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Osteoporosis and vitamin D: Is there a relationship?

Posted on: October 16, 2013   by  John Cannell, MD


The press is full of Professor Ian Reid’s meta-analysis showing vitamin D does not help osteoporosis. Some of the press has been reporting that there is no benefit of vitamin D at all, instead of reporting there is no benefit on osteoporosis.

The basis of Dr Reid’s meta-analysis is that in research to date, vitamin D hasn’t had an appreciable effect on bone mineral density. I think while vitamin D might have a beneficial effect on bone mineral density (not major however), this will always be hard to study and any positive trials will be drowned out by trials not executed perfectly.

When managing osteoporosis, we also need to think about falls and fractures prevention, something not covered in Dr Reid’s meta-analysis. It is also something the press lacks perspective to be able to cover. The United States Preventative Services Task Force recommended vitamin D to prevent falls in May of 2012. Since falls lead to fractures in 5% of cases, vitamin D is important for the prevention of fractures and thus important in osteoporosis. Two meta-analyses to date have found vitamin D prevents fractures.

In terms of bone health, I think the co-nutrient status is particularly important. If one generates a list of what nutrients bone needs and a list of what nutrients American are often deficient in and see where the two lists significantly overlap, one comes up with potential deficiencies in magnesium, boron, silica, zinc and vitamin K2. Furthermore, this does not include the bone degrading chronic low-grade metabolic acidosis due in part to potassium deficiency that is so common in today’s society. Bone needs much more than vitamin D.

Editor’s note: This article was edited on 10/18/13 to remove comment from Dr Robert Heaney. It needed to be removed due to copyright rules.

7 Responses to Osteoporosis and vitamin D: Is there a relationship?

  1. [email protected]

    The problem with the meta-analysis is very basic.
    Many previous studies have found that at least 2,000 IU of Vitamin D3 and some Calcium is needed
    This meta-analysis included many studies which:
    Used 1,000 IU of D3 with Calcium more often than once per month.
    Details, a copy of the study, and list of 46 outrageous titles in the press are at

    By the way, even with all of the above limitations, the meta-analysis identified 6 studies which
    found bone mineral density to increase with Vitamin D. This fast was never mentioned in any of the 46 press items.

  2. Rita and Misty

    It is complicated.

    Studies indicate that insufficient sleep can negatively impact bone health.
    Studies indicate that vitamin D benefits sleep.

    Studies indicate that resistance exercise benefits bone health.
    Studies indicate that vitamin D benefits muscle strength, which in turn helps with resistance exercise…and therefore….???

    There are few simple answers in life.

    Every solution comes with its own unique set of problems.


  3. Ian

    This is so fascinating. Why would a professor of endocrinology and head of a “bone density unit” publish such a study which is clearly deficient in so many basic controls and variables?
    I could understand it if an undergraduate student conducted the study but that would not then be published.

    A second fascination is that the Lancet published this. Why?
    This study forms a great exercise for any science or medical undergraduate needing to enhance their critical knowledge of scientific analysis and experimentation.

  4. Brant Cebulla

    Just a follow up note to Dr Cannell’s piece — it’s really hard to pull off a good BMD study for a nutrient. More important than dose is making sure your study population is not getting very much of that nutrient to start the study.

    In terms of vitamin D, studies show that it’s probably more important to study the effects of vitamin D supplementation on a deficient population than give them a large dose of vitamin D.

    There have been successful RCTs using only 1,000 IU/day that started participants at 13 ng/ml: http://www.ncbi.nlm.nih.gov/pubmed/23585346

    And there have been unsuccessful RCTs that have used much higher doses, like 6,500 IU/day but baseline vitamin D status was already high around 30 ng/ml: http://www.ncbi.nlm.nih.gov/pubmed/21909730

    It seems like you only need a level of 30-35 ng/ml for optimal bone density. If your population starts in this range or close to, you’ve already set your trial up for failure.

    The reason the study was published in the Lancet is because for meta-analyses, you are introducing your own biases when you start to examine them individually and say, “I like how they setup this study, I’m going to include it, but I don’t like how this was setup, I’m not going to include it.” So this study is a classic meta-analysis, designed how an information scientist would design it.

    Unfortunately, given the large room for failure in BMD-vitamin-D RCTs, a meta-analysis will never do vitamin D justice.

    Lastly, I’d like to stress that this meta–analysis only looked at BMD. It did not setup another analysis for fracture prevention, which is the big thing in osteoporosis.

  5. Ron Carmichael

    Brant’s observations are most legitimate. The situation is a good example of an ongoing chronic deficiency in the fundamental knowledge of the researchers regarding what is mother-nature-compatible. Correcting FROM a Vitamin D deficiency to an MN-normalcy will yield the most useful data yet routinely researchers register a FAIL on this point.
    “Failure to correct” yields worse-than-useless data, as the media has demonstrated over and over again by seizing upon the wrong aspect and mis-informing the civilian population around the world by trumpeting mal-conclusions of mercury-vaccine proportions.
    When the study is fundamentally retarded by the ignorance of the person(s) designing the protocol of a study, GIGO becomes a relevant acronym. (Garbage In, Garbage Out)…
    What I cannot fathom is how year after year, so many researchers around the world fail to first educate themselves on the wisdom of Cannell, Veith, et al, BEFORE they waste millions of dollars in lost opportunity to improve the health of well, millions of people…It is a good thing I am an optimist

  6. Rita and Misty

    Being the frugal girl that I am, I wonder if here in the United States there is a way for Suzy Q Taxpayer to gather other like-minded and frustrated citizens, who are tired of seeing their tax dollars wasted, and complain about the millions of dollars in lost opportunity to improve the health of the public.

    I’m always grateful to the vitamin D docs and scientists whose research has truly impacted my life for the better. I don’t have their scientific skill, but other talents are also needed to see that vitamin D, the Essential Nutrient, receives it’s due justice….

  7. [email protected]

    Yes there is much more to good health than taking one supplement. Mg is needed with D. Many minerals are needed for bones. I’m always amazed at the ads for calcium for bones, as if that’s all bones are made of. As for this study, I’m not surprised at this pseudoscience- most of it is. The AIDS virus is another fraud where amazingly there is no study confirming that HIV causes AIDS but the study references go in circles, none ever referencing this core study. And the most prominent researcher in the field dodged the question and walked away. See Inventing the AIDS Virus. Incredible story by highly reputable authors. Given that optimal Vit D levels would save (or cost the sick care industry) billions, no wonder there is a propaganda campaign to discredit it. And I just heard about the latest antibiotic resistant bacteria, a sad story of a young athletic woman needing a LUNG TRANSPLANT to get rid of the bacteria! Reminded me of “Vitamin D- the Antibiotic Vitamin” in Science News SEVERAL years ago. Sad.

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