Vitamin D supplementation and fracture risk: Evidence for a U-shaped effect

Maturitas ◽  
2020 ◽  
Vol 141 ◽  
pp. 63-70
Author(s):  
Panagiotis Anagnostis ◽  
Julia K. Bosdou ◽  
Eustathios Kenanidis ◽  
Michael Potoupnis ◽  
Eleftherios Tsiridis ◽  
...  
Keyword(s):  
Vitamin D ◽  
Fracture Risk ◽  
Vitamin D Supplementation

scholarly journals Osteoporosis in Patients with Chronic Kidney Diseases: A Systemic Review

2020 ◽  
Vol 21 (18) ◽  
pp. 6846 ◽  
Author(s):  
Chia-Yu Hsu ◽  
Li-Ru Chen ◽  
Kuo-Hu Chen
Keyword(s):  
Vitamin D ◽  
Bone Turnover ◽  
Fracture Risk ◽  
Renal Osteodystrophy ◽  
Bone Structure ◽  
Kidney Diseases ◽  
Treatment Strategies ◽  
Vitamin D Supplementation ◽  
Systemic Review ◽  
Lifestyle Modifications

Chronic kidney disease (CKD) is associated with the development of mineral bone disorder (MBD), osteoporosis, and fragility fractures. Among CKD patients, adynamic bone disease or low bone turnover is the most common type of renal osteodystrophy. The consequences of CKD-MBD include increased fracture risk, greater morbidity, and mortality. Thus, the goal is to prevent the occurrences of fractures by means of alleviating CKD-induced MBD and treating subsequent osteoporosis. Changes in mineral and humoral metabolism as well as bone structure develop early in the course of CKD. CKD-MBD includes abnormalities of calcium, phosphorus, PTH, and/or vitamin D; abnormalities in bone turnover, mineralization, volume, linear growth, or strength; and/or vascular or other soft tissue calcification. In patients with CKD-MBD, using either DXA or FRAX to screen fracture risk should be considered. Biomarkers such as bALP and iPTH may assist to assess bone turnover. Before initiating an antiresorptive or anabolic agent to treat osteoporosis in CKD patients, lifestyle modifications, such as exercise, calcium, and vitamin D supplementation, smoking cessation, and avoidance of excessive alcohol intake are important. Managing hyperphosphatemia and SHPT are also crucial. Understanding the complex pathogenesis of CKD-MBD is crucial in improving one’s short- and long-term outcomes. Treatment strategies for CKD-associated osteoporosis should be patient-centered to determine the type of renal osteodystrophy. This review focuses on the mechanism, evaluation and management of patients with CKD-MBD. However, further studies are needed to explore more details regarding the underlying pathophysiology and to assess the safety and efficacy of agents for treating CKD-MBD.

Vitamin D Supplementation and Fracture Risk

2011 ◽  
Vol 171 (3) ◽  
pp. 265 ◽  
Author(s):  
Heike A. Bischoff-Ferrari ◽  
Bess Dawson-Hughes ◽  
Susan J. Whiting
Keyword(s):  
Vitamin D ◽  
Fracture Risk ◽  
Vitamin D Supplementation

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

2017 ◽  
Vol 9 (4) ◽  
pp. 89-95 ◽  
Author(s):  
Thomas R. Hill ◽  
Terry J. Aspray
Keyword(s):  
Vitamin D ◽  
Fracture Risk ◽  
Vitamin D Deficiency ◽  
Calcium Absorption ◽  
Vitamin D Supplementation ◽  
Optimum Dose ◽  
Main Concern ◽  
Mineral Density ◽  
Vitamin D Metabolism ◽  
The Impact

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.

scholarly journals Vitamin D and bone health outcomes in older age

2013 ◽  
Vol 72 (4) ◽  
pp. 372-380 ◽  
Author(s):  
Tom R. Hill ◽  
Terence J. Aspray ◽  
Roger M. Francis
Keyword(s):  
Older Adults ◽  
Vitamin D ◽  
Health Outcomes ◽  
Fracture Risk ◽  
Vitamin D Deficiency ◽  
Bone Health ◽  
Vitamin D Supplementation ◽  
Drop Out ◽  
Vitamin D Status ◽  
Mineral Density

The aim of this review is to summarise the evidence linking vitamin D to bone health outcomes in older adults. A plethora of scientific evidence globally suggests that large proportions of people have vitamin D deficiency and are not meeting recommended intakes. Older adults are at particular risk of the consequences of vitamin D deficiency owing to a combination of physiological and behavioural factors. Epidemiological studies show that low vitamin D status is associated with a variety of negative skeletal consequences in older adults including osteomalacia, reduced bone mineral density, impaired Ca absorption and secondary hyperparathyroidism. There seems to be inconsistent evidence for a protective role of vitamin D supplementation alone on bone mass. However, it is generally accepted that vitamin D (17·5 μg/d) in combination with Ca (1200 mg/d) reduces bone loss among older white subjects. Evidence for a benefit of vitamin D supplementation alone on reducing fracture risk is varied. According to a recent Agency for Healthcare Research and Quality review in the USA the evidence base shows mixed results for a beneficial effect of vitamin D on decreasing overall fracture risk. Limitations such as poor compliance with treatment, incomplete assessment of vitamin D status and large drop-out rates however, have been highlighted within some studies. In conclusion, it is generally accepted that vitamin D in combination with Ca reduces the risk of non-vertebral fractures particularly those in institutional care. The lack of data on vitamin D and bone health outcomes in certain population groups such as diverse racial groups warrants attention.

scholarly journals The influence of genetic susceptibility and calcium plus vitamin D supplementation on fracture risk

2017 ◽  
Vol 105 (4) ◽  
pp. 970-979 ◽  
Author(s):  
Youjin Wang ◽  
Jean Wactawski-Wende ◽  
Lara E Sucheston-Campbell ◽  
Leah Preus ◽  
Kathleen M Hovey ◽  
...  
Keyword(s):  
Vitamin D ◽  
Fracture Risk ◽  
Genetic Susceptibility ◽  
Vitamin D Supplementation

Vitamin D supplementation and fracture risk in adults: a new insight

2014 ◽  
Vol 25 (10) ◽  
pp. 2497-2498 ◽  
Author(s):  
T. Sugiyama ◽  
S. Tanaka ◽  
T. Miyajima ◽  
Y. T. Kim ◽  
H. Oda
Keyword(s):  
Vitamin D ◽  
Fracture Risk ◽  
Vitamin D Supplementation
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