Osteoporosis prevention and treatment: The importance of vitamin D

• Even in Australia vitamin D deficiency is common, but it is under-recognised. • Evidence is accumulating that vitamin D supplementation reduces falls and fragility fractures, particularly in groups at risk vitamin D deficiency. The number-needed-to-treat to prevent falls in the elderly is small (n=15). • Assays for 25-hydroxyvitamin D often do not measure vitamin D₂ (ergocalciferol) as well as vitamin D₃ (cholecalciferol). This makes assessing treatment responses to vitamin D₂ supplements difficult. • Vitamin D deficiency should be corrected prior to treatment with intravenous bisphosphonates to avoid hypocalcemia. Low vitamin D levels should also be corrected in patients on oral bisphosphonates. • Calcium supplements will need to be given with vitamin D supplements if patients' dietary calcium intakes are suboptimal. • More studies regarding the role of vitamin D supplementation in the primary prevention of fragility fractures in the elderly are required.