Vieth, R. The role of vitamin D in the prevention of osteoporosis. Ann. Med. 37, 278-285

Department of Nutritional Sciences, Laboratory Medicine and Pathology, University of Toronto, Ontario, Canada.
Annals of Medicine (Impact Factor: 3.89). 02/2005; 37(4):278-85. DOI: 10.1080/07853890510007313
Source: PubMed


The need for vitamin D to prevent rickets was the drive for selection of lighter skin color in temperate climates. Anthropologists also know that as human populations developed more sedentary lifestyles, this coincided with a decline in bone quantity, quality, and fracture resistance. Since osteoporosis occurs after the reproductive years, there is no way that natural selection could have adapted our biology to prevent it. However, osteoporosis can be largely prevented by optimizing physical activity, and the vitamin D-related factors of environment, and nutrition. The role of vitamin D3 in osteoporosis is conclusively established from a very simple meta-analysis of the four randomized, placebo-controlled clinical trials into the effect of 20 microg (800 IU) per day. These have all demonstrated that this dose prevents approximately 30% of hip or non-vertebral fractures compared to placebo, in adults older than 65 years. Intakes less than this have never been found effective. The lowest average serum 25-hydroxyvitamin D concentration in any study demonstrating fracture reduction was 74 nmol/L. Thus, 25-hydroxyvitamin D levels in older adults should exceed this amount. The role of vitamin D supplementation is to provide humans with the nutrient in an amount closer to our species' biological norm. This amount of vitamin D results in the optimal function of many aspects of health, including balance and muscle strength that lessen the risk of fracture beyond what is possible via the quality and quantity of bone itself.

Download full-text


Available from: Reinhold Vieth
  • Source
    • "It enhances the absorption of calcium in small intestine and important in mineralization of bone (Holic, 2002). Bones become skinny, fragile and soft or deformed due to increased pervasiveness of hypovitaminosis D. 70-80 nmol/L is the normal serum level of 25- hydroxyvitamin D. (Vieth, 2005). This serum level and higher dietary intake of vitamin D are significantly related with reduced risk of osteoporosis (Holick, 2005). "

    Full-text · Article · Jun 2014
  • Source
    • "Sunshine therefore remains the principal natural source of vitamin D, providing 80–90% of the requirement in the absence of fortified food. Although exposing a part of the body (for example the face, trunk and arms) to the sun in summer can provide 10 000 IU of vitamin D in less than half an hour, this supply disappears within a few weeks and cannot readily be replenished throughout the year except in tropical countries (Vieth, 1999; Hollis, 2005; Vieth, 2005; Diffey, 2010). Moreover, elderly and dark-skinned subjects are less able to synthesize vitamin D than young, light-skinned subjects who, if they protect themselves too much from the sun (by clothing or sun-block), may also rapidly find themselves in a state of vitamin D insufficiency (Vieth, 1999; Armas et al., 2007; Binkley et al., 2007). "
    [Show abstract] [Hide abstract]
    ABSTRACT: The role of hypovitaminosis D as a possible risk factor for multiple sclerosis is reviewed. First, it is emphasized that hypovitaminosis D could be only one of the risk factors for multiple sclerosis and that numerous other environmental and genetic risk factors appear to interact and combine to trigger the disease. Secondly, the classical physiological notions about vitamin D have recently been challenged and the main new findings are summarized. This vitamin could have an important immunological role involving a number of organs and pathologies, including autoimmune diseases and multiple sclerosis. Furthermore, human requirements for this vitamin are much higher than previously thought, and in medium- or high-latitude countries, they might not be met in the majority of the general population due to a lack of sunshine and an increasingly urbanized lifestyle. Thereafter, the different types of studies that have helped to implicate hypovitaminosis D as a risk factor for multiple sclerosis are reviewed. In experimental autoimmune encephalomyelitis, vitamin D has been shown to play a significant immunological role. Diverse epidemiological studies suggest that a direct chain of causality exists in the general population between latitude, exposure to the sun, vitamin D status and the risk of multiple sclerosis. New epidemiological analyses from France support the existence of this chain of links. Recently reported immunological findings in patients with multiple sclerosis have consistently shown that vitamin D significantly influences regulatory T lymphocyte cells, whose role is well known in the pathogenesis of the disease. Lastly, in a number of studies on serum levels of vitamin D in multiple sclerosis, an insufficiency was observed in the great majority of patients, including at the earliest stages of the disease. The questionable specificity and significance of such results is detailed here. Based on a final global analysis of the cumulative significance of these different types of findings, it would appear likely that hypovitaminosis D is one of the risk factors for multiple sclerosis.
    Preview · Article · Jul 2010 · Brain
  • Source
    • "Low serum concentrations of vitamin D is widespread in the U.K [6] and moderate vitamin deficiency in older people results in poor bone and muscle strength [7,8]. Serum 25 (OH) vitamin D concentrations that correlate with clinically significant effects on muscle function and fracture prevention is at least 70 nmol/L [9]. It is still unclear whether addition of calcium/vitamin D supplements leads to an incremental benefit in patients taking bisphosphonates and whether achievement of serum level of vitamin D of at least 70 nmol/L has an impact on the skeletal response to bisphosphonates. "
    [Show abstract] [Hide abstract]
    ABSTRACT: It is still unclear whether addition of calcium/vitamin D supplements leads to an incremental benefit in patients taking bisphosphonates and whether achievement of serum level of 25 (OH) vitamin D of at least 70 nmol/L has an impact on the skeletal response to bisphosphonates. Moreover the maintenance of BMD after bisphosphonates withdrawal with the continuation of calcium/vitamin D supplements only, remains uncertain. The aims were to assess the impact of vitamin D status on changes in bone mineral density (BMD) in firstly patients with post-menopausal osteoporosis on bisphosphonates and secondly following discontinuation of bisphosphonates after long-term use. Two patient groups were recruited. The first study population comprised of 112 women treated with a bisphosphonate. The second study population consisted of 35 women who had been on bisphosphonates for > 5 years in whom the treatment agent was discontinued. Baseline BMD, changes in BMD following treatment, duration of treatment, serum 25 (OH) vitamin D, parathyroid hormone (PTH), urine C-terminal telopeptides of type 1 collagen (CTX) were obtained on the study participants. In the first study group, subjects with serum vitamin D concentrations (> 70 nmol/L) had a significantly lower serum PTH level (mean [SEM] 41 2 ng/L). PTH concentrations of 41 ng/L or less was associated with a significantly higher increase in BMD at the hip following treatment with bisphosphonates compared to patients with PTH > 41 ng/L (2.5% [0.9] v/s -0.2% [0.9], P = 0.04). In the second study group, discontinuation of bisphosphonate for 15 months after long-term treatment did not result in significant bone loss at the lumbar spine and total hip, although a trend towards gradual decline in BMD at the femoral neck was observed. the data suggest that optimal serum 25 (OH) vitamin D concentration may lead to further reduction in bone loss at the hip in patients on bisphosphonates. A prospective controlled trial is needed to evaluate whether the response to bisphosphonates is influenced by vitamin D status. BMD is preserved at the lumbar spine and total hip following discontinuation of bisphosphonate for a short period following long-term treatment, although a gradual loss occurs at the femoral neck.
    Full-text · Article · Jan 2007 · BMC Musculoskeletal Disorders
Show more