Vitamin D Supplementation for Extraskeletal Indications in Older Persons

Low levels of vitamin D have been implicated in a wide variety of conditions highly prevalent in the geriatric population, including fractures, functional limitations, cancer, cardiovascular disease, and depression. Vitamin D supplementation is often considered integral to the prevention of falls and fractures in the setting of osteoporosis. For other conditions, however, consensus is lacking, and the clinician may struggle to balance competing recommendations around screening, supplementation, and monitoring. This review seeks to provide an overview of the available evidence on the use of vitamin D supplementation to ameliorate sarcopenia, enhance cognition, treat depression, prevent cancer, and reduce mortality-outcomes that are common concerns in the geriatric population for which the merits of treatment are not always certain. Evidence suggests vitamin D supplementation may decrease mortality. Therefore, it may be reasonable to prescribe routine supplementation with oral cholecalciferol 800 to 1000 IU daily to all patients aged ≥65 years who do not have a contraindication. No screening or monitoring would be recommended for this population. We additionally recommend the use of oral cholecalciferol over ergocalciferol for any routine supplementation as this benefit was only observed with cholecalciferol. For patients with depression or cognitive disorders, we recommend screening for vitamin D deficiency, treating with oral cholecalciferol if present, and monitoring periodically to target a level of >30 ng/mL as an adjunct to usual care. The level of evidence certainly would not justify the use of vitamin D in place of more evidence-based therapies, but given the burden of these conditions in the geriatric population, we believe the potential benefit justifies the minimal risk.