Current Osteoporosis Reports

, Volume 4, Issue 3, pp 96–102 | Cite as

The role of vitamin D for bone health and fracture prevention

  • Michael F. HolickEmail author


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.


Osteoporosis Chronic Fatigue Syndrome Nonvertebral Fracture Intestinal Calcium Absorption Adequate Calcium Intake 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


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References and Recommended Reading

  1. 1.
    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.PubMedCrossRefGoogle Scholar
  2. 2.
    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.PubMedGoogle Scholar
  3. 3.
    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.Google Scholar
  4. 4.
    Dawson-Hughes B, Heaney RP, Holick, MF, et al.: Estimates of optimal vitamin D status [editorial]. Osteoporos Int 2005, 16:713–716.PubMedCrossRefGoogle Scholar
  5. 5.
    Christakos S, Dhawan P, Liu Y, et al.: New insights into the mechanisms of vitamin D action. J Cell Biochem 2003, 88:695–705.PubMedCrossRefGoogle Scholar
  6. 6.
    Khosla S: The OPG/RANKL/RANK system. Endocrinology 2001, 142:5050–5055.PubMedCrossRefGoogle Scholar
  7. 7.
    Rosen CJ: Clinical practice. Postmenopausal osteoporosis [review]. N Engl J Med 2005, 353:595–603.PubMedCrossRefGoogle Scholar
  8. 8.
    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.PubMedCrossRefGoogle Scholar
  9. 9.
    Chapuy MC, Preziosi P, Maaner M, et al.: Prevalence of vitamin D insufficiency in an adult normal population. Osteoporos Int 1997, 7:439–443.PubMedCrossRefGoogle Scholar
  10. 10.
    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.PubMedCrossRefGoogle Scholar
  11. 11.
    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.PubMedGoogle Scholar
  12. 12.
    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.PubMedGoogle Scholar
  13. 13.
    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.Google Scholar
  14. 14.
    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.PubMedGoogle Scholar
  15. 15.
    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.PubMedCrossRefGoogle Scholar
  16. 16.
    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.PubMedGoogle Scholar
  17. 17.
    Malabanan A, Veronikis IE, Holick MF: Redefining vitamin D insufficiency. Lancet 1998, 351:805–806.PubMedCrossRefGoogle Scholar
  18. 18.
    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.PubMedCrossRefGoogle Scholar
  19. 19.
    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.PubMedGoogle Scholar
  20. 20.
    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.PubMedCrossRefGoogle Scholar
  21. 21.
    Vieth R: Vitamin D supplementation, 25-hydroxyvitamin D concentrations, and safety [review]. Am J Clin Nutr 1999, 69:842–856.PubMedGoogle Scholar
  22. 22.
    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.PubMedGoogle Scholar
  23. 23.
    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.PubMedCrossRefGoogle Scholar
  24. 24.
    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.Google Scholar
  25. 25.
    McGrath JJ, Kimlin MG, Saha S, et al.: Vitamin D insuffiency in south-east Queensland [letter]. Med J Aust 2001, 174:150–151.PubMedGoogle Scholar
  26. 26.
    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.PubMedGoogle Scholar
  27. 27.
    Sedrani SH: Low 25-hydroxyvitamin D and normal serum calcium concentrations in Saudi Arabia: Riyadh region. Ann Nutr Metab 1984, 28:181–185.PubMedCrossRefGoogle Scholar
  28. 28.
    Matsuoka LY, Ide L, Wortsman J, et al.: Sunscreens suppress cutaneous vitamin D synthesis. J Clin Endocrinol Metab 1987, 64:1165–1168.PubMedCrossRefGoogle Scholar
  29. 29.
    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.PubMedCrossRefGoogle Scholar
  30. 30.
    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.PubMedCrossRefGoogle Scholar
  31. 31.
    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.PubMedGoogle Scholar
  32. 32.
    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.PubMedCrossRefGoogle Scholar
  33. 33.
    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.CrossRefGoogle Scholar
  34. 34.
    Plotnikoff GA, Quigley JM: Prevalence of severe hypovitaminosis D in patients with persistent, nonspecific musculoskeletal pain. Mayo Clin Proc 2003, 78:1463–1470.PubMedCrossRefGoogle Scholar
  35. 35.
    Holick MF: Vitamin D deficiency: what a pain it is [editorial]. Mayo Clin Proc 2003, 78:1457–1459.PubMedCrossRefGoogle Scholar
  36. 36.
    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.PubMedCrossRefGoogle Scholar
  37. 37.
    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.PubMedCrossRefGoogle Scholar
  38. 38.
    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.PubMedCrossRefGoogle Scholar
  39. 39.
    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.CrossRefGoogle Scholar
  40. 40.
    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.PubMedCrossRefGoogle Scholar
  41. 41.
    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.PubMedCrossRefGoogle Scholar
  42. 42.
    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.PubMedCrossRefGoogle Scholar
  43. 43.
    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.PubMedCrossRefGoogle Scholar
  44. 44.
    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.PubMedCrossRefGoogle Scholar
  45. 45.
    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.PubMedCrossRefGoogle Scholar
  46. 46.
    Smith H, Anderson F, Raphael H, et al.: Annual intramuscular vitamin D and fractures in the elderly. J Bone Miner Res 2004, 19:A1032.CrossRefGoogle Scholar
  47. 47.
    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.PubMedGoogle Scholar
  48. 48.
    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.PubMedCrossRefGoogle Scholar
  49. 49.
    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.PubMedCrossRefGoogle Scholar
  50. 50.
    Holick MF, Jenkins M: The UV Advantage. New York: iBooks; 2004.Google Scholar
  51. 51.
    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.PubMedCrossRefGoogle Scholar
  52. 52.
    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.PubMedGoogle Scholar
  53. 53.
    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.PubMedCrossRefGoogle Scholar
  54. 54.
    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.PubMedGoogle Scholar
  55. 55.
    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.PubMedCrossRefGoogle Scholar

Copyright information

© Current Science Inc 2006

Authors and Affiliations

  1. 1.Boston University School of MedicineBostonUSA

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