ARS | Publication request: Vitamin D recommendations for older adults

Submitted to: Osteoporosis International
Publication Type: Book / Chapter
Publication Acceptance Date: April 16, 2010
Publication Date: July 7, 2010
Citation: Dawson-Hughes, B., Mthal, A., Bonjour, J., Boonen, S., Burckhardt, P., El-Hadjj Fuleihan, G., Josse, R.G., Lips, P., Torres, J., Yoshimura, N. 2010. Vitamin D recommendations for older adults. In: Johnson, T., editor. Osteoporosis International. 7th edition. London, England: Springer London. p.1151-1154.

Technical Abstract: This position paper of the International Osteoporosis Foundation makes recommendations for vitamin D nutrition in elderly men and women from an evidence-based perspective. The key recommendations are that the optimal level of 25-hydroxyvitamin D for musculoskeletal health is 75 nmol/L. An intake of 800 to 1000 IU/d of vitamin d will bring a group average value to 75 nmol/L, but higher doses would be needed to ensure that almost all older adults reached 75 nmol/l. The efficacy of doses higher than 800 IU/d (for fractures) and 1000 IU/d (for falls) however has not been evaluated in RCTs. It is therefore premature to recommend higher intakes for all older adults at this time. The repletion dose will vary among individuals according to their starting level, their BMI, their effective sun exposure, and other unidentified factors. An intake lower than 800 IU/d may be adequate for individuals with regular effective sun exposure. Intake may need to be adjusted upward to as much as 2000 IU/d in individuals who are obese, and in those with osteoporosis, limited sun exposure (institutionalized, homebound), and malabsorption. In these and other high risk individuals, we recommend measuring the serum 25OHD level. The required dose to reach 75 nmol/L can be estimated from the measured level. Each 100 IU of added vitamin D will increase the serum 25OHD level by about 1.0 ng/ml (range 0.7 to 1.1 ng/ml). Because of the variability in individual 25OHD responses to supplemental vitamin D, however, in high risk individuals, the serum 25OHD levels should be retested after about 3 months of supplementation to confirm that the target 25OHD level has been reached.