Heaney RP, Dowell S, et al.: Vitamin D and its major metabolites: serum levels after graded oral dosing in healthy men. Osteoporos Int 1998, 8:222–230. CrossRef
- Tangpricha V, Koutkia P, Rieke SM, et al.: Fortification of orange juice with vitamin D: a novel approach to enhance vitamin D nutritional health. Am J Clin Nutr 2003, 77:1478–1483.
- Malabanan A, Veronikis IE, Holick MF: Redefining vitamin D insufficiency. Lancet 1998, 351:805–806. CrossRef
- Armas LAG, Hollis B, Heaney RP: Vitamin D2 is much less effective than vitamin D in humans. J Clin Endocrinol Metab 2004, 89:5387–5391. CrossRef
- Trang HM, Cole DE, Rubin LA, et al.: Evidence that vitamin D increases serum 25-hydroxyvitamin D more efficiently than does vitamin D2. Am J Clin Nutr 1998, 68:854–858.
- Koutkia P, Chen TC, Holick MF: Vitamin D intoxication associated with an over-the-counter supplement [letter]. N Engl J Med 2001, 345:66–67. CrossRef
- Vieth R: Vitamin D supplementation, 25-hydroxyvitamin D concentrations, and safety [review]. Am J Clin Nutr 1999, 69:842–856.
- Nesby-O’Dell S, Scanlon KS, Cogswell ME, et al.: Hypovitaminosis D prevalence and determinants among African American and white women of reproductive age: third National Health and Nutrition Examination Survey, 1988–1994. Am J Clin Nutr 2002, 76:187–192.
- Lips P: Vitamin D deficiency and secondary hyperparathyroidism in the elderly: consequences for bone loss and fractures and therapeutic implications. Endocr Rev 2001, 22:477–501. CrossRef
- Blau EM, Brenneman SK, Bruning AL, et al.: Prevalence of vitamin D insufficiency in an osteoporosis population in Southern California. J Bone Miner Res 2004, 19(Suppl:1):S342.
- McGrath JJ, Kimlin MG, Saha S, et al.: Vitamin D insuffiency in south-east Queensland [letter]. Med J Aust 2001, 174:150–151.
- Marwaha RK, Tandon N, Reddy D, et al.: Vitamin D and bone mineral density status of healthy schoolchildren in northern India. Am J Clin Nutr 2005, 82:477–482.
- Sedrani SH: Low 25-hydroxyvitamin D and normal serum calcium concentrations in Saudi Arabia: Riyadh region. Ann Nutr Metab 1984, 28:181–185. CrossRef
- Matsuoka LY, Ide L, Wortsman J, et al.: Sunscreens suppress cutaneous vitamin D synthesis. J Clin Endocrinol Metab 1987, 64:1165–1168. CrossRef
- Clemens TL, Adams JS, Henderson SL, Holick MF: Increased skin pigment reduces the capacity of skin to synthesise vitamin D. Lancet 1982, 1(8263):74–76. CrossRef
- Webb AR, Kline L, Holick MF: Influence of season and latitude on the cutaneous synthesis of vitamin D: Exposure to winter sunlight in Boston and Edmonton will not promote vitamin D synthesis in human skin. J Clin Endocrinol Metab 1988, 67:373–378. CrossRef
- Wortsman J, Matsuoka LY, Chen TC, et al.: Decreased bioavailability of vitamin D in obesity. Am J Clin Nutr 2000, 72:690–693. Erratum in: Am J Clin Nutr 2003, 77:1342.
- Bakhtiyarova S, Lesnyak O, Kyznesova N, et al.: Vitamin D status among patients with hip fracture and elderly control subjects in Yekaterinburg, Russia. Osteoporos Int 2006, 17:441–446. CrossRef
- Malabanan AO, Turner AK, Holick MF: Severe generalized bone pain and osteoporosis in a premenopausal black female: effect of vitamin D replacement. J Clin Densitometr 1998, 1:201–204. CrossRef
- Plotnikoff GA, Quigley JM: Prevalence of severe hypovitaminosis D in patients with persistent, nonspecific musculoskeletal pain. Mayo Clin Proc 2003, 78:1463–1470. CrossRef
- Holick MF: Vitamin D deficiency: what a pain it is [editorial]. Mayo Clin Proc 2003, 78:1457–1459. CrossRef
- Glerup H, Mikkelsen K, Poulsen L, et al.: Hypovitaminosis D myopathy without biochemical signs of ostemalacia bone involvement. Calcif Tissue Int 2000, 66:419–424. CrossRef
- Chapuy MC, Arlot ME, Duboeuf F, et al.: Vitamin D and calcium to prevent hip fractures in elderly women. N Engl J Med 1992, 327:1637–1642. CrossRef
- Dawson-Hughes B, Harris SS, Krall EA, et al.: Effect of calcium and vitamin D supplementation on bone density in men and women 65 years of age or older. N Engl J Med 1997, 337:670–676. CrossRef
- 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 2002, 19:370–378. CrossRef
- Porthouse J, Cockayne S, King C, et al.: Randomised controlled trial of calcium and supplementation with cholecalciferol (vitamin D) for prevention of fractures in primary care. BMJ 2005, 330:1003–1008. CrossRef
- Grant AM, Avenell A, Campbell MK, et al.; RECORD Trial Group: Oral vitamin D and calcium for secondary prevention of low-trauma fractures in elderly people (Randomised Evaluation of Calcium Or vitamin D, RECORD): a randomised placebo-controlled trial. Lancet 2005, 365:1621–1628. CrossRef
- Jackson RD, LaCroix AZ, Gass M, et al.; Women’s Health Initiative Investigators: Calcium plus vitamin D supplementation and the risk of fractures. N Engl J Med 2006, 354:669–683. The authors report on the calcium and vitamin D supplementation arm of the Women’s Health Initiative. Although the authors and the press have concluded that calcium with vitamin D supplementation was of no benefit for decreasing risk of fractures, it should be noted that the patients who took their calcium and vitamin D at least 80% of the time had a 29% reduced risk of hip fracture. Equally important is that most patients were vitamin D-deficient at initiation of the study and those who were vitamin D-deficient at baseline were at higher risk of fracture. CrossRef
- Bischoff-Ferrari HA, Willet WC, Wong JB, et al.: Fracture prevention with vitamin D supplementation: a metaanalysis of randomized controlled trials. JAMA 2005, 293:2257–2264. This meta-analysis of the randomized controlled trials provides convincing evidence that vitamin D supplementation needs to be at least 800 IU/d in order to be of benefit for reducing risk of vertebral and nonvertebral fractures. CrossRef
- Trivedi DP, Doll R, Khaw KT: Effect of four monthly oral vitamin D (cholecalciferol) supplementation on fractures and mortality in men and women living in the community: randomized double blind controlled trial. BMJ 2003, 326:469–474. The authors provide a simple but effective method of decreasing risk of hip fracture by simply mailing to their patients every 4 months a tablet containing 100,000 IU of vitamin D. CrossRef
- Heikinheimo RJ, Inkovaara JA, Harju EJ, et al.: Annual injection of vitamin D and fractures of aged bones. Calcif Tissue Int 1992, 51:105–110. CrossRef
- Smith H, Anderson F, Raphael H, et al.: Annual intramuscular vitamin D and fractures in the elderly. J Bone Miner Res 2004, 19:A1032. CrossRef
- Bischoff-Ferrari HA, Dietrich T, Orav EJ, et al.: Higher 25-hydroxyvitamin D concentrations are associated with better lower-extremity function in both active and inactive persons aged >r = 60 y. Am J Clin Nutr 2004, 80:752–758.
- Bischoff-Ferrari HA, Dawson-Hughes B, Willett WC, et al.: Effect of vitamin D on falls: a meta-analysis [review]. JAMA 2004, 291:1999–2006. The authors conducted a meta-analysis and provide convincing evidence that vitamin D supplementation decreases risk of falling. CrossRef
- Bischoff HA, Stahelin HB, Dick W, et al.: Effects of vitamin D and calcium supplementation on falls: a randomized controlled trial. J Bone Miner Res 2003, 18:343–351. CrossRef
- Holick MF, Jenkins M: The UV Advantage. New York: iBooks; 2004.
- Chapuy MC, Pamphile R, Paris E, et al.: Combined calcium and vitamin D upplementation in elderly women: confirmation of reversal of secondary hyperparathyroidism and hip fracture risk: the Decalyos II study. Osteoporos Int 2002, 13:257–264. CrossRef
- Chapuy MC, Arlot ME, Delmas PD, Meunier PJ: Effect of calcium and cholecalciferol treatment for three years on hip fractures in elderly women. BMJ 1994, 308:1081–1082.
- Meyer HE, Smedshaug GB, Kvaavik E, et al.: Can vitamin D supplementation reduce the risk of fracture in the elderly? A randomized controlled trial. J Bone Miner Res 2002, 17:709–715. CrossRef
- Lips P, Graafmans WC, Ooms ME, et al.: Vitamin D supplementation and fracture incidence in elderly persons: a randomized, placebo-controlled clinical trial. Ann Intern Med 1996, 124:400–406.
- Pfeifer M, Begerow B, Minne HW, et al.: Effects of a shortterm vitamin D and calcium supplementation on body sway and secondary hyperparathyroidism in elder women. J Bone Miner Res 2000, 15:1113–1118. CrossRef
- The role of vitamin D for bone health and fracture prevention
Current Osteoporosis Reports
Volume 4, Issue 3 , pp 96-102
- Cover Date
- Print ISSN
- Online ISSN
- Current Medicine Group
- Additional Links
- Author Affiliations
- 1. Boston University School of Medicine, 715 Albany Street, M-1013, 02118, Boston, MA, USA