Opinion | Published:

Vitamin D and falls — the dosage conundrum

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


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.

Access optionsAccess options

Rent or Buy article

Get time limited or full article access on ReadCube.


All prices are NET prices.


  1. 1.

    et al. Clinical review: the effect of vitamin D on falls: a systematic review and meta-analysis. J. Clin. Endocrinol. Metab. 96, 2997–3006 (2011).

  2. 2.

    , , & Vitamin D supplementation and falls: a trial sequential meta-analysis. Lancet Diabetes Endocrinol. 2, 573–580 (2014).

  3. 3.

    , & Differences in overlapping meta-analyses of vitamin D supplements and falls. J. Clin. Endocrinol. Metab. 99, 4265–4272 (2014).

  4. 4.

    et al. Annual high-dose oral vitamin D and falls and fractures in older women: a randomized controlled trial. JAMA 303, 1815–1822 (2010).

  5. 5.

    et al. Monthly high-dose vitamin D treatment for the prevention of functional decline: a randomized clinical trial. JAMA Intern. Med. 176, 175–183 (2016).

  6. 6.

    Institute of Medicine (US) Committee to Review Dietary Reference Intakes for Vitamin D and Calcium. Dietary Reference Intakes for Calcium and Vitamin D (National Academies Press, 2011).

  7. 7.

    et al. Development of the common data base for the FICSIT trials. J. Am. Geriatr. Soc. 41, 297–308 (1993).

  8. 8.

    , , & Epidemiology of falls and osteoporotic fractures: a systematic review. Clinicoecon. Outcomes Res. 5, 9–18 (2013).

  9. 9.

    et al. Serum vitamin D and falls in older women in residential care in Australia. J. Am. Geriatr. Soc. 51, 1533–1538 (2003).

  10. 10.

    & The effect of falls and fall injuries on functioning in community-dwelling older persons. J. Gerontol. A Biol. Sci. Med. Sci. 53, M112–M119 (1998).

  11. 11.

    et al. Prevention of falls in the elderly trial (PROFET): a randomised controlled trial. Lancet 353, 93–97 (1999).

  12. 12.

    et al. Activity restriction induced by fear of falling and objective and subjective measures of physical function: a prospective cohort study. J. Am. Geriatr. Soc. 56, 615–620 (2008).

  13. 13.

    & Racial/ethnic predictors of falls among older adults: the health and retirement study. J. Aging Health 26, 1060–1075 (2014).

  14. 14.

    WHO. International Classification of Diseases and Related Health Problems. 10th Revision (2003),

  15. 15.

    , , & Emergency department visits for injurious falls among the elderly, 2006. HCUP Statistical Brief #80. Healthcare Cost And Utilization Project (2009).

  16. 16.

    , , & The costs of fatal and non-fatal falls among older adults. Inj. Prev. 12, 290–295 (2006).

  17. 17.

    , , , & Falls leading to femoral neck fractures in lucid older people. J. Am. Geriatr. Soc. 44, 156–160 (1996).

  18. 18.

    & The prognosis of falls in elderly people living at home. Age Ageing 28, 121–125 (1999).

  19. 19.

    et al. Global and regional mortality from 235 causes of death for 20 age groups in 1990 and 2010: a systematic analysis for the Global Burden of Disease Study 2010. Lancet 380, 2095–2128 (2012).

  20. 20.

    , , , & Prevention of falls and consequent injuries in elderly people. Lancet 366, 1885–1893 (2005).

  21. 21.

    et al. Interventions to prevent falls in older adults: An updated systematic review (Agency for Healthcare Research and Quality (US), 2010).

  22. 22.

    et al. Vitamin D status in relation to one-year risk of recurrent falling in older men and women. J. Clin. Endocrinol. Metab. 91, 2980–2985 (2006).

  23. 23.

    et al. Higher 1.25-dihydroxyvitamin D3 concentrations associated with lower fall rates in older community-dwelling women. Osteoporos. Int. 17, 1318–1328 (2006).

  24. 24.

    et al. Serum parathyroid hormone predicts time to fall independent of vitamin D status in a frail elderly population. J. Clin. Endocrinol. Metab. 89, 1572–1576 (2004).

  25. 25.

    et al. Treatment of vitamin D insufficiency in postmenopausal women: a randomized clinical trial. JAMA Intern. Med. 175, 1612–1621 (2015).

  26. 26.

    et al. Exercise and vitamin D in fall prevention among older women: a randomized clinical trial. JAMA Intern. Med. 175, 703–711 (2015).

  27. 27.

    et al. Effect of annual intramuscular vitamin D on fracture risk in elderly men and women — a population-based, randomized, double-blind, placebo-controlled trial. Rheumatology (Oxford) 46, 1852–1857 (2007).

  28. 28.

    , & Falls are increased on recommended doses of vitamin D in elderly women [poster abstract]. Presented at the ASBMR 2015 Annual Meeting (2015).

  29. 29.

    American Geriatrics Society Workgroup on Vitamin D Supplementation for Older Adults. Recommendations abstracted from the American Geriatrics Society Consensus Statement on vitamin D for prevention of falls and their consequences. J. Am. Geriatr. Soc. 62, 147–152 (2014).

  30. 30.

    , , & Combination treatment with estrogen and calcitriol in the prevention of age-related bone loss. J. Clin. Endocrinol. Metab. 86, 3618–3628 (2001).

  31. 31.

    et al. Alfacalcidol reduces the number of fallers in a community-dwelling elderly population with a minimum calcium intake of more than 500 mg daily. J. Am. Geriatr. Soc. 52, 230–236 (2004).

  32. 32.

    US National Library of Science. ClinicalTrials.gov (2016).

Download references


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.

Author information


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

    • J. Christopher Gallagher


  1. Search for J. Christopher Gallagher in:

Competing interests

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

Corresponding author

Correspondence to J. Christopher Gallagher.

About this article

Publication history




Further reading