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.
Keywords
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Article info
Publication history
Published online: January 13, 2015
Accepted:
December 29,
2014
Received in revised form:
December 28,
2014
Received:
June 12,
2014
Identification
Copyright
© 2015 Elsevier Ireland Ltd. Published by Elsevier Inc. All rights reserved.
