Summary of evidence-based review on vitamin D efficacy and safety in relation to bone health

Abstract

The objective of this evidence review was to synthesize the literature on the effectiveness and safety of nutritional and ultraviolet radiation sources of vitamin D with respect to bone health outcomes at all stages of life. The goals were to identify knowledge gaps for the research community and to highlight areas that required further research. We completed an extensive literature search of multiple databases and a multilevel selection process with synthesis of results from 167 included studies. We included a variety of outcomes (eg, falls, bone mineral density, fractures, and adverse events). This report provides an overview of the methods and a summary of the key findings. In addition, we discuss areas where the evidence is inconclusive, as well as methodologic issues that we encountered. We found inconsistent evidence of an association between serum 25-hydroxyvitamin D [25(OH)D] concentration and bone mineral content in infants and fair evidence of an association with bone mineral content or density in older children and older adults. The evidence of an association between serum 25(OH)D concentration and some clinical outcomes (fractures, performance measures) in postmenopausal women and older men was inconsistent, and the evidence of an association with falls was fair. We found good evidence of a positive effect of consuming vitamin D-fortified foods on 25(OH)D concentrations. The evidence for a benefit of vitamin D on falls and fractures varied. We found fair evidence that adults tolerated vitamin D at doses above current dietary reference intake levels, but we had no data on the association between long-term harms and higher doses of vitamin D.Am J Clin Nutr 2008;88(suppl):513S-9S.

Adverse interaction of low-calcium diet and low 25(OH)D levels on lumbar spine mineralization in late-pubertal girls

“…(1)(2)(3)(4)(5)(6) But data on a possible impact of low vitamin D status are less convincing. (7,8) Indeed, associations between low 25-hydroxyvitamin D [25(OH)D] levels, below 25 to 30 nmol/L (9) or 40 to 45 nmol/L, (10,11) and impaired bone mineralization have been observed at appendicular sites (ie, tibia and forearm) in girls during growth but not at trabecular bone sites (eg, hip, femoral neck, or lumbar spine) (9,12,13) or only during the early phase of puberty in severely vitamin D-deficient girls with 25(OH)D levels below 20 nmol/L. (13) Serum 25(OH)D levels are considered the best marker of vitamin D status and have been used commonly to assess the prevalence of vitamin D deficiency/insufficiency in healthy children and adolescents.…”

Vitamin D supply of patients with hip fracture

“…A jelen tanulmányunkban a szombathelyi Markusovszky Egyetemi Oktatókórház Baleseti Sebészeti Osztályán kezelt 203 csípőtáji törött beteg D-vitamin-ellátottságát elemezzük a PTHi-, kalcium-(Ca), albuminszintjeik ismeretében, tekintetbe véve a krónikus betegségeiket és életvitelüket is. Több szerző foglalkozik a csípőtáji töröttek D-vitamin-hiányának felmérésével, felvetve a D-vitamin-pótlás szükségességét is [1,2,4,5,15,16,17,18,19), de a 25-hidroxi-D-vitamin-szintek és gyógyulási, túlélési kilá-tások közötti kapcsolatról még kevés adat áll rendelkezésre, ezért elemeztük a csípőtáji törött betegeink adatait ebből a szempontból.…”

Nutrición infantil y salud ósea

“…El marcador nutricional más importante es la tasa de 25 hidroxicolecalciferol (25-OHCC), procedente de la hidroxilación hepática de la provitamina de la piel, ya que ha demostrado su correlación con el grado de mineralización ósea [30][31][32] . Sin embargo, el 1,25 dihidrocolecalciferol (de procedencia renal) no refleja bien el estado de los depósitos y ni tan siquiera se correlaciona con el déficit de vitamina D, dadas las modificaciones que sobre éste induce la respuesta de la parathormona.…”

“…Además de los anteriormente referidos, otros nutrientes se han relacionado con la osteoporosis. Entre ellos podemos destacar el magnesio (que se deposita junto con el P y el Ca en el hueso), el Zn, la vitamina K (cofactor para la síntesis de osteocalcina), la vitamina C (implicada en la matriz colágena), el retinol, vitaminas del grupo B, el cociente Na/K, etc., que explican en conjunto el papel protector de una dieta rica en fruta y verdura [48][49][50] .…”