Effect of vitamin D on bone strength in older African Americans: a randomized controlled trial



There is controversy over whether African Americans have higher vitamin D requirements than recommended by the Institute of Medicine. We previously reported that maintaining serum 25(OH)D above 30 ng/mL does not prevent age-related bone loss. Herein, we report that bone strength is also unaffected by maintaining this level in this population.


The role of vitamin D in bone strength has not been investigated in the African American (AA) population.


A 3-year randomized controlled trial was designed to examine the effect of vitamin D supplementation on physical performance, bone loss, and bone strength in healthy older AA women. A total of 260 postmenopausal AA women, ages ≥ 60 years were randomized to a vitamin D3 or placebo arm. Vitamin D3 dose was adjusted to maintain serum 25OHD > 30 ng/mL. Bone mineral density, femoral axis length, and femoral neck (FN) width were measured by dual-energy X-ray absorptiometry. Composite indices of FN strength [compression strength index (CSI), bending strength index (BSI), and impact strength index (ISI)] were computed.


The mean age of participants was 68.2 ± 4.9 years. Baseline characteristics between groups were similar. The average dose of vitamin D3 was 3490 ± 1465 IU/day in the active group. The mean serum 25OHD was 46.8 ± 1.2 ng/mL versus 20.7 ± 1.1 ng/mL in the active versus placebo group. Serum 25OHD did not correlate with any composite indices. The longitudinal differences observed in FN width, CSI, BSI, and ISI in both groups were not statistically significant (all p values > 0.05). Further, there was no group × time interaction effect for any of the composite indices (all p values > 0.05).


Maintaining serum 25OHD > 30 ng/mL (75 nmol/L) does not affect bone strength in older AA women. There is no evidence to support vitamin D intake greater than the recommended RDA by the Institute of Medicine in this population for bone strength.

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Fig. 1



25-Hydroxy vitamin D


Bone mineral density


Bending strength index


Confidence interval


Compression strength index


Dual-energy X-ray absorptiometry


Femoral neck


Femoral neck width


Hip axis length


Hip structure analysis


Impact strength index


International units


Parathyroid hormone


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We thank the study participants and staff at the Bone Mineral Research Center for their contribution, and the Data Safety and Monitoring Board Committee Members: Munro Peacock, MD, DSc; Bess Dawson-Hughes, MD; Lynette Smith, MS; Judy Hannah, PhD; Rebecca Costello, PhD; Christopher Sempos, PhD; Andy Hoofnagle MD, PhD, Director, Nutrition and Obesity Research Center, University of Washington.

Funding information

This research was supported by grants from the National Institute of Health (NIH) and Office of Dietary Supplements (ODS); R01-AG032440-05.

Author information

JFA designed and supervised the study; SI, the study statistician, was responsible for the data and statistical analyses. RD contributed to data gathering and data interpretation, presented the data, and wrote the manuscript. JFA and SI contributed to the writing and review of the manuscript. LR, the laboratory director, was responsible for the biochemical assays. All authors had final approval of the submitted and published versions.

Correspondence to R. Dhaliwal.

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Dhaliwal, R., Islam, S., Mikhail, M. et al. Effect of vitamin D on bone strength in older African Americans: a randomized controlled trial. Osteoporos Int (2020) doi:10.1007/s00198-019-05275-1

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  • Aging
  • Bone strength
  • Clinical trial
  • Fracture prevention
  • Osteoporosis
  • Vitamin D