Abstract
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.
Keywords
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Article info
Publication history
Published online: November 18, 2019
Footnotes
The authors declare no conflicts of interest.
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© 2019 AMDA - The Society for Post-Acute and Long-Term Care Medicine.
