Vitamin D and osteoporosis-related fracture

The age-related decline in mass and quality of bone (osteoporosis) and muscle (sarcopenia) leads to an exponential increased risk for osteoporosis-related fracture with advancing age in older adults. As vitamin D inadequacy plausibly causally contributes to these declines, optimization of vitamin D status might reduce the deterioration of bone and muscle function with age. Putative mechanisms by which vitamin D inadequacy may increase fracture risk include both direct and indirect effects on bone and muscle. However, controversy currently clouds the role(s) of vitamin D in osteoporosis-related fracture, the amount of vitamin D required and the optimal 25-hydroxyvitamin D level. This review provides an overview of current knowledge and suggests a clinical approach to vitamin D status in older adults with, or at risk for, osteoporosis-related fracture. These recommendations are likely to evolve as additional data becomes available.

► Many patients with osteoporosis and/or fragility fracture have vitamin D deficiency.
► Vitamin D deficiency may be causally related to the development of osteoporosis and sarcopenia.
► Vitamin D deficiency is associated with muscle weakness and increased falls risk.
► The optimal 25(OH)D level in osteoporosis patients is controversial, but 30 ng/mL is suggested.