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The role of vitamin D in maintaining bone health in older people

Lookup NU author(s): Professor Thomas HillORCiD, Dr Terry AsprayORCiD

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Abstract

© 2017, © The Author(s), 2017. This review summarises aspects of vitamin D metabolism, the consequences of vitamin D deficiency, and the impact of vitamin D supplementation on musculoskeletal health in older age. With age, changes in vitamin D exposure, cutaneous vitamin D synthesis and behavioural factors (including physical activity, diet and sun exposure) are compounded by changes in calcium and vitamin D pathophysiology with altered calcium absorption, decreased 25-OH vitamin D [25(OH)D] hydroxylation, lower renal fractional calcium reabsorption and a rise in parathyroid hormone. Hypovitaminosis D is common and associated with a risk of osteomalacia, particularly in older adults, where rates of vitamin D deficiency range from 10–66%, depending on the threshold of circulating 25(OH)D used, population studied and season. The relationship between vitamin D status and osteoporosis is less clear. While circulating 25(OH)D has a linear relationship with bone mineral density (BMD) in some epidemiological studies, this is not consistent across all racial groups. The results of randomized controlled trials of vitamin D supplementation on BMD are also inconsistent, and some studies may be less relevant to the older population, as, for example, half of participants in the most robust meta-analysis were aged under 60 years. The impact on BMD of treating vitamin D deficiency (and osteomalacia) is also rarely considered in such intervention studies. When considering osteoporosis, fracture risk is our main concern, but vitamin D therapy has no consistent fracture-prevention effect, except in studies where calcium is coprescribed (particularly in frail populations living in care homes). As a J-shaped effect on falls and fracture risk is becoming evident with vitamin D interventions, we should target those at greatest risk who may benefit from vitamin D supplementation to decrease falls and fractures, although the optimum dose is still unclear.

Publication metadata

Author(s): Hill TR, Aspray TJ

Publication type: Review

Publication status: Published

Journal: Therapeutic Advances in Musculoskeletal Disease

Year: 2017

Volume: 9

Issue: 4

Pages: 89-95

Print publication date: 01/04/2017

Online publication date: 14/02/2017

Acceptance date: 03/01/2017

ISSN (print): 1759-720X

ISSN (electronic): 1759-7218

Publisher: SAGE Publications Ltd

URL: https://doi.org/10.1177/1759720X17692502

DOI: 10.1177/1759720X17692502

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