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Usefulness of Vitamin D supplements for bone health
I was surprised to read this one study on Vitamin D supplementation. I would expect a recommendation to wear less sunscreen! Of course, the opinion may change in the medical establishment, as it often does. See below:
That daily vitamin D pill doesn't lower risk of bone fractures, study finds
It has seemed like such a good idea for such a long time, but a large new study in NEJM again knocks down vitamin D taken as a supplement or part of a multivitamin, concluding it does not help prevent broken bones. When our bodies make the vitamin from sunlight or eat it in food, yes, it helps keep bones healthy. But daily doses of supplemental vitamin D did not significantly lower total bone fractures, nonvertebral fractures, or hip fractures in a study of 25,871 adults, more than half of whom were women, and one-fifth were Black.
“The key here is that it takes only small to moderate amounts of vitamin D to improve bone health to maintain bone health,” study leader JoAnn Manson of Brigham and Women’s Hospital, who has led multiple vitamin D studies, told STAT’s Elissa Welle. “And more is not necessarily better.”
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From all of the trainings and studies I have seen, too little or too much vitamin D is harmful for bones. The optimal 25(OH)D3 levels for osteoporosis treatments are between 30-50ng/mL (75-125nmol/L). It's really tough to get enough from the sun and almost impossible if you wear sunscreen. The good news is that the D3 supplements are identical to the D3 your body produces. Attached is a summary slide outlining what I have found on vitamin D.
The bottom line is adjust your vitamin D3 intake to get 25(OH)D3 levels between 30-50ng/mL (75-125nmol/L).
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3 ReactionsOn Tymlos I needed 3,000 units while on Tymlos. I read that it "eats D3." Sure enough it stayed the same at 52 for those two years.
Hi
My endocrinologist put me on. Vit D with K my numbers were low. Have osteopenia and osteoporosis in spine with t7 compression fracture.
I made a conscious effort to all winter to go out in the sun 20-30 minutes but exposure was restricted to my face only with no sunscreen (I live in Ottawa, Canada). I supplemented 2000 IUs of Vit D all winter and tested in March at 75 nmol/L (30 ng/mL). I can't see how anyone in a northern climate would get enough Vit D naturally. My understanding is that you can store Vit D so wondering if a trip south would help. Does anyone know how long you can store it for and what amounts?
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1 ReactionThat NEJM study is so important—and also a great reminder that context matters. Like others here, I still take vitamin D—but for more than just bone health. My levels used to be low too, and supplementing helped me reach a stable range.
Here’s what I’ve learned while digging into the research:
Vitamin D is actually more of a hormone than a classic vitamin. Its impact on immune modulation, inflammation, and even mood is just as important as skeletal benefits. And yes, we’re seeing growing evidence that "more" isn't better—but adequate still matters.
I focus more on blood levels than pill counts now. If you’re not getting much sun (like many of us in northern climates), it’s worth talking to your doctor about testing levels and finding a dose that keeps you in that 40–60 ng/mL sweet spot.
Grateful for this discussion—so much nuance and personal context that he
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3 ReactionsIF 30-50ng is the 'sweet spot' then why do labs report the reference number as between 30-100ng? Is there some evidence that a D3 reading above 50ng is harmful in some way, and if so, in what way is it harmful?
Sweet spot doesn't mean higher numbers are bad. I interpret it as "30-50 is sufficient for most people." People with osteoporosis can use higher amounts to help the body absorb calcium, along with taking K2 to help the calcium get to the bones.
I believe vitamin D toxicity is associated with levels 150 and higher. Too much can cause hypercalcimia, which can result in plaque in the arteries.
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2 ReactionsMy vitamin D levels always hovered around the 30-31 mark. But I read that people with osteoporosis should be higher so I increased my daily D dosage. It is now at 58 and my endocrinologist says it's perfect.
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3 ReactionsHi @rjd - Here is a link to the arguments I found for 30-50ng/mL https://youtu.be/xKNdqISXkFY?si=YE-MdSAuEITxGiiU&t=1017 . There is some evidence that levels above 50ng/mL increases your risk of falling and there is also some belief that elevated 25(OH)D could increase osteoclast activity increasing bone resorption. There are vitamin D receptors on the osteoclasts and while primarily they are 1,25(OH)2D receptors, they can react to 25(OH)D levels to some extent.
rjd, njx58 has the answer. The National Institute of Clinical Health likes 30-50, but the Endocrine Society likes70 to 100. I have osteoporosis so I keep mine at 70. With endocrine disorders you'd want to maintain higher levels because it reduces the inflammation caused by autoimmune and such.
When I started Forteo, my levels dropped, so I increased intake.
Vitamin D has a half life of 12 to 13 days. An d can be stored at half levels for 2 to 3 months. If you are lucky enough to have extra fat, your body is able to store vitamin D longer.
I really like your question. We have to think our way through everything.
Sauce for the goose isn't sauce for the gander.
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