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Hill TR, Aspray TJ. The role of vitamin D in maintaining bone health in older people. Ther Adv Musculoskelet Dis. 2017;9(4):89-95doi: 10.1177/1759720X17692502.
Hill, T. R., & Aspray, T. J. (2017). The role of vitamin D in maintaining bone health in older people. Therapeutic advances in musculoskeletal disease, 9(4), 89-95. https://doi.org/10.1177/1759720X17692502
Hill, Thomas R, and Aspray, Terry J. "The role of vitamin D in maintaining bone health in older people." Therapeutic advances in musculoskeletal disease vol. 9,4 (2017): 89-95. doi: https://doi.org/10.1177/1759720X17692502
Hill TR, Aspray TJ. The role of vitamin D in maintaining bone health in older people. Ther Adv Musculoskelet Dis. 2017 Apr;9(4):89-95. doi: 10.1177/1759720X17692502. Epub 2017 Feb 14. PMID: 28382112; PMCID: PMC5367643.
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Ther Adv Musculoskelet Dis. 2017 Apr;9(4):89-95. doi: 10.1177/1759720X17692502. Epub 2017 Feb 14.

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

Therapeutic advances in musculoskeletal disease

Thomas R Hill, Terry J Aspray

Affiliations

  1. Human Nutrition Research Centre, Newcastle University, Newcastle upon Tyne, UK.
  2. Consultant Physician, Musculoskeletal Unit, Freeman Hospital, Newcastle upon Tyne, NE7 7DN, UK, Institute for Cellular Medicine, Newcastle University, Newcastle upon Tyne.

PMID: 28382112 PMCID: PMC5367643 DOI: 10.1177/1759720X17692502

Abstract

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.

Keywords: Vitamin D; bone health; older people; osteomalacia; osteoporosis

Conflict of interest statement

Conflict of interest statement: The authors declare that there is no conflict of interest.

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