Expert consensus on vitamin D in osteoporosis
Sha Lei1#, Xiaoya Zhang1#, Lige Song1,2#, Jinhui Wen3, Zheng Zhang4, Jianqing Tian5, Rui Yang6, Shuhang Xu7, Shanhu Qiu8, Richard J. MacIsaac9,10, Jasna Aleksova9,11,12, Fabrice Mac-Way13, Marie-Ève Dupuis13,14, David Benaiges15,16,17,18, Didac Mauricio19, Andrei P. Sommer20, Joshua I. Barzilay21, John C. Gallagher22, Lingling Pan1, Linlin Ji1, Ping Fang1, Ying Li1, Qi Liu1, Jiasheng Zhao1, Ying Xue1, Yuqin Shen23, Lemin Wang23, Junfeng Han1,24*, Guanghui Liu1,24*
Correspondence to: Junfeng Han, MD; Guanghui Liu, MD. Department of Endocrinology and Metabolism, Tongji Hospital, School of Medicine, Tongji University, 389 Xincun Rd., Shanghai 200065, China; Diabetic Foot Center, Tongji Hospital, School of Medicine, Tongji University, Shanghai, China. Email: tjhjf@163.com; lghdoctor@126.com.
Background: Adequate vitamin D is essential for maintaining optimal bone health, preventing and treating of osteoporosis. However, in recent years, large clinical trials and meta-analyses on the efficacy of vitamin D supplementation to prevent fractures in populations at different risks have been equivocal. The optimal level of 25-hydroxyvitamin D (25[OH]D) remains controversial. Recommendations vary between societies. The lack of standardized assays also poses a challenge in interpreting available research data.
Methods: We systematically searched for articles in MEDLINE database through PubMed, which included meta-analysis, systematic reviews of randomized controlled trials (RCTs) and observational studies that assessed measurement, diagnosis and treatment about vitamin D deficiency. The experts evaluated the available literature, graded references according to the type of study and described the strength recommendations.
Results: This expert consensus is based on the review of relevant clinical evidence and provides nine key recommendations on vitamin D deficiency in populations at different risks, especially in patients with osteoporosis. Supporting information is provided in the subsequent appendix box.
Conclusions: This expert consensus is a practical tool for endocrinologists, general physicians for the diagnosis, assessment, and treatment of populations at different risks of vitamin D deficiency, especially in patients with osteoporosis. Clinicians should be aware of the evidence but make individualized decisions based on specific patients or situation.
Download the PDF from VitaminDWiki
Consensus summary from PDF (sorted by level of evidence)
- Best measurement method: serum 25[OH]D is identified as the optimal method for assessing vitamin D status
level 1 evidence, strong recommendation) - Osteoporosis and serum levels: serum 25[OH]D levels should be maintained at ≥75 nmol/L in patients with osteoporosis
level 1 evidence, strong recommendation) - Supplements for older adults: for adults over 50 at high risk of vitamin D deficiency, a minimum daily supplementation of 1,200 mg of calcium and 800 IU of vitamin D is recommended
level 1 evidence, strong recommendation) - Post-supplementation testing: routine measurement of serum 25[OH]D within 3 months of initiating supplementation is not necessary
level 1 evidence, strong recommendation) - Fracture prevention: evaluating vitamin D supplementation alone or in conjunction with calcium for primary fracture prevention in community-dwelling adults should consider the balance of potential harms and benefits
level 1 evidence, weak recommendation) - Low-risk adults: in adults under 50 with a low risk of vitamin D insufficiency, daily supplementation exceeding 400 IU of vitamin D and 1,000 mg of calcium is not recommended
level 1 evidence, weak recommendation) - Standardization issues: in the absence of standardized 25[OH]D assays, serum 25[OH]D levels from different clinical laboratories may not be comparable
level 2 evidence, strong recommendation) - At-risk patients: measurement of serum 25[OH]D measurement is recommended for patients at risk of vitamin D deficiency
level 2 evidence, strong recommendation) - Calcium and vitamin D status: adequate calcium intake and vitamin D status are essential before initiating anti-resorptive therapy in patients with vitamin D deficiency
level 2 evidence, weak recommendation)
VitaminDWiki – Overview Osteoporosis and vitamin D contains
- FACT: Bones need Calcium (this has been known for a very long time)
- FACT: Vitamin D improves Calcium bioavailability (3X ?)
- FACT: Should not take > 750 mg of Calcium if taking lots of vitamin D (Calcium becomes too bio-available)
- FACT: Adding vitamin D via Sun, UV, or supplements increased vitamin D in the blood
- FACT: Vitamin D supplements are very low cost
- FACT: Many trials, studies. reviews, and meta-analysis agree: adding vitamin D reduces osteoporosis
- FACT: Toxic level of vitamin D is about 4X higher than the amount needed to reduce osteoporosis
- FACT: Co-factors help build bones.
- FACT: Vitamin D Receptor can restrict Vitamin D from getting to many tissues, such as bones
- It appears that to TREAT Osteoporosis:
- Calcium OR vitamin D is ok
- Calcium + vitamin D is good
- Calcium + vitamin D + other co-factors is great
- Low-cost Vitamin D Receptor activators sometimes may be helpful
- CONCLUSION: To PREVENT many diseases, including Osteoporosis, as well as TREAT Osteoporosis
- Category Osteoporosis has
223 items - Category Bone Health has
315 items Note: Osteoporosis causes bones to become fragile and prone to fracture
Osteoarthritis is a disease where damage occurs to the joints at the end of the bones
VitaminDWiki – Consensus Vitamin D category contains:
73 Vitamin D consensus publications - French pediatric consensus: 30 – 60 ng of Vitamin D – Feb 2022
- 15 Clinical guidelines now recommend vitamin D – Nov 2021
- 34 clinical practice Vitamin D guidelines, huge diversity – Nov 2021
- Minimum National Vitamin D recommendations range from 200 to 4,000 IU – July 2021
- Controversies and consensus in Vitamin D – 3rd Conference Sept 2019
- Vitamin D Consensus 4,000 to 10,000 IU, upper limit 100 ng – Italy 2018
- 4,000 IU of Vitamin D is OK - 19 organizations agree - 2018 six say 10,000 IU is OK
- 17 reasons why are doctors reluctant to accept vitamin D
- Doctors and medical communities appear to be poor audiences to convince that vitamin D is good
3+ VitaminDWiki Consensus pages have BONE OR OSTEOPOROSIS in the title
The list is automatically updated
Items found: 3
VitaminDWiki – Calcium hazards and bioavailability contains
- All items with Calcium in VitaminDWiki
229 items - Supplements taken by the founder of VitaminDWiki he takes Calcium from Red Marine Algae
- Calcium from food or supplements associated with more deaths (US Cohort of 31,000 people) – April 2019
- More Calcium absorbed with more vitamin D – 6.7% more with 4000 IU – RCT March 2014
- Decrease Calcium and Increase Magnesium when increasing vitamin D
- Calcium supplements proven to NOT reduce fractures, but are proven to INCREASE heart problems – July 2015
- More than 1.4 grams of Calcium increased male death rate by 1.4 X – Sept 2018
- 10,000 IU of Vitamin D is too much if you also take Calcium supplements – RCT Sept 2018
- Calcium Essential to Limit Osteoporosis but Avoid Excess, Say Europeans - Nov 2017
- Hypercalcemia can result from excess Vitamin D (if not reduce Ca or increase water) Oct 2016
- Must balance co-factors when increasing vitamin D 500 Ca, 500 Mg - which has the following concept graph
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- Category Bone Health has