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Comment & Response
January 7, 2020

High-Dose Vitamin D Supplementation and Bone Health

Author Affiliations
  • 1Section of Clinical Biochemistry, University of Verona, Verona, Italy
  • 2Section of Endocrinology, Diabetes, and Metabolism, University of Verona, Verona, Italy
JAMA. 2020;323(1):92. doi:10.1001/jama.2019.18138

To the Editor Dr Burt and colleagues concluded that treatment of healthy adults with high-dose vitamin D supplementation for 3 years did not have any beneficial effects on volumetric bone mineral density (BMD) and bone strength.1 Although these results appear similar to findings that disputed the effectiveness of vitamin D supplementation in the general population,2 we emphasize that these results should not be generalized. The baseline mean serum 25-hydroxyvitamin D (25[OH]D) concentrations in the 3 groups randomized to different doses of supplementation ranged from 76.7 to 81.3 nmol/L, considerably higher than currently accepted thresholds for diagnosing vitamin D deficiency (≤50 nmol/L) and insufficiency (≤75 nmol/L).3 Although participants with serum 25(OH)D concentrations less than 30 nmol/L were excluded from the study, it cannot be concluded that those with serum 25(OH)D values between 30 and 75 nmol/L would have responded more favorably to high-dose vitamin D supplementation in terms of volumetric BMD and bone strength. We believe that a further subanalysis of these patients might be advisable.