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Abstract
Background:
Vitamin D insufficiency has deleterious consequences on health outcomes. In elderly or postmenopausal women, it may exacerbate osteoporosis.
Scope:
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.
Findings:
Vitamin D has both skeletal and extra-skeletal benefits. Patients with serum 25-hydroxyvitamin D (25-(OH)D) levels <50 nmol/L have increased bone turnover, bone loss, and possibly mineralization defects compared with patients with levels >50 nmol/L. Similar relationships have been reported for frailty, nonvertebral and hip fracture, and all-cause mortality, with poorer outcomes at <50 nmol/L.
Conclusion:
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.
Transparency
Declaration of funding
This study was not funded.
Declaration of financial/other relationships
R.R. has disclosed receiving consulting and lecture fees for Merck Sharp and Dohme, Eli Lilly, Amgen, Novartis, Servier, Nycomed, Nestlé, and Danone. S.B. has disclosed receiving consulting and lecture fees, fees for advisory boards, and/or grant support from Amgen, Eli Lilly, GlaxoSmithKline, Merck, Novartis, Ono, Roche, Sanofi-Aventis, Servier, and Warner Chilcott. M.-L.B. has disclosed receiving support from Fondazione F.I.R.M.O. (Fondazione Italiana Ricerca Malattie Ossee) and grants from Merck Sharpe & Dohme, Nycomed, Roche, Glaxo, Eli Lilly, and Wyeth, as well as speaker fees from Procter and Gamble, Merck Sharpe & Dohme, Nycomed, and Wyeth. O.B. has disclosed receiving grants for research from GlaxoSmithKline, IBSA, Merck Sharp & Dohme, Theramex, Novartis, Pfizer, Rottapharm, and Servier; consulting or lecture fees from IBSA, Rottapharm, and Servier; and reimbursement for attending meetings from IBSA, Merck Sharp & Dohme, Novartis, Pfizer, Rottapharm, Theramex, Servier. C.C. has disclosed receiving consulting fees and fees for advisory boards for Alliance for Better Bone Health, Glaxo Smith Kline, Roche, Merck Sharp and Dohme, Lilly, Amgen, Wyeth, Novartis, Servier, and Nycomed. J.A.K. has disclosed receiving consulting fees, fees for advisory boards, lecture fees, and/or grant support from the majority of companies concerned with skeletal metabolism. J.-M.K. has disclosed receiving speaker and/or consultant fees and/or research support from Amgen, Daiichi-Sankyo, Glaxo SmithKline, Merck Sharp & Dohme, Novartis, Nycomed, Servier, and Roche. J.D.R. has disclosed receiving consulting fees or fees for advisory boards for Amgen, Madaus, Merck, Servier; Lecture fees for Leo, Lilly, Novartis, Servier, and Teva. G.W. has disclosed receiving consulting fees or fees for advisory boards for Novartis and Lilly, as well as lecture fees from Lilly, Servier, Theramex, and Daiichi Sankyo and clinical trial investigator fees from Servier, Lilly, MSD, Amgen, Nycomed, and Roche. J.-Y.R. has disclosed receiving consulting fees, paid advisory boards, lecture fees, and/or grant support from Servier, Novartis, Negma, Lilly, Wyeth, Amgen, GlaxoSmithKline, Roche, Merckle, Nycomed, NPS, Theramex, UCB, Merck Sharp and Dohme, Rottapharm, IBSA, Genevrier, Teijin, Teva, Ebewee Pharma, Zodiac, Analis, Novo-Nordisk, and Bristol Myers Squibb.
CMRO peer reviewers may have received honoraria for their review work. The peer reviewers on this manuscript have disclosed that they have no relevant financial relationships.
Acknowledgments
This paper was derived from a Working Group meeting supported by the European Society for Clinical and Economic Aspects of Osteoporosis and Osteoarthritis (ESCEO).