Vitamin D Supplementation in the Prevention of Hip Fractures in the Elderly Population

Objective: Osteoporosis and the resultant fractures are a serious public health concern.  One of every three women and one in six men will sustain a hip fracture by the age of ninety.  Vitamin D is necessary for healthy bones, and low serum vitamin D has been associated with increased risk of fractures.  However, it is unclear as to whether or not routine supplementation of vitamin D is advisable.  The objective of this narrative review was to ascertain if vitamin D supplementation is preventive of fractures in the older population.

Methods: A literature search was performed using the PubMed and Cochrane Library databases. Fifteen pertinent studies were identified and reviewed. 

Results: Vitamin D supplementation, in low doses and alone, did not appear to diminish fracture risk.  However, vitamin D at doses above 700 IU daily, especially when combined with calcium, demonstrated an association with decreased risk of fracture.  Some studies found significantly diminished fracture rates at doses between 800 and 2000 IU.  These findings were most pronounced in institutional settings, which may relate to compliance to the treatment.  In addition, vitamin D supplementation appears to be safe at the levels tested. 

Conclusion:  The conclusion is that vitamin D oral supplementation at higher doses of at least 700-800 IU daily, particularly in combination with calcium supplementation, may be preventive for those older individuals at risk for fracture.  These results may have significant benefit from a public health perspective.