Submitted to: Journal of the American Medical Association
Publication Type: Book / chapter
Publication Acceptance Date: 4/23/2010
Publication Date: 5/12/2010
Citation: Dawson-Hughes, B., Harris, S. 2010. Vitamin D recommendations for older adults. Journal of the American Medical Association. 303(18):1861-1862. Interpretive Summary:
Technical Abstract: Many randomized, controlled trials indicate that vitamin D will lower falls and fractures, so it was reasonable for Sanders et al. to hypothesize that a single annual 500,000 IU oral dose of vitamin D3 would be effective in reducing falls and fractures in older women with one or more risk factors for falling. Not only was this regimen not effective in lowering risk, it increased risk of falls and fractures, with the greatest increase occurring in the first three months after dosing. We can only speculate on the biological plausibility of these findings. One possibility is that the high dose of vitamin D triggered more rapid degradation of the active metabolite of vitamin D. Another possibility is that subjects taking the vitamin D were more active and therefore had more opportunity for falls and fractures. These findings do not alter the importance of correcting widespread vitamin D deficiency and insufficiency, however, they do indicate that the approach taken to supplementation, specifically, the vitamin D dosing regimen, is important. They raise the possibility that infrequent high doses of vitamin D are counterproductive and they also raise some question about the ultimate value of the common clinical practice of treating vitamin D deficient patients with loading doses of vitamin D at the outset of repletion. We have no evidence for adverse effects of more frequent, lower dose regimens, so daily, weekly, or monthly dosing with vitamin D3 appear to be our best options at this time.