Expert consensus on vitamin D in osteoporosis

Sha Lei^#¹, Xiaoya Zhang^#¹, Lige Song^#^{1

2}, Jinhui Wen³, Zheng Zhang⁴, Jianqing Tian⁵, Rui Yang⁶, Shuhang Xu⁷, Shanhu Qiu⁸, Richard J MacIsaac^{9

10}, Jasna Aleksova^{9

11

12}, Fabrice Mac-Way¹³, Marie-Ève Dupuis^{13

14}, David Benaiges^{15

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 Han^#^{1

24}, Guanghui Liu^#^{1

24}

Affiliations

¹ Department of Endocrinology and Metabolism, Tongji Hospital, School of Medicine, Tongji University, Shanghai, China.
² Institute of Osteoporosis and Metabolic Bone Diseases, Tongji Hospital, School of Medicine, Tongji University, Shanghai, China.
³ Department of Endocrinology and Metabolism, Clinical Medical College & Affiliated Hospital of Chengdu University, Chengdu University, Chengdu, China.
⁴ Department of Endocrinology and Metabolism, Renhe Hospital Affiliated to Shanghai University, Shanghai, China.
⁵ Department of Endocrinology and Metabolism, Xiamen Humanity Hospital Fujian Medical University, Xiamen, China.
⁶ Department of Endocrinology and Metabolism, Zhujiang Hospital, Southern Medical University, Guangzhou, China.
⁷ Endocrine and Diabetes Center, Jiangsu Province Hospital on Integration of Chinese and Western Medicine, Jiangsu Province Academy of Traditional Chinese Medicine, Nanjing University of Traditional Chinese Medicine, Nanjing, China.
⁸ Department of General Practice, Zhongda Hospital, Institute of Diabetes, School of Medicine, Southeast University, Nanjing, China.
⁹ Department of Endocrinology & Diabetes, St Vincent's Hospital Melbourne, Melbourne, Australia.
¹⁰ Department of Medicine, University of Melbourne, Victoria, Australia.
¹¹ Department of Medicine, Monash University, Melbourne, Australia.
¹² Department of Endocrinology, Monash Health, Melbourne, Australia.
¹³ CHU de Québec Research Center, L'Hôtel-Dieu de Québec Hospital, Faculty and Department of Medicine, Université Laval, Quebec, Canada.
¹⁴ Department of Medicine, Nephrology Service Hôpital Maisonneuve-Rosemont, Affiliated to Université de Montréal, Montréal, Canada.
¹⁵ Department of Endocrinology and Nutrition, Hospital del Mar, Passeig Marítim, Barcelona, Spain.
¹⁶ Department of Endocrinology and Nutrition, Consorci Sanitari Alt Penedès-Garraf, Espirall, Vilafranca del Penedès, Spain.
¹⁷ Institut Hospital del Mar d'Investigacions Mèdiques (IMIM), Dr. Aiguader, Barcelona, Spain.
¹⁸ Department of Medicine, Universitat Pompeu Fabra, Plaça de la Mercè, Barcelona, Spain.
¹⁹ Department of Endocrinology & Nutrition, CIBERDEM, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain.
²⁰ Faculty of Science, Isra University, Amman, Jordan.
²¹ Kaiser Permanente of Georgia and the Division of Endocrinology, Emory University School of Medicine, Atlanta, GA, USA.
²² Bone Metabolism Unit, Division of Endocrinology, Creighton University School of Medicine, Omaha, USA.
²³ Department of Rehabilitation, Tongji Hospital, School of Medicine, Tongji University, Shanghai, China.
²⁴ Diabetic Foot Center, Tongji Hospital, School of Medicine, Tongji University, Shanghai, China.

^# Contributed equally.

PMID: 39981430
PMCID: PMC11836767
DOI: 10.21037/aoj-24-48

Review

Expert consensus on vitamin D in osteoporosis

Sha Lei et al. Ann Jt. 2025.

. 2025 Jan 21:10:1.

doi: 10.21037/aoj-24-48. eCollection 2025.

Authors

Affiliations

¹ Department of Endocrinology and Metabolism, Tongji Hospital, School of Medicine, Tongji University, Shanghai, China.
² Institute of Osteoporosis and Metabolic Bone Diseases, Tongji Hospital, School of Medicine, Tongji University, Shanghai, China.
³ Department of Endocrinology and Metabolism, Clinical Medical College & Affiliated Hospital of Chengdu University, Chengdu University, Chengdu, China.
⁴ Department of Endocrinology and Metabolism, Renhe Hospital Affiliated to Shanghai University, Shanghai, China.
⁵ Department of Endocrinology and Metabolism, Xiamen Humanity Hospital Fujian Medical University, Xiamen, China.
⁶ Department of Endocrinology and Metabolism, Zhujiang Hospital, Southern Medical University, Guangzhou, China.
⁷ Endocrine and Diabetes Center, Jiangsu Province Hospital on Integration of Chinese and Western Medicine, Jiangsu Province Academy of Traditional Chinese Medicine, Nanjing University of Traditional Chinese Medicine, Nanjing, China.
⁸ Department of General Practice, Zhongda Hospital, Institute of Diabetes, School of Medicine, Southeast University, Nanjing, China.
⁹ Department of Endocrinology & Diabetes, St Vincent's Hospital Melbourne, Melbourne, Australia.
¹⁰ Department of Medicine, University of Melbourne, Victoria, Australia.
¹¹ Department of Medicine, Monash University, Melbourne, Australia.
¹² Department of Endocrinology, Monash Health, Melbourne, Australia.
¹³ CHU de Québec Research Center, L'Hôtel-Dieu de Québec Hospital, Faculty and Department of Medicine, Université Laval, Quebec, Canada.
¹⁴ Department of Medicine, Nephrology Service Hôpital Maisonneuve-Rosemont, Affiliated to Université de Montréal, Montréal, Canada.
¹⁵ Department of Endocrinology and Nutrition, Hospital del Mar, Passeig Marítim, Barcelona, Spain.
¹⁶ Department of Endocrinology and Nutrition, Consorci Sanitari Alt Penedès-Garraf, Espirall, Vilafranca del Penedès, Spain.
¹⁷ Institut Hospital del Mar d'Investigacions Mèdiques (IMIM), Dr. Aiguader, Barcelona, Spain.
¹⁸ Department of Medicine, Universitat Pompeu Fabra, Plaça de la Mercè, Barcelona, Spain.
¹⁹ Department of Endocrinology & Nutrition, CIBERDEM, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain.
²⁰ Faculty of Science, Isra University, Amman, Jordan.
²¹ Kaiser Permanente of Georgia and the Division of Endocrinology, Emory University School of Medicine, Atlanta, GA, USA.
²² Bone Metabolism Unit, Division of Endocrinology, Creighton University School of Medicine, Omaha, USA.
²³ Department of Rehabilitation, Tongji Hospital, School of Medicine, Tongji University, Shanghai, China.
²⁴ Diabetic Foot Center, Tongji Hospital, School of Medicine, Tongji University, Shanghai, China.

^# Contributed equally.

PMID: 39981430
PMCID: PMC11836767
DOI: 10.21037/aoj-24-48

Abstract

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.

Keywords: Vitamin D deficiency; measurement of vitamin D; osteoporosis; vitamin D deficiency threshold.

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Conflict of interest statement

Conflicts of Interest: All authors have completed the ICMJE uniform disclosure form (available at https://aoj.amegroups.com/article/view/10.21037/aoj-24-48/coif). The authors have no conflicts of interest to declare.

References

1. Kanis JA, Melton LJ, 3rd, Christiansen C, et al. The diagnosis of osteoporosis. J Bone Miner Res 1994;9:1137-41. 10.1002/jbmr.5650090802 - DOI - PubMed
1. Si L, Winzenberg TM, Chen M, et al. Residual lifetime and 10 year absolute risks of osteoporotic fractures in Chinese men and women. Curr Med Res Opin 2015;31:1149-56. 10.1185/03007995.2015.1037729 - DOI - PubMed
1. Rizzoli R, Biver E, Brennan-Speranza TC. Nutritional intake and bone health. Lancet Diabetes Endocrinol 2021;9:606-21. 10.1016/S2213-8587(21)00119-4 - DOI - PubMed
1. Aloia J, Bojadzievski T, Yusupov E, et al. The relative influence of calcium intake and vitamin D status on serum parathyroid hormone and bone turnover biomarkers in a double-blind, placebo-controlled parallel group, longitudinal factorial design. J Clin Endocrinol Metab 2010;95:3216-24. 10.1210/jc.2009-1294 - DOI - PubMed
1. Weaver CM, Alexander DD, Boushey CJ, et al. Calcium plus vitamin D supplementation and risk of fractures: an updated meta-analysis from the National Osteoporosis Foundation. Osteoporos Int 2016;27:367-76. 10.1007/s00198-015-3386-5 - DOI - PMC - PubMed

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Expert consensus on vitamin D in osteoporosis

Affiliations

Expert consensus on vitamin D in osteoporosis

Authors

Affiliations

Abstract

Conflict of interest statement

References

Publication types

LinkOut - more resources

Full Text Sources