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Vitamin D does not improve bone health or prevent fractures, finds study

There is ‘little justification’ for prescribing vitamin D to maintain or improve musculoskeletal health and clinical guidelines should be changed to reflect this, a study has suggested.

Vitamin D supplementation does not reduce falls or fracture risk, and also does not improve bone mineral density, a study published in the Lancet Diabetes and Endocrinology concluded.

The study, carried out by researchers from the Universities of Auckland and Aberdeen, was a meta-analysis of 81 clinical trials, including over 53,000 patients, looking at the effects of vitamin D on fracture rates, falls and bone mineral density. Most studies included women aged over 65 with serum vitamin D levels of less than 50nmol/L and taking vitamin D doses of more than 800IU per day.

The analysis found that vitamin D supplementation did not reduce total fractures, hip fractures or falls by 15% - a clinically meaningful threshold. When the researchers reduced the thresholds, they found that vitamin D still did not reduce falls by 7.5% or total fractures by 5%. They also found that bone mineral density did not increase by a clinically significant level in those taking vitamin D.

The authors said in the paper that they believed the results mean that there is ‘no justification’ for further trials of vitamin D on musculoskeletal outcomes as there is no longer any ambiguity about its benefits.

They said in the paper: ‘In summary, vitamin D supplementation did not have meaningful effects on fracture, falls, or bone mineral density, and future trials are unlikely to alter these conclusions. Therefore, there is little justification for the use of vitamin D supplements to maintain or improve musculoskeletal health, and clinical guidelines should reflect these findings.’

They did caveat that vitamin D supplementation was still appropriate for groups at high risk of rare conditions such as rickets and osteomalacia, which can result after prolonged lack of exposure to the sun.

Researchers found earlier this year that there was no strong link between vitamin D levels and adverse pregnancy outcomes such as gestational diabetes, despite the NICE recommendation that GPs should recommend vitamin D supplementation at first contact with pregnant women. 

Lancet Diabetes Endocrinol 2018; available online 4 October

Readers' comments (9)

  • Let common sense prevail

    What exactly does Vitamin D achieve? We are told to supplement almost everyone because we are all deficient, but where is the pathology caused by that deficiency? I don't get too many cases of rickets coming through the door.
    Our prescribing should be driven by science, not Mumsnet.

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  • Hopefully this will need to more focused and evidence-based vitamin D testing too. Rather than the current chaotic situation!

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  • Doctor McDoctor Face

    Omega3 was going to save hearts. HRT was going to stop osteoporosis. Glucosamine was going to cure arthritis......

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  • Good. Please stop checking it unless really good clinical grounds and you are prepared to follow up the result yourself rather than pass to GP.

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  • Exactly - it's not even a proper vitamin but a steroid pre-cursor. Prof Tim Spector excellent on this - massive over-medicalisation of normal healthy people being told they have an illness. Target JUST at risk groups for testing.

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  • The link to Lancet Diabetes and Endocrinology doesn't appear to be functioning.
    Please can Pulse quote the article's reference details?

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  • David Banner

    Let’s hope that the (pseudo)vitamin D madness of the last 5 years will pass. The only useful aspect of this mass hysteria has been the fobbing off of the TATT with a placebo for their inevitably low Vit D level. The millions wasted on unnecessary blood tests and NHS scrips is a scandal.

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  • Vinci Ho

    Clearly , resources in any publicly funded health service in the world are limited by the reality of people living longer . The definition of diseases and purpose of treating them should be carefully scrutinised, especially on the matter of impacting qualities of life( which could mean differently to different cohorts).
    Overdoagnosis is a real issue and overlooked everyday, simply because we seem to have succumbed to our belief in the ‘power’ of 21st century science culture. This is further compounded by anticipated risks of medico-legal penalty for doing less instead of doing more, as well as the constant push of new products into the market by pharmaceutical companies.
    I recall the seven ‘drivers’ of overdiagnosis suggested the article in BMJ recently (18-25 August 2018):
    (1) Brodening disease definitions
    (2)Technology
    (3)Public health interventions (widespread screening)
    (4) Culture of medical care
    (5) Clinician cognitive errors
    (6) System factors (financial incentives)
    (7) Evidence limitations

    Truth is all , I mean all , regulatory bodies should look very carefully at the differentiation between treating medical needs and satisfying demands from over-medicalisation.
    I call the latter ‘medical populism’.

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  • Edoardo Cervoni

    Quote: "They did caveat that vitamin D supplementation was still appropriate for groups at high risk of rare conditions such as rickets and osteomalacia, which can result after prolonged lack of exposure to the sun."
    it seems to me that it is quite likely that there is some work to be done on "normal" reference range for VitD, which is most likely to be also linked to ethnicity and seasonality. It is possible that, taking into account the "pandemic" prevalence of "low VitD" according to blood test results in otherwise healthy adults and children, the reference range should be "adjusted downwards".
    It may be added that, as someone else highlighted before me, VitD testing should be done appropriately to be meaningful.

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