Two very different Vitamin D outcomes for the elderly

Daily dose needs to be increased
Daily recommended intakes for older adults should be increased to 1,000 IU in order to ensure bone health and help reduce the risk of falls, says the International Osteoporosis Foundation. A new position statement by the foundation, published in Osteoporosis International, examined all available evidence to support new recommendations for optimal vitamin D status, and found that older adults should consume between 800 and 1,000 International Units (IU) per day in order to ensure sufficient blood levels of the vitamin. “Global vitamin D status shows widespread insufficiency and deficiency,” said the statement’s lead author Professor Bess Dawson-Hughes of Tufts University. “This high prevalence of suboptimal levels raises the possibility that many falls and fractures can be prevented with vitamin D supplementation. This is a relatively easy public health measure that could have significant positive effects on the incidence of osteoporotic fractures.”

The influential Institute of Medicine (IOM) in the US is conducting a review of the available vitamin D science and is due to deliver its findings this summer. Many expect the IOM to recommend RDIs much above the current levels of 400 IU.

• The estimated average vitamin D requirement of older adults to reach a serum 25OHD level of 75 nmol/l (30ng/ml) is 20 to 25 micrograms per day (800 to 1,000 IU per day).

• Intakes may need to increase to as much as 50 micrograms (2,000 IU) per day in individuals who are obese, have osteoporosis, limited sun exposure (e.g. housebound or institutionalized), or have malabsorption.

• For high risk individuals it is recommended to measure serum 25OHD levels and treat if deficient.

The dangers of a single annual dose
The findings of study in the high-profile Journal of the American Medical Association (JAMA) that concluded that a once-a-year high dose of vitamin D may increase an elderly woman’s rate of falls and fractures compared to women who received placebo. The trial randomly assigned 2,256 community-dwelling women over the age of 70 to receive either placebo or an annual oral dose of 500,000 IU of vitamin D3 (cholocalciferol) for between 3 to 5 years. Australian researchers found that women in the vitamin D group experienced 15 per cent more falls than women in the placebo group. Furthermore, women in the vitamin D group had 26 per cent more fractures and a 31 per cent higher incidence of falls than women in the placebo group. “This is the first study to demonstrate increased risk of falls associated with any vitamin D intervention and the second study to demonstrate an increased fracture risk associated with annual high-dose vitamin D therapy in elderly women,” wrote the researchers. “Thus, it is reasonable to speculate that high serum levels of vitamin D or metabolites resulting from the large annual dose, subsequent de­crease in the levels, or both might be causal.

Bonnie - 500,000IU! I'm surprised there were not other major health issues associated with this high of a dose. Some of my clients take 50,000IU as a loading dose for a short period of time to ramp up their levels quickly. I am horrified that a study would be performed using this high of a dose.