To the Editor: Our scepticism about the value of many of the burgeoning number of clinical guidelines is reinforced by the position statement on vitamin D and health for adults.1 It was surprising not to find an explicit statement that there is Level I evidence that vitamin D monotherapy does not prevent falls2 or fractures3 or reduce mortality.4 Instead, Nowson and colleagues conclude that “there is good evidence that vitamin D plus calcium supplementation effectively reduces fractures and falls in older men and women”. This statement is misleading. Vitamin D (± calcium) does not prevent falls in men.5 Co-administered calcium and vitamin D only prevents fractures in frail institutionalised older women, not in healthy community-dwelling older men or women.3
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- 1. Nowson CA, McGrath JJ, Ebeling PR, et al. Vitamin D and health in adults in Australia and New Zealand: a position statement. Med J Aust 2012; 196: 686-687. <MJA full text>
- 2. Murad MH, Elamin KB, Abu Elnour NO, et al. The effect of vitamin D on falls: a systematic review and meta-analysis. J Clin Endocrinol Metab 2011; 96: 2997-3006.
- 3. Avenell A, Gillespie WJ, Gillespie LD, O’Connell D. Vitamin D and vitamin D analogues for preventing fractures associated with involutional and post-menopausal osteoporosis. Cochrane Database Syst Rev 2009; (2): CD000227.
- 4. Elamin MB, Abu Elnour NO, Elamin KB, et al. Vitamin D and cardiovascular outcomes: a systematic review and meta-analysis. J Clin Endocrinol Metab 2011; 96: 1931-1942.
- 5. Bischoff-Ferrari HA, Dawson-Hughes B, Staehelin HB, et al. Fall prevention with supplemental and active forms of vitamin D: a meta-analysis of randomised controlled trials. BMJ 2009; 339: b3692.
- 6. US Preventive Services Task Force. Vitamin D and calcium supplementation to prevent cancer and osteoporotic fractures in adults: draft recommendation statement. AHRQ Publication No. 12-05163-EF-2. Rockville, Md: USPSTF, 2012. http://www.uspreventiveservicestaskforce.org/uspstf12/vitamind/draftrecvitd.htm (accessed Nov 2012).
- 7. Ministry of Health and Cancer Society of New Zealand. Consensus statement on Vitamin D and sun exposure in New Zealand. Wellington: Ministry of Health, 2012: 10. http://www.health.govt. nz/publication/consensus-statement-vitamin-d-and-sun-exposure-new-zealand (accessed Nov 2012).
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