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Effect of supplemental vitamin D3 on bone mineral density: a systematic review and meta-analysis.

  • 2022-10-29
  • Nutrition reviews 81(5)
    • Elham Kazemian
    • Ali Pourali
    • Fatemeh Sedaghat
    • Mehrdad Karimi
    • Vahid Basirat
    • Zohreh Sajadi Hezaveh
    • Sayed Hossein Davoodi
    • Michael F Holick

Study Design

Type
Meta-Analysis
Methods
Systematic review and meta-analysis; searched PubMed, Scopus, Cochrane, Web of Science, and AGRIS databases through April 30, 2022; 39 of 6409 records included; random-effects model used for meta-analysis; one-stage random-effects dose-response model used

Context

There is still controversy over the effect of vitamin D3 supplementation on bone health.

Objective

The effects of vitamin D3 supplementation on bone mineral density (BMD) and markers of bone turnover, as well as the dose-response relationship between vitamin D3 and bone health in adults, were evaluated.

Data sources

The PubMed, Scopus, Cochrane, Web of Science, and AGRIS databases were searched for articles published through April 30, 2022. Thirty-nine of the 6409 records identified met the inclusion criteria.

Data extraction

Data were extracted from articles by 2 authors, and data extraction was cross-checked independently. A random-effects model was used to estimate the pooled effect size and the associated 95%CI for the effect of vitamin D3 for each outcome. A one-stage random-effects dose-response model was used to estimate the dose-response relationship between vitamin D3 supplementation and BMD.

Data analysis

Results of meta-analysis showed a beneficial effect of vitamin D3 at the lumbar spine (standardized mean difference [SMD] = 0.06; 95%CI, 0.01-0.12) and femoral neck (SMD = 0.25; 95%CI, 0.09-0.41). Dose-response analysis revealed a linear relationship between vitamin D3 supplementation doses and BMD at the femoral neck, lumbar spine, and total hip sites. No significant effect of vitamin D3 supplementation on whole-body or total hip BMD was observed (P > 0.05). Vitamin D3 supplementation significantly decreased BMD at both proximal and distal forearm (SMD = -0.16; 95%CI, -0.26 to -0.06). The variables of ethnicity, age, baseline 25-hydroxyvitamin D (25[OH]D), menopause status, vitamin D3 dosing frequency, and bone health status (P interaction = 0.02) altered the effect of vitamin D3 supplementation on BMD. Additionally, a nonlinear relationship between vitamin D3 supplement doses and markers of bone turnover was found.

Conclusion

A protective effect of vitamin D3 supplementation on BMD of the lumbar spine, femoral neck, and total hip is implicated.

Systematic review registration

PROSPERO registration number CRD42017054132.

Research Insights

  • Vitamin D→Improved Bone Mineral Density

    No significant effect of vitamin D3 supplementation on whole-body or total hip BMD was observed (P > 0.05)

    Effect
    Neutral
    Effect size
    Small
  • Vitamin D→Reduced Bone Mineral Density

    Vitamin D3 supplementation significantly decreased BMD at both proximal and distal forearm (SMD = -0.16; 95%CI, -0.26 to -0.06)

    Effect
    Harmful
    Effect size
    Small
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