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Vitamin D supplementation in elderly or postmenopausal women: a 2013 update of the 2008 recommendations from the European Society for Clinical and Economic Aspects of Osteoporosis and Osteoarthritis (ESCEO)

Vitamin D supplementation in elderly or postmenopausal women: a 2013 update of the 2008 recommendations from the European Society for Clinical and Economic Aspects of Osteoporosis and Osteoarthritis (ESCEO)
Vitamin D supplementation in elderly or postmenopausal women: a 2013 update of the 2008 recommendations from the European Society for Clinical and Economic Aspects of Osteoporosis and Osteoarthritis (ESCEO)
Vitamin D insufficiency has deleterious consequences on health outcomes. In elderly or postmenopausal
women, it may exacerbate osteoporosis.

There is currently no clear consensus on definitions of vitamin D insufficiency or minimal targets for vitamin
D concentrations and proposed targets vary with the population. In view of the potential confusion for
practitioners on when to treat and what to achieve, the European Society for Clinical and Economic Aspects
of Osteoporosis and Osteoarthritis (ESCEO) convened a meeting to provide recommendations for clinical
practice, to ensure the optimal management of elderly and postmenopausal women with regard to vitamin D
supplementation.

Vitamin D has both skeletal and extra-skeletal benefits. Patients with serum 25-hydroxyvitamin D (25-(OH)D)
levels550 nmol/L have increased bone turnover, bone loss, and possibly mineralization defects compared with patients with levels450 nmol/L. Similar relationships have been reported for frailty, nonvertebral and hip fracture, and all-cause mortality, with poorer outcomes at550 nmol/L.

The ESCEO recommends that 50 nmol/L (i.e. 20 ng/mL) should be the minimal serum 25-(OH)D concentration at the population level and in patients with osteoporosis to ensure optimal bone health. Below this threshold, supplementation is recommended at 800 to 1000 IU/day. Vitamin D supplementation is safe up to 10,000 IU/day (upper limit of safety) resulting in an upper limit of adequacy of 125 nmol/L 25-(OH)D. Daily consumption of calcium- and vitamin-D-fortified food products (e.g. yoghurt or milk) can help improve vitamin D intake. Above the threshold of 50 nmol/L, there is no clear evidence for additional benefits of supplementation. On the other hand, in fragile elderly subjects who are at elevated risk for falls and fracture, the ESCEO recommends a minimal serum 25-(OH)D level of 75 nmol/L (i.e. 30 ng/mL), for the greatest impact on fracture.
bone health, guidance, osteoporosis, supplementation, vitamin D
0300-7995
305-313
Rizzoli, R.
2214fb77-8fb7-4c0b-bfc4-9f8d3cace5d7
Boonen, S.
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Brandi, M.L.
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Bruyere, O.
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Cooper, C.
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Kanis, J.A.
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Kaufman, J.M.
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Ringe, J.D.
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Weryha, G.
abd87755-4125-492f-a97d-585fb6d3e732
Reginster, J.Y.
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Rizzoli, R.
2214fb77-8fb7-4c0b-bfc4-9f8d3cace5d7
Boonen, S.
19c70ece-493f-4b7c-9bf9-5e4a4a887ba4
Brandi, M.L.
4147f967-9c22-494d-ae35-c8141161413d
Bruyere, O.
9c455ea4-7f77-407f-ab5a-ecb571db8245
Cooper, C.
e05f5612-b493-4273-9b71-9e0ce32bdad6
Kanis, J.A.
8da04a36-08a7-4310-b4b4-a6d432439587
Kaufman, J.M.
b79b47cd-16f0-4619-bf7c-fb77b115d2cd
Ringe, J.D.
28bfb3bb-3ef5-4d52-8f96-1a05ab813fb5
Weryha, G.
abd87755-4125-492f-a97d-585fb6d3e732
Reginster, J.Y.
4083b457-5347-4ece-a53e-af19c8868c42

Rizzoli, R., Boonen, S., Brandi, M.L., Bruyere, O., Cooper, C., Kanis, J.A., Kaufman, J.M., Ringe, J.D., Weryha, G. and Reginster, J.Y. (2013) Vitamin D supplementation in elderly or postmenopausal women: a 2013 update of the 2008 recommendations from the European Society for Clinical and Economic Aspects of Osteoporosis and Osteoarthritis (ESCEO). Current Medical Research and Opinion, 29 (4), 305-313. (doi:10.1185/03007995.2013.766162). (PMID:23320612)

Record type: Article

Abstract

Vitamin D insufficiency has deleterious consequences on health outcomes. In elderly or postmenopausal
women, it may exacerbate osteoporosis.

There is currently no clear consensus on definitions of vitamin D insufficiency or minimal targets for vitamin
D concentrations and proposed targets vary with the population. In view of the potential confusion for
practitioners on when to treat and what to achieve, the European Society for Clinical and Economic Aspects
of Osteoporosis and Osteoarthritis (ESCEO) convened a meeting to provide recommendations for clinical
practice, to ensure the optimal management of elderly and postmenopausal women with regard to vitamin D
supplementation.

Vitamin D has both skeletal and extra-skeletal benefits. Patients with serum 25-hydroxyvitamin D (25-(OH)D)
levels550 nmol/L have increased bone turnover, bone loss, and possibly mineralization defects compared with patients with levels450 nmol/L. Similar relationships have been reported for frailty, nonvertebral and hip fracture, and all-cause mortality, with poorer outcomes at550 nmol/L.

The ESCEO recommends that 50 nmol/L (i.e. 20 ng/mL) should be the minimal serum 25-(OH)D concentration at the population level and in patients with osteoporosis to ensure optimal bone health. Below this threshold, supplementation is recommended at 800 to 1000 IU/day. Vitamin D supplementation is safe up to 10,000 IU/day (upper limit of safety) resulting in an upper limit of adequacy of 125 nmol/L 25-(OH)D. Daily consumption of calcium- and vitamin-D-fortified food products (e.g. yoghurt or milk) can help improve vitamin D intake. Above the threshold of 50 nmol/L, there is no clear evidence for additional benefits of supplementation. On the other hand, in fragile elderly subjects who are at elevated risk for falls and fracture, the ESCEO recommends a minimal serum 25-(OH)D level of 75 nmol/L (i.e. 30 ng/mL), for the greatest impact on fracture.

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e-pub ahead of print date: 7 February 2013
Published date: April 2013
Keywords: bone health, guidance, osteoporosis, supplementation, vitamin D
Organisations: Faculty of Medicine

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Local EPrints ID: 354084
URI: http://eprints.soton.ac.uk/id/eprint/354084
ISSN: 0300-7995
PURE UUID: f578ae2a-69bd-42d8-a126-5de8f1d95b85
ORCID for C. Cooper: ORCID iD orcid.org/0000-0003-3510-0709

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Date deposited: 01 Jul 2013 08:21
Last modified: 17 Dec 2019 01:56

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Contributors

Author: R. Rizzoli
Author: S. Boonen
Author: M.L. Brandi
Author: O. Bruyere
Author: C. Cooper ORCID iD
Author: J.A. Kanis
Author: J.M. Kaufman
Author: J.D. Ringe
Author: G. Weryha
Author: J.Y. Reginster

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