Benefit–risk assessment of vitamin D supplementation

Abstract

Summary

Current intake recommendations of 200 to 600 IU vitamin D per day may be insufficient for important disease outcomes reduced by vitamin D.

Introduction

This study assessed the benefit of higher-dose and higher achieved 25-hydroxyvitamin D levels [25(OH)D] versus any associated risk.

Methods and results

Based on double-blind randomized control trials (RCTs), eight for falls (n = 2426) and 12 for non-vertebral fractures (n = 42,279), there was a significant dose–response relationship between higher-dose and higher achieved 25(OH)D and greater fall and fracture prevention. Optimal benefits were observed at the highest dose tested to date for 700 to 1000 IU vitamin D per day or mean 25(OH)D between 75 and 110 nmol/l (30–44 ng/ml). Prospective cohort data on cardiovascular health and colorectal cancer prevention suggested increased benefits with the highest categories of 25(OH)D evaluated (median between 75 and 110 nmol/l). In 25 RCTs, mean serum calcium levels were not related to oral vitamin D up to 100,000 IU per day or achieved 25(OH)D up to 643 nmol/l. Mean levels of 75 to 110 nmol/l were reached in most RCTs with 1,800 to 4,000 IU vitamin D per day without risk.

Conclusion

Our analysis suggests that mean serum 25(OH)D levels of about 75 to 110 nmol/l provide optimal benefits for all investigated endpoints without increasing health risks. These levels can be best obtained with oral doses in the range of 1,800 to 4,000 IU vitamin D per day; further work is needed, including subject and environment factors, to better define the doses that will achieve optimal blood levels in the large majority of the population.

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Correspondence to H. A. Bischoff-Ferrari.

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Heike Bischoff-Ferrari is supported by a Swiss National Foundation Professorship Grant (PP00B-114864). This project was supported by an investigator-initiated and unrestricted grant provided by DSM and by a Centre Grant of the University of Zurich and the Town of Zurich (Centre on Aging and Mobility).

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Bischoff-Ferrari, H.A., Shao, A., Dawson-Hughes, B. et al. Benefit–risk assessment of vitamin D supplementation. Osteoporos Int 21, 1121–1132 (2010). https://doi.org/10.1007/s00198-009-1119-3

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Keyword

  • Falls
  • Fractures
  • Hypercalcemia
  • Recommendations
  • Risk
  • Vitamin D