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Vitamin D: 100 years of discoveries, yet controversy continues.

The lancet. Diabetes & endocrinology
May 1, 2023
J Christopher Gallagher et al. (2 authors)
Journal ArticleReviewHuman Study
Study Details

Study Goal

The researchers aimed to evaluate the efficacy and safety of vitamin D supplementation, including its combination with calcium, particularly in preventing fractures and other diseases.

Results Summary

The study found that vitamin D supplementation, often combined with calcium, did not show efficacy in preventing fractures, falls, or other diseases like cancer and cardiovascular conditions. Some trials reported adverse events such as increased fractures and hospitalizations in older adults.

Population

Older people (aged >65 years) and individuals with severe vitamin D deficiency (serum 25-hydroxyvitamin D <25nmol/L).

Effective Dosage

Not specified

Duration

Not specified

Interactions

None mentioned

Extracted Claims (13)
InterventionDirectionEndpointPopulationDosageImpactClaim #
various doses and routes of administration of vitamin D
no change
preventing fractures
-
no significant change
did not show efficacy
#1
various doses and routes of administration of vitamin D
no change
preventing falls
-
no significant change
did not show efficacy
#2
various doses and routes of administration of vitamin D
no change
preventing cancer
-
no significant change
did not show efficacy
#3
various doses and routes of administration of vitamin D
no change
preventing cardiovascular diseases
-
no significant change
did not show efficacy
#4
various doses and routes of administration of vitamin D
no change
preventing type 2 diabetes
-
no significant change
did not show efficacy
#5
various doses and routes of administration of vitamin D
no change
preventing asthma
-
no significant change
did not show efficacy
#6
various doses and routes of administration of vitamin D
no change
preventing respiratory infections
-
no significant change
did not show efficacy
#7
long-term high-dose treatments of vitamin D
increase
hypercalcaemia
-
-
adverse events
#8
long-term high-dose treatments of vitamin D
increase
nephrocalcinosis
-
-
adverse events
#9
high doses of vitamin D supplementation
increase
fractures
older people (aged >65 years)
-
increased
#10
high doses of vitamin D supplementation
increase
falls
older people (aged >65 years)
-
increased
#11
high doses of vitamin D supplementation
increase
hospitalisations
older people (aged >65 years)
-
increased
#12
calcium supplements combined with vitamin D
neutral
fracture risk
the highest risk groups
-
insufficient data about their efficacy and effect
#13
Abstract

Over the past 100 years, many major breakthroughs and discoveries have occurred in relation to vitamin D research. These developments include the cure of rickets in 1919, the discovery of vitamin D compounds, advances in vitamin D molecular biology, and improvements in our understanding of endocrine control of vitamin D metabolism. Furthermore, recommended daily allowances for vitamin D have been established and large clinical trials of vitamin D, aimed at clarifying the effect of Vitamin D in the prevention of multiple diseases, have been completed. However, disappointingly, these clinical trials have not fulfilled the expectations many had 10 years ago. In almost every trial, various doses and routes of administration did not show efficacy of vitamin D in preventing fractures, falls, cancer, cardiovascular diseases, type 2 diabetes, asthma, and respiratory infections. Although concerns about side-effects of long-term high-dose treatments, such as hypercalcaemia and nephrocalcinosis, have been around for four decades, some trials from the past 5 years have had new and unexpected adverse events. These adverse events include increased fractures, falls, and hospitalisations in older people (aged >65 years). Several of these clinical trials were powered appropriately for a primary outcome but did not include dose response studies and were underpowered for secondary analyses. Furthermore, more attention should be paid to the safety of high doses of vitamin D supplementation, particularly in older people. In addition, despite universal recommendations by osteoporosis societies for combining calcium supplements with vitamin D there remains insufficient data about their efficacy and effect on fracture risk in the highest risk groups. More trials are needed for people with severe vitamin D deficiency (ie, serum 25-hydroxyvitamin D <25nmol/L [10ng/mL]). In this Personal View, we summarise and discuss some of the major discoveries and controversies in the field of vitamin D.

Medical Subject Headings (MeSH)
HumansAgedDiabetes Mellitus, Type 2Vitamin DVitaminsFractures, BoneOsteoporosisVitamin D DeficiencyDietary Supplements
Study Links
Quality Scores
SafetyNot Assessed
Efficacy30/10
Quality75/10
Citation Metrics
Total Citations54
Citations/Year27.0
Relative Citation Ratio14.62
NIH Percentile98.9%
Research Impact Scores
APT Score0.95
Weight Score3.06
Normalized Score0.47
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