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Vitamin D and falls — the dosage conundrum

Nature Reviews Endocrinology volume 12, pages 680684 (2016) | Download Citation

Abstract

Falls are a major health problem in elderly individuals. Although intensive physical therapy and management of hazards in the home can reduce falls by 25%, long-term practicality limits their use. Interest in vitamin D as a medical therapy has led to many trials; however, results using daily oral doses of vitamin D have been inconsistent. In the past 5 years, studies on the effect of bolus doses of vitamin D have produced surprising results. Bolus doses of vitamin D, given annually (at a dose of 300,000 IU or 500,000 IU) or monthly (at a dose of 24,000 IU or 60,000 IU) — equivalent to approximate daily doses of 800 IU, 1400 IU and 2,000 IU — result in a significant increase in the number of falls and fractures associated with serum levels of 25-hydroxyvitamin D greater than 40–45 ng/ml (equivalent to 100–112 nmol/l). These unexpected results show increased falls and fractures are adverse events related to vitamin D administration. Until further safety data is available, bolus dosing or daily doses should not exceed 3,000 IU and serum levels of 25-hydroxyvitamin D should not exceed 40–45 ng/ml (equivalent to 100–112 nmol/l) in elderly individuals.

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Acknowledgements

J.C.G. conducted a dose-ranging trial on vitamin D that was supported by the National Institute on Aging (Grant number RO1-AG28168) and the Office of Dietary Supplements.

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Affiliations

  1. Bone Metabolism Unit, Division of Endocrinology, Creighton University School of Medicine, 601 North 30th Street, Omaha, Nebraska 68131, USA.

    • J. Christopher Gallagher

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Competing interests

J.C.G. was on the Advisory Board of, and has received honoraria from, Teva.

Corresponding author

Correspondence to J. Christopher Gallagher.

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DOI

https://doi.org/10.1038/nrendo.2016.123

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