When It Comes to Bone, Vitamin D Supplementation Falls Short

October 22, 2013

When It Comes to Bone, Vitamin D Supplementation Falls Short

  1. Bruce Soloway, MD

In a large meta-analysis, vitamin D supplementation generally did not increase bone-mineral density.

  1. Bruce Soloway, MD

Calcium supplements, which are taken by nearly half of U.S. adults for skeletal benefits, often include vitamin D. However, the role of vitamin D supplementation itself in maintaining bone quality remains unclear: Vitamin D supplements have not lowered fracture risk, and their effect on bone-mineral density (BMD) has varied. In a meta-analysis, investigators combined data from 23 randomized controlled trials (4082 adult participants; 92% women) in which BMD was a measured outcome and in which inclusion or dose of vitamin D varied. Studies differed in patients' mean baseline 25-hydroxyvitamin D level, vitamin D dose and duration, and concomitant interventions (primarily calcium supplementation).

Patients who took vitamin D supplements had significantly greater increases in BMD at the femoral neck but not at the total hip, lumbar spine, forearm, or total body. Vitamin D supplementation was associated with significantly greater increases in BMD at the total hip in studies where mean baseline 25-hydroxyvitamin D level was <20 ng/mL and at the lumbar spine in studies where vitamin D dose was less than 800 IU daily. Otherwise, outcomes were similar among trials.


In general, this study showed no significant increase in bone-mineral density with vitamin D supplementation. Such a result is consistent with the understanding that vitamin D acts primarily to increase gut absorption of calcium (not directly on bone metabolism), and these results support the Institute of Medicine's conclusion that adults with baseline 25-hydroxyvitamin D levels >20 ng/mL do not require supplementation.

Editor Disclosures at Time of Publication

  • Disclosures for Bruce Soloway, MD at time of publication Nothing to disclose


Reader Comments (14)

Cathy A. Hurley Physician, Internal Medicine, Private Clinic

I work in a small town in the Texas Hill Country. We have many farmers and ranchers in this area who spend all their time outside and have skin that looks like old, tanned leather. Yet, we test their Vitamin D levels, and many are still very low. I find this fascinating. Apparently, at some point, many people's bodies stop responding to sunshine by producing Vitamin D. I would be interested in any comments.

Raghu Kadiyala Fellow-In-Training, Endocrinology, London

Vitamin D supplements most beneficial in people with primary hyperparathyroidism and osteoporosis. In others no added value in aiming for a higher vitamin D levels.

Stuart Brilliant Other

It would seem, that given the relatively short average duration of the studies (23.5 months) that it is premature to draw a conclusion based on these results.

H Robert Silverstein Physician, Preventive Medicine, Preventive Medi ine Center

This abstract/article gets an almost "your joking." The editors of f this NEJM Journal Watch need to be more careful in what titles they permit to be written and with what implied conclusions.There is a large and growing cadre of evidence-based physicians who believe that the essential and routine dose of D3 replacement is 3,000-5,000 U D3 a day.. As far as I am concerned, this study does not even ask a valid question: which, as implied again, was missed by the editors of this Journal Watch.

maltsev DM Physician, Pediatrics/Adolescent Medicine, Kazan medical academy

It is very interesing

Humberto Lucio Salas Valencia Physician, Family Medicine/General Practice


Carol Vassar, MD Physician, Internal Medicine, private practice

That these studies were looking for increase in bones density rather than reduction of rate of bone loss is interesting. Studies by Riggs over 30 years ago looking at Premarin, Calcuim, Vit D, fluoride, and exercise showed increased density only with fluoride and descrease in fractures only with exercise. We have made progress with bisphosphonates. For the rest of the population, do we have long term data that it is safe to take the recommended amounts for the 30-60 years that can be expected from following the recommendations?

hari sharma Other Healthcare Professional, Health Law/Ethics/Public Policy, gurgaon,india

there are no effective D supplements.it is only sunshine which provides vitamin D

Cleaves M. Bennett MD Physician, Nephrology, retired

Primitive humans wore little clothing and spent a lot of time in the sun. They produced vitamin D naturally. Modern humans wear clothes head to toe and spend a lot of time indoors. It makes sense to supplement Vitamin D, at low expense and low risk. Exercise makes the bones and muscles stronger. So I walk my dogs and ride my horses daily and I take vitamin D daily. I don’t care what some scientist in a lab concludes. It just makes common sense! I am 79 years old in excellent health and plan to stay that way to age 100.

Mary Snell,M.D. Physician, Internal Medicine, WFHC

Basically this article said what I knew

MARK ZILNER Other Healthcare Professional, Pharmacology/Pharmacy, Institutional Pharmacy

Which patient group(s) should be targeted for baseline 25-hydroxyvitamin D levels?
Are there patient group(s) recommended to empircally take (without necessarily first obtaining a baseline 25-hydroxyvitamin D level), an oral Vit D supplement?
When should a provider obtain a 25-hydroxyvitamin D level?
What dose is now recommended for daily supplementation?
I see more and more oral Vit D being prescribed in long term care/corrections.

ALESSANDRO CAPITANINI Physician, Nephrology, Civil hospital

In my opinion it' s important to consider the potential effects of vitamin D out of bone metabolism such as potential cardiovascular protection.

François Isabelle St-Hubert, Quebec

If I understand, sedentary cohorts with low sexual, thyroid, growth hormones and all endocrine disturbances that come with that, don't benefit from vitamin D suplementation alone? Unless studies were a little too inclusive. Since we're all contaminated with this modern life, we don't have ideal cohorts, do we?
Cohorts with a 100 times more UVB exposure, like when humans lived outside half naked with no daily soapy shower, would be better vitamin D subjects...

Pat Brennan

Was D3 used in test? Should have been.

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