Supplementation with vitamin D did not prevent fractures or falls or show any clinically meaningful effects on bone mineral density, and there is insufficient evidence to justify using vitamin D to maintain or improve musculoskeletal health, according to findings of a meta-analysis published in the Lancet Diabetes Endocrinology.

Vitamin D and calcium supplements have often been administered together to treat and prevent osteoporosis, but the researchers in the current review note that recent data have suggested that the evidence is weak or inconsistent for calcium supplements and fracture prevention. This has been the case with or without vitamin D co-administration. In this systematic review and random-effects meta-analysis, the effect of vitamin D supplementation on fractures, falls, and bone density was evaluated. A total of 81 randomized controlled trials with a combined cohort of 53, 537 participants met the inclusion criteria.

The pooled analyses showed that vitamin D supplementation did not affect total fracture (n = 44,790; relative risk [RR], 1.00; 95% CI, 0.93-1.07), hip fracture (n = 36,655; RR, 1.11; 95% CI, 0.97-1.26), or falls (n = 34,144; RR, 0.97; 95% CI, 0.93-1.02). The results were similar in trials that compared high-dose with low-dose vitamin D and in subgroup analyses of randomized controlled trials using doses greater than 800 IU/day. Additionally, no evidence was found to support between-group differences in bone mineral density throughout trial durations.

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“There is little justification for the use of vitamin D supplements to maintain or improve musculoskeletal health (except for the prevention or treatment of rickets and osteomalacia in high-risk groups), and clinical guidelines should reflect these conclusions,” wrote the investigators.

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Bolland MJ, Grey A, Avenell A. Effects of vitamin D supplementation on musculoskeletal health: a systematic review, meta-analysis, and trial sequential analysis [published online October 4, 2018]. Lancet Diabetes Endocrinol. doi:10.1016/S2213-8587(18)30265-1