Recommendations abstracted from the American Geriatrics Society Consensus Statement on vitamin D for Prevention of Falls and Their Consequences.
J Am Geriatr Soc. 2014 Jan;62(1):147-52. doi: 10.1111/jgs.12631. Epub 2013 Dec 18.
American Geriatrics Society Workgroup on Vitamin D Supplementation for Older Adults.
Judge J, Birge S, Gloth F 3rd, Heaney RP, Hollis BW, Kenny A, Kiel DP, Saliba D, Schneider DL, Vieth R.
The goal of this Consensus Statement is to help primary care practitioners achieve adequate vitamin D intake from all sources in their older patients, with the goal of reducing falls and fall-related injuries. The workgroup graded the quality of evidence and assigned an evidence level using established criteria. Based on the evidence for fall and fracture reduction in the clinical trials of older community-dwelling and institutionalized persons and metaanalyses, the workgroup concluded that a serum 25 hydroxyvitamin D (25(OH)D) concentration of 30 ng/mL (75 nmol/L) should be a minimum goal to achieve in older adults, particularly in frail adults, who are at higher risk of falls, injuries, and fractures. The workgroup concluded that the goal- -to reduce fall injuries related to low vitamin D status- - could be achieved safely and would not require practitioners to measure serum 25(OH)D concentrations in older adults in the absence of underlying conditions that increase the risk of hypercalcemia (e.g., advanced renal disease, certain malignancies, sarcoidosis).
© 2013, Copyright the Authors Journal compilation © 2013, The American Geriatrics Society.
|Baseline supplement needs|
|Starting supplement dose||3,000 IU/d||3,000 IU|
|Food input (Table 1)|
For most older adults, food input is small. Average input
from food in U.S. adults = 150–225 IU/d
|Subtract estimated input of|
vitamin D from food
|Daily multivitamins with or without calcium and vitamin tablets Subtract total daily vitamin D units IU|
Unprotected sun exposurea
NOT recommended as a strategy:If exposure is uncertain, do not adjust supplement dose.
Do not adjust for institutionalized residents.
Adjust dose only if individual has unprotected sun exposure
(in bathing suit or shorts and short sleeved shirt) for
15 minutes in sun several days per week. During summer months only,
|subtract 500–1,000 IU/d with|
regular unprotected sun exposure
during summer months*
|Obesity or high body mass (>90 kg) is associated with|
lower vitamin D levels and ~20% lower 25(OH)D response to supplementation.17,18
|Add 500–800 IU/d||+ IU|
|Skin pigmentation19%%%Mexican Americans and African Americans have lower|
vitamin D levels than non-Hispanic whites.
|Add 300–600 IU/d||+ IU|
|Total additional supplement dose per day|
Do not exceed 4,000 IU/d except in cases of special populations (see below).
See Statements 5 and 6 to determine choice of vitamin D2 or D3%%%formulation based on patient preference of frequency of supplementation.
For special populations, monitoring serum 25(OH)D levels may be useful in helping to verify adjusted dose.
Agents that bind vitamin D in the gut (e.g., cholestyramine)
Agents that accelerate the breakdown of vitamin D (e.g., inducers of
the cytochrome P450 pathway such as phenytoin and phenobarbital)
|Increase dose according|
to serum 25(OH)D
|Malabsorption syndromes||Increase dose according to serum 25(OH)D|
- Vitamin D may prevent falls and fractures without Calcium – an overview of 9 meta-analysis – Oct 2012
- Published Recommendations has the following summary chart