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Expert consensus: Osteoporosis needs Vitamin D – Jan 2025

Expert consensus on vitamin D in osteoporosis

Sha Lei1#, Xiaoya Zhang1#, Lige Song1,2#, Jinhui Wen3, Zheng Zhang4, Jianqing Tian5, Rui Yang6, Shuhang Xu7, Shanhu Qiu8, Richard J. MacIsaac9,10, Jasna Aleksova9,11,12, Fabrice Mac-Way13, Marie-Ève Dupuis13,14, David Benaiges15,16,17,18, Didac Mauricio19, Andrei P. Sommer20, Joshua I. Barzilay21, John C. Gallagher22, Lingling Pan1, Linlin Ji1, Ping Fang1, Ying Li1, Qi Liu1, Jiasheng Zhao1, Ying Xue1, Yuqin Shen23, Lemin Wang23, Junfeng Han1,24*, Guanghui Liu1,24*
Correspondence to: Junfeng Han, MD; Guanghui Liu, MD. Department of Endocrinology and Metabolism, Tongji Hospital, School of Medicine, Tongji University, 389 Xincun Rd., Shanghai 200065, China; Diabetic Foot Center, Tongji Hospital, School of Medicine, Tongji University, Shanghai, China. Email: tjhjf at 163.com; lghdoctor at 126.com.

Consensus summary
Best measurement method: serum 25[OH]D is identified as the optimal method for assessing vitamin D status level 1 evidence, strong recommendation
• Standardization issues: in the absence of standardized 25[OH]D assays, serum 25[OH]D levels from different clinical laboratories may not be comparable level 2 evidence, strong recommendation
• At-risk patients: measurement of serum 25[OH]D measurement is recommended for patients at risk of vitamin D deficiency level 2 evidence, strong recommendation
• Osteoporosis and serum levels: serum 25[OH]D levels should be maintained at ≥75 nmol/L in patients with osteoporosis level 1 evidence, strong recommendation
• Low-risk adults: in adults under 50 with a low risk of vitamin D insufficiency, daily supplementation exceeding 400 IU of vitamin D and 1,000 mg of calcium is not recommended level 1 evidence, weak recommendation
• Supplements for older adults: for adults over 50 at high risk of vitamin D deficiency, a minimum daily supplementation of 1,200 mg of calcium and 800 IU of vitamin D is recommended level 1 evidence, strong recommendation
• Post-supplementation testing: routine measurement of serum 25[OH]D within 3 months of initiating supplementation is not necessary level 1 evidence, strong recommendation
• Fracture prevention: evaluating vitamin D supplementation alone or in conjunction with calcium for primary fracture prevention in community-dwelling adults should consider the balance of potential harms and benefits level 1 evidence, weak recommendation
• Calcium and vitamin D status: adequate calcium intake and vitamin D status are essential before initiating anti-resorptive therapy in patients with vitamin D deficiency level 2 evidence, weak recommendation


Background: Adequate vitamin D is essential for maintaining optimal bone health, preventing and treating of osteoporosis. However, in recent years, large clinical trials and meta-analyses on the efficacy of vitamin D supplementation to prevent fractures in populations at different risks have been equivocal. The optimal level of 25-hydroxyvitamin D (25[OH]D) remains controversial. Recommendations vary between societies. The lack of standardized assays also poses a challenge in interpreting available research data.

Methods: We systematically searched for articles in MEDLINE database through PubMed, which included meta-analysis, systematic reviews of randomized controlled trials (RCTs) and observational studies that assessed measurement, diagnosis and treatment about vitamin D deficiency. The experts evaluated the available literature, graded references according to the type of study and described the strength recommendations.

Results: This expert consensus is based on the review of relevant clinical evidence and provides nine key recommendations on vitamin D deficiency in populations at different risks, especially in patients with osteoporosis. Supporting information is provided in the subsequent appendix box.

Conclusions: This expert consensus is a practical tool for endocrinologists, general physicians for the diagnosis, assessment, and treatment of populations at different risks of vitamin D deficiency, especially in patients with osteoporosis. Clinicians should be aware of the evidence but make individualized decisions based on specific patients or situation.
 Download the PDF from VitaminDWiki

VitaminDWiki – Overview Osteoporosis and vitamin D contains

  • FACT: Bones need Calcium (this has been known for a very long time)
  • FACT: Vitamin D improves Calcium bioavailability (3X ?)
  • FACT: Should not take > 750 mg of Calcium if taking lots of vitamin D (Calcium becomes too bio-available)
  • FACT: Adding vitamin D via Sun, UV, or supplements increased vitamin D in the blood
  • FACT: Vitamin D supplements are very low cost
  • FACT: Many trials, studies. reviews, and meta-analysis agree: adding vitamin D reduces osteoporosis
  • FACT: Toxic level of vitamin D is about 4X higher than the amount needed to reduce osteoporosis
  • FACT: Co-factors help build bones.
  • FACT: Vitamin D Receptor can restrict Vitamin D from getting to many tissues, such as bones
  • It appears that to TREAT Osteoporosis:
  •        Calcium OR vitamin D is ok
  •        Calcium + vitamin D is good
  •        Calcium + vitamin D + other co-factors is great
  •        Low-cost Vitamin D Receptor activators sometimes may be helpful
  • CONCLUSION: To PREVENT many diseases, including Osteoporosis, as well as TREAT Osteoporosis
  • Category Osteoporosis has 224 items
  • Category Bone Health has 315 items

Note: Osteoporosis causes bones to become fragile and prone to fracture
  Osteoarthritis is a disease where damage occurs to the joints at the end of the bones

VitaminDWiki – Consensus Vitamin D category contains:

73 Vitamin D consensus publications


Expert consensus: Osteoporosis needs Vitamin D – Jan 2025        
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