HFHT's Practising Wisely Newsletter
For the whole healthcare team.
Hey, Reader! Tune in to the Using Antibiotics Wisely Webinar on Nov 1!
Before we get to today's article on Vitamin D, we wanted to let you know that Choosing Wisely will be hosting a webinar on Thursday, November 1 at noon to learn about some NEW materials that you can use in your practice to help spread the word to patients about using antibiotics properly. Full details about the webinar are available on the Choosing Wisely website.
Issue 62: Drop the D?
October 30, 2018
Should we drop the D? Not completely, but studies continue to question effectiveness of vitamin D when it comes to everything from fighting the flu, to reducing the risk of multiple sclerosis or diabetes.

Issue 50 of HFHT’s Practising Wisely, from Feb 20, 2018 advised that the use of supplements that included calcium, vitamin D, or both compared with placebo or no treatment was not associated with a lower risk of fractures among community-dwelling older adults. You can view this back issue in our Quick Links section.

A more recent systematic review published Oct. 4, 2018 in The Lancer Diabetes & Endocrinology, looked at the Effects of vitamin D supplementation on musculoskeletal health and aimed to determine the effect of vitamin D supplementation on fractures, falls, and bone density. You can view this article by visiting the Quick Links section of our newsletter.

The findings suggest that vitamin D supplementation does not prevent fractures or falls or have clinically meaningful effects on bone mineral density. There were no differences between the effects of higher and lower doses of vitamin D. There is little justification to use vitamin D supplements to maintain or improve musculoskeletal health.

The lead author, Dr. Mark Boland, from the University of Auckland in New Zealand states: "Since the last major review of evidence in 2014, more than 30 randomized, controlled trials on vitamin D and bone health have been published, nearly doubling the evidence available. On the strength of existing evidence, we believe there is little justification for more trials of vitamin D supplements looking at musculoskeletal outcomes.”

So it would appear that healthy people with healthy levels of vitamin D are unlikely to see any benefits.

But what is vitamin D, and why is it important?

Vitamin D is essential for bone health and it is an important tool in the prevention of rickets and osteomalacia in high-risk groups.

It is found in a few foods naturally such as fatty fish, liver, cheese, egg yolks and to a great extent fortified food, for example milk and cereals and when ultraviolet rays from sunlight strike the skin and trigger vitamin D synthesis.
For groups at risk for Vitamin D deficiency, such as breastfed infants, older adults and people with limited sun exposure, dietary supplements might be required to meet the daily need for vitamin D.

However a report cited in the NIH fact sheet concludes that it is still not possible to specify a relationship between vitamin D and health outcomes other than bone health. You can also find a link to this fact sheet in our Quick Links section.

So it would appear that healthy people with healthy levels of vitamin D are unlikely to see any benefits.

For those worried about bone health, an exercise program, builds strength, decreases the likelihood of falling as well as the rate at which bone is broken down.
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