5 reasons to stop prescribing vitamin D for bones
There is little reason to continue prescribing vitamin D for bone health, because it doesn’t prevent fractures, falls or improve bone density.
The authors of a large meta-analysis published in Lancet Diabetes and Endocrinology say their findings show vitamin D supplementation has little justification — except in rare cases of rickets or osteomalacia where exposure to sunlight is a factor.
Since the last major review in 2014, more than 30 randomised controlled trials on bone health and vitamin D have been published, nearly doubling the evidence-base available.
“Our findings suggest that vitamin D supplementation does not prevent fracture or falls, or have clinically meaningful effects on bone mineral density,” say the researchers, led by Dr Mark Bolland, of the University of Auckland, New Zealand.
“There were no differences between the effects of higher and lower doses of vitamin D.
“There is little justification to use vitamin D supplements to maintain or improve musculoskeletal health. Guidelines should reflect this.”
Here are five key reasons to stop recommending vitamin D as a way of improving bone health:
- This is the largest meta-analysis to date, combining data from 81 randomised controlled trials, involving more 53,500 participants, with more than half the studies involving daily dosing.
- Vitamin D supplementation was shown to have no effect on total fracture, hip fracture or falls.
- For bone mineral density outcomes, the between-group differences were 0.25% for lumbar spine, 0.76% for femoral neck, and 0.13% for total body, none of which were clinically relevant.
- More than 90% of the trials reported achieving 25-hyroxyvitamin D concentrations of 50nmol/L or more and 58% reported achieving concentrations of 75nmol/L or more.
- Dr Bolland and colleagues are leaders in the field of meta-analysis and have taken great care to analyse the data in every way possible, according to a linked editorial in the same journal.
And what about the extra-skeletal benefits of vitamin D?
According to the editorial author, Professor Chris Gallagher, of Creighton University in the US, those results are coming soon, with studies on almost 100,000 participants currently enrolled in randomised controlled trials of vitamin D supplementation due to report within three years.
“I look forward to those studies giving us the last word on vitamin D,” Professor Gallagher concluded.
More information: Lancet Diabetes and Endocrinology 2018; online.