title: Vitamin D: A Narrative Review Examining the Evidence for Ten Beliefs.
abstract: Over the past decade, a large body of observational evidence has suggested an association between lower vitamin D status (25-hydroxyvitamin D) and multiple acute and chronic disorders, including cancer, multiple sclerosis, depression and respiratory tract infections. This evidence has fostered the hypothesis that increasing vitamin D intake may treat and prevent such disorders. Our objective was to perform a critical analysis of the highest-level evidence for ten common beliefs regarding vitamin D for the prevention of falls, fractures and respiratory tract infections, the reduction of cancer incidence/mortality and overall mortality, and the prevention or treatment of depression/mental well-being, rheumatoid arthritis and multiple sclerosis, as well as maximum dosing and regular testing. We searched the Cochrane Database of Systematic Reviews and PubMed (up to August 2014) for randomized controlled trials and systematic reviews/meta-analyses based on those studies. All searches were performed, all evidence reviewed and each section written by at least two authors. The evidence shows that vitamin D supplementation provides some benefit in fracture prevention (likely ∼10-15 % relative reduction), particularly at a dose ≥800 IU and with calcium; a likely benefit in the rate of falls, though it is less clear whether the number of fallers changes; and a possible small (∼5 %) relative reduction in mortality. Evidence does not support the use of vitamin D supplementation for the prevention of cancer, respiratory infections or rheumatoid arthritis. Similarly, evidence does not support vitamin D supplementation for the treatment of multiple sclerosis and rheumatoid arthritis or for improving depression/mental well-being. Regular testing of 25-hydroxyvitamin D is generally not required, and mega-doses (≥300,000 IU) appear to increase harms. Much of the evidence is at high risk of bias, with multiple flaws, including analyses of secondary endpoints, small and underpowered studies, inconsistent results and numerous other issues. Therefore, enthusiasm for a vitamin D panacea should be tempered.
authors.affiliation: Evidence-Based Medicine, Department of Family Medicine - Research Program, University of Alberta, 6-10 University Terrace, Edmonton, AB, T6G 2T4, Canada. michael.allan@ualberta.ca.
authors.forename: G Michael
authors.initials: GM
authors.lastname: Allan
authors.affiliation: The Foundation for Medical Practice Education, Hamilton, ON, Canada.
authors.forename: Lynda
authors.initials: L
authors.lastname: Cranston
authors.affiliation: Evidence-Based Medicine, Department of Family Medicine - Research Program, University of Alberta, 6-10 University Terrace, Edmonton, AB, T6G 2T4, Canada.
authors.forename: Adrienne
authors.initials: A
authors.lastname: Lindblad
authors.affiliation: Faculty of Pharmaceutical Sciences, University of British Columbia, Vancouver, BC, Canada.
authors.forename: James
authors.initials: J
authors.lastname: McCormack
authors.affiliation: Evidence-Based Medicine, Department of Family Medicine - Research Program, University of Alberta, 6-10 University Terrace, Edmonton, AB, T6G 2T4, Canada.
authors.forename: Michael R
authors.initials: MR
authors.lastname: Kolber
authors.affiliation: Evidence-Based Medicine, Department of Family Medicine - Research Program, University of Alberta, 6-10 University Terrace, Edmonton, AB, T6G 2T4, Canada.
authors.forename: Scott
authors.initials: S
authors.lastname: Garrison
authors.affiliation: Evidence-Based Medicine, Department of Family Medicine - Research Program, University of Alberta, 6-10 University Terrace, Edmonton, AB, T6G 2T4, Canada.
authors.forename: Christina
authors.initials: C
authors.lastname: Korownyk
mesh_terms: D000058:Accidental Falls / Q000517:prevention & control*; D019587:Dietary Supplements; D004305:Dose-Response Relationship, Drug; D050723:Fractures, Bone / Q000517:prevention & control; D006801:Humans; D015201:Meta-Analysis as Topic; D009026:Mortality; D064887:Observational Studies as Topic; D011446:Prospective Studies; D016032:Randomized Controlled Trials as Topic; D014807:Vitamin D / Q000008:administration & dosage* / Q000031:analogs & derivatives / Q000097:blood; D014815:Vitamins / Q000008:administration & dosage*
chemical_list: D014815:Vitamins; D014807:Vitamin D; C104450:25-hydroxyvitamin D
keywords: depression; falls; fracture; mortality; upper respiratory tract infection; vitamin D