Importance of Vitamin D in Reducing Fracture Risk in Elderly

By: Nirali Patel, Pharm. D. Rph.

Research suggests that vitamin D plays a role in the prevention of more than just fractures. Adequate intake appears to decrease the risk of colon cancer and perhaps other cancers. The risk of diabetes, hypertension, cardiovascular disease, and multiple sclerosis may also be linked to low levels of vitamin D. A 2009 meta-analysis determined that for people over the age of 65 years, taking vitamin D 482 IU to 770 IU/day can decrease non-vertebral fracture risk by 20%, and hip fracture risk by 18%. Non-vertebral fracture risk was reduced by 29% in community-living seniors, and by 15% in institutionalized patients taking these doses. Based on this analysis, 800 IU of vitamin D daily for 1 to 7 years will prevent one hip fracture and 1 non-vertebral fracture. It is interesting to note that vitamin D 800 IU daily has not been effective for fracture prevention in all studies, and some studies using 400 IU daily have shown benefit. The key is to take enough vitamin D to achieve adequate serum levels. Recommend aiming for at least 30 ng/mL…but under 100 ng/ml.   

Recommended starting with 800 to 2000 IU/day for most adults to prevent deficiency and maintain adequate levels. Patients at risk for deficiency, such as those with bone pain or muscle weakness, taking meds that increase fracture risk (corticosteroids, etc.), or in older patients with a previous fall, it is recommend to increase the vitamin D dose if it doesn’t achieve adequate levels. Suggest 1000 IU/day for every 10 ng/mL shortfall. It is also important to note that that vitamin D3 (cholecalciferol) is a little more potent than D2 (ergocalciferol). Furthermore, meta-analysis of fracture studies suggests cholecalciferol is more effective for reducing fracture risk. It is recommend waiting at least 6 weeks to check 25-hydroxyvitamin D levels after starting treatment or a dose increase.