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The role of vitamin D in osteoporosis

      Highlights

      • Circulating vitamin D predominately arises from synthesis in the skin after exposure to sunlight.
      • Vitamin D deficiency is world-wide epidemic and presents when serum 25 hydroxyvitamin D levels fall below 50 nmol/L.
      • Vitamin D deficiency is a factor in the multifactorial causes of non-vertebral & hip fractures, falls and loss of muscles power.
      • Vitamin D deficiency should be aggressively treated with higher pharmacological doses with the aim of achieving serum levels above or equal to 75 nmol/L.
      • Further RCTs are needed to evaluate a possible isolated or combined role for vitamin D in reduced bone mass densiity and, non-vertebral fractures.
      • Future research should focus on the effects and implications of treating vitamin D deficiency with high pharmacological doses (>1000 IU).
      • The aim is to achieve a general consensus on recommended doses of vitamin D supplementation.

      Abstract

      It is known that circulating vitamin D predominantly originates from cutaneous synthesis and therefore should be considered as a hormone rather than a vitamin. Vitamin D deficiency (<50 nmol/L) is a worldwide epidemic with multiple implications on human health, due to its role in various physiological systems. Various studies have shown that with higher serum 25 hydroxyvitamin D levels, there is a decrease in the incidence of non-vertebral and hip fractures. There is limited research data on the management of vitamin D deficiency using therapeutic doses. The majority of studies focus on lower physiological doses rather than high pharmacological doses. In order to reach serum levels of 75 nmol/L from a deficiency state, higher doses than 800–1000 IU/day are required. Future focus should be on the implications of a rise in systemic 25(OH)D3 levels from a deficiency state to 75 nmol/L on bone density and fracture risk, and the use of high doses in cases of vitamin D deficiency. Vitamin D treatment and supplementation need to be re-evaluated in the light of new evidence suggesting that high pharmacological doses need to be used in order to obtain the desired effect in the prevention of osteoporosis and recurrence of osteoporotic fractures.

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