Vitamin D Supplementation: Who, and How Much?

Bret Stetka, MD; Robyn Lucas, PhD, BSc, MBChB, MPH&TM, MHE


January 13, 2014

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Hello. I'm Bret Stetka, Editorial Director at Medscape. Welcome to the F1000 Practice-Changing Minute, during which we report commentaries from the Faculty of 1000 on highly rated studies that may change clinical practice. Today's commentary covers the study "Effects of Vitamin D Supplements on Bone Mineral Density: A Systematic Review and Meta-analysis," by Reid and colleagues and published in the Lancet.[1] Our commentator has given this study a ranking of "Changes Clinical Practice," with the conclusion that vitamin D supplementation should not be prescribed to individuals without risk factors. Judicious testing of patients who have identifiable risk factors for vitamin D deficiency should be undertaken and treatment given as required if levels are < 40 nmol/L.

The following F1000 commentary is from Dr. Robyn Lucas of the Australian National University, Canberra, Australia. In her commentary on this study, Dr. Lucas wrote:

Prescribing vitamin D supplementation for osteoporosis to prevent fracture is common practice in many countries. Despite a few meta-analyses showing that vitamin D supplementation alone does not prevent hip fracture, several clinical trials and meta-analyses do show a decrease in risk of fractures and falls; however, the latter are mainly seen when supplementation is with vitamin D supplementation plus calcium.

The current study examines vitamin D supplementation in relation to bone mineral density. The study authors found little evidence of a convincing positive effect of vitamin D supplementation in improving bone mineral density. They conclude that their analysis gives no support for the target of > 75 nmol/L concentration of 25-hydroxyvitamin D...which aligns well with the 2010 report of the Institute of Medicine, which determined that 40 nmol/L was an adequate concentration.

This study thus provides further support that there are health risks associated with vitamin D deficiency, but there is little evidence that levels higher than 40-50 nmol/L provide additional benefit.

Vitamin D supplementation should be reserved for those with risk factors for deficiency or proven deficiency on testing with an accurate and precise assay.

This concludes today's commentary from Dr. Lucas. For the F1000 Practice-Changing Minute, I am Bret Stetka. Thank you for listening.


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