Conflicting reports on vitamin D supplementation: Evidence from randomized controlled trials

A significant number of children and adolescents worldwide have low serum 25(OH)D values relative to the 2010 Institute of Medicine criteria. Since approximately 90% of adult bone mineral content (BMC) is accrued by the end of adolescence, and approximately 40% of adult BMC accumulated during the 4 years surrounding peak BMC velocity, low circulating 25(OH)D during this time may attenuate gains in adolescent bone strength. Reduced bone mineralization and strength during pubertal growth tracks into adulthood and could lead to an increased risk of skeletal fractures. Observational studies examining the relationships between vitamin D and bone are conflicting and few randomized controlled trials (RCTs) have been conducted in children and adolescents. Four of these RCTs, however, provide moderate support for the role of vitamin D supplementation on BMC accrual in adolescent females with baseline serum concentrations <50 nmol/L. Though the daily vitamin D doses employed in these trials ranged from 200 to 3000 IU per day, it is not clear if a dose-response effect exists. Specific maturational stages were associated with optimal bone responses in each of these trials, but they were not consistent across studies. Furthermore, data on male children and among ethnicities other than white and Asian youth were limited in these studies and therefore reduce the generalizability of the findings. Finally, the evidence linking vitamin D supplementation to improved muscle gains and function, important variables to consider in bone health investigations during growth, might imply indirect effects of supplementation on bone. In conclusion, future RCTs are warranted that address the mechanisms by which vitamin D improves bone mineralization in adolescents, including trials that address the impact of vitamin D on muscle function.