Summary of evidence-based review on vitamin D efficacy and safety in relation to bone health

• Published in: The American journal of clinical nutrition 2008-08, Vol.88 (2S), p.513S-519S
• Main Authors: Cranney, Ann, Weiler, Hope A, O'Donnell, Siobhan, Puil, Lorri
• Format: Article
• Language: English
• Subjects: 25-hydroxycholecalciferol; Biological and medical sciences; Bone and Bones - drug effects; Bone and Bones - metabolism; Bone density; Bone Density - drug effects; Bone Density - physiology; Bone Density Conservation Agents - adverse effects; Bone Density Conservation Agents - therapeutic use; bone fractures; bone metabolism; Clinical outcomes; Diet; dietary nutrient sources; Dose-Response Relationship, Drug; Evidence-Based Medicine; Feeding. Feeding behavior; Female; Fundamental and applied biological sciences. Psychology; human health and safety; Humans; life cycle (organisms); literature reviews; Male; men; Nutrition; nutrition assessment; Osteoporosis - prevention & control; Safety; solar radiation; Treatment Outcome; Ultraviolet radiation; Vertebrates: anatomy and physiology, studies on body, several organs or systems; Vitamin D; Vitamin D - adverse effects; Vitamin D - analogs & derivatives; Vitamin D - blood; Vitamin D - therapeutic use; Vitamin D Deficiency - prevention & control; vitamin supplements; women
• ISSN: 0002-9165; 1938-3207
• DOI: 10.1093/ajcn/88.2.513S

The objective of this evidence review was to synthesize the literature on the effectiveness and safety of nutritional and ultraviolet radiation sources of vitamin D with respect to bone health outcomes at all stages of life. The goals were to identify knowledge gaps for the research community and to highlight areas that required further research. We completed an extensive literature search of multiple databases and a multilevel selection process with synthesis of results from 167 included studies. We included a variety of outcomes (eg, falls, bone mineral density, fractures, and adverse events). This report provides an overview of the methods and a summary of the key findings. In addition, we discuss areas where the evidence is inconclusive, as well as methodologic issues that we encountered. We found inconsistent evidence of an association between serum 25-hydroxyvitamin D [25(OH)D] concentration and bone mineral content in infants and fair evidence of an association with bone mineral content or density in older children and older adults. The evidence of an association between serum 25(OH)D concentration and some clinical outcomes (fractures, performance measures) in postmenopausal women and older men was inconsistent, and the evidence of an association with falls was fair. We found good evidence of a positive effect of consuming vitamin D-fortified foods on 25(OH)D concentrations. The evidence for a benefit of vitamin D on falls and fractures varied. We found fair evidence that adults tolerated vitamin D at doses above current dietary reference intake levels, but we had no data on the association between long-term harms and higher doses of vitamin D.