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Vitamin D and Bone Health

The Evidence

A systematic review of the evidence conducted in 2009 for the Institute of Medicine by the Tufts Evidence-based Practice Center in preparation for revisions to the Dietary Reference Intakes for vitamin D and calcium concluded the following regarding vitamin D and bone health.¹ The results reported in this section of the Tufts Evidence-based Review are based on the Ottawa EPC Evidence Report/Technology Assessments entitled Effectiveness and Safety of Vitamin D in Relation to Bone Health and on an updated literature review of studies published after its completion.

Rickets

• The Ottawa EPC report concluded that there is “fair” evidence, regardless of the type of assay, of an association between low serum 25(OH)D concentrations and confirmed rickets;
• According to the report, there is inconsistent evidence regarding the threshold concentration of serum 25(OH)D above which rickets does not occur;
• No new studies examining the association between vitamin D and rickets were identified.

Fractures, falls, or performance measures of strength

• The Ottawa EPC report concluded that the associations between serum 25(OH)D concentrations and risk of fractures, risk of falls, and performance measures of strength among postmenopausal women or elderly men are inconsistent;
• Findings from three additional randomized controlled trials reported no significant effects of vitamin D supplementation (dosage range 400–822 IU/d) in reducing the risk of total fractures or falls in adults > 70 years.

Bone mineral density (BMD) or bone mineral content (BMC)

• The Ottawa EPC report concluded that observational studies suggested a correlation between higher serum 25(OH)D concentrations and higher BMC indices for older children and adolescents (6 months to 18 years);
• In addition, there was “fair” evidence among observational studies of postmenopausal women and elderly men to support an association between higher serum 25(OH)D and higher BMD or increases in BMD at the femoral neck;
• Consistent with the findings of randomized controlled trials in the Ottawa EPC report, the three additional randomized controlled trials that were included showed no significant effects of vitamin D supplementation on BMC in children or BMD in adults.

Another systematic review of the evidence examined the burden of disease due to vitamin D deficiency in Canada and how this could change if the mean serum 25(OH)D concentration of Canadians were increased from 67 to 105 nmol/L, a value that would ensure that over half of the population has levels in the optimal range. This review found the following with respect to vitamin D and bone health:²

• The minimum level of 25(OH)D to achieve optimal bone health should be 80 nmol/L for all people.

Learn more on the subject:

• Vitamin D and Health
• Vitamin D and Growth
• Vitamin D and Immunologic Outcomes

Keywords: rickets, fracture, vitamin D, bone health

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