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Optimal Vitamin D Status for the Prevention and Treatment of Osteoporosis

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Abstract

Vitamin D3 (cholecalciferol) sufficiency is essential for maximising bone health. Vitamin D enhances intestinal absorption of calcium and phosphorus. The major source of vitamin D for both children and adults is exposure of the skin to sunlight. Season, latitude, skin pigmentation, sunscreen use, clothing and aging can dramatically influence the synthesis of vitamin D in the skin. Very few foods naturally contain vitamin D or are fortified with vitamin D. Serum 25-hydroxyvitamin D [25(OH)D; calcifediol] is the best measure of vitamin D status. Vitamin D deficiency [as defined by a serum 25(OH)D level of <50 nmol/L (<20 ng/mL)] is pandemic. This deficiency is very prevalent in osteoporotic patients. Vitamin D deficiency causes osteopenia, osteoporosis and osteomalacia, increasing the risk of fracture. Unlike osteoporosis, which is a painless disease, osteomalacia causes aching bone pain that is often misdiagnosed as fibromyalgia or chronic pain syndrome or is simply dismissed as depression. Vitamin D deficiency causes muscle weakness, increasing the risk of falls and fractures, and should be aggressively treated with pharmacological doses of vitamin D. Vitamin D sufficiency can be sustained by sensible sun exposure or ingesting at least 800–1000IU of vitamin D3 daily. Patients being treated for osteoporosis should be adequately supplemented with calcium and vitamin D to maximise the benefit of treatment.

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Acknowledgements

This work was supported in part by National Institutes of Health grants M01RR00533 and AR36963 and the UV Foundation. The author has acted as a consultant to Quest Diagnostics on assays for vitamin D metabolites.

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  1. Department of Medicine, Section of Endocrinology, Nutrition, and Diabetes, Vitamin D, Skin and Bone Research Laboratory, Boston University Medical Center, Boston, Massachusetts, USA

    Michael F. Holick

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Holick, M.F. Optimal Vitamin D Status for the Prevention and Treatment of Osteoporosis. Drugs Aging 24, 1017–1029 (2007). https://doi.org/10.2165/00002512-200724120-00005

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