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Dosing targets for vitamin D supplementation for fracture prevention

By Bianca Nogrady
An expert panel has recommended targets for serum vitamin D concentrations and vitamin D supplement dosing for fall and fracture prevention in high-risk populations.

Writing in the Australasian Journal on Ageing, a group of Australian and US experts set out to address uncertainties in the evidence on the efficacy and dosing of vitamin D.

‘There is a lot of divergent and contradictory information about vitamin D and its efficacy on fracture prevention,’ said lead author Professor Gustavo Duque, from the Australian Institute for Musculoskeletal Science at The University of Melbourne and Western Health.

The paper cited a recent Cochrane review which found high-quality evidence that vitamin D alone is unlikely to be effective in preventing fractures, but which also acknowledged that the existing studies were limited to vitamin D3 doses below 800 IU/day.

The panel concluded that physicians should aim for a target serum vitamin D concentration of 50 to 60 nmol/L year round, but no more than 100 nmol/L.

With respect to dosing, they recommended a maintenance dose of 1000 IU/day or an equivalent weekly or monthly dose, which Professor Duque said could go as high as 4000 IU/day without any risk of side effects.

‘It is now well known that dosing of vitamin D below 800 IU/day is not effective to prevent falls and fractures and that doses above 60,000 IU/month increase falls and fracture risk,’ he told Endocrinology Today.

Frail older individuals, with baseline vitamin D levels below 30 nmol/L, are most likely to get the greatest therapeutic benefit from vitamin D supplementation, in combination with higher dietary calcium.

‘Other populations that would benefit include older fallers, frail older persons, patients on oral corticosteroids, nursing home residents and sarcopenic individuals,’ Professor Duque said.
Australas J Ageing 2017; 36 Suppl 1: 8-13

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