Vitamin D: 100 years of discoveries, yet controversy continues.
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
| Intervention | Direction | Endpoint | Population | Dosage | Impact | Claim # |
|---|---|---|---|---|---|---|
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 |
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.