Role of vitamin D supplementation in the management of musculoskeletal diseases: update from an European Society of Clinical and Economical Aspects of Osteoporosis, Osteoarthritis and Musculoskeletal Diseases (ESCEO) working group

Aging Clin Exp Res. 2022 Nov;34(11):2603-2623. doi: 10.1007/s40520-022-02279-6. Epub 2022 Oct 26.


Vitamin D is a key component for optimal growth and for calcium-phosphate homeostasis. Skin photosynthesis is the main source of vitamin D. Limited sun exposure and insufficient dietary vitamin D supply justify vitamin D supplementation in certain age groups. In older adults, recommended doses for vitamin D supplementation vary between 200 and 2000 IU/day, to achieve a goal of circulating 25-hydroxyvitamin D (calcifediol) of at least 50 nmol/L. The target level depends on the population being supplemented, the assessed system, and the outcome. Several recent large randomized trials with oral vitamin D regimens varying between 2000 and 100,000 IU/month and mostly conducted in vitamin D-replete and healthy individuals have failed to detect any efficacy of these approaches for the prevention of fracture and falls. Considering the well-recognized major musculoskeletal disorders associated with severe vitamin D deficiency and taking into account a possible biphasic effects of vitamin D on fracture and fall risks, an European Society for Clinical and Economic Aspects of Osteoporosis, Osteoarthritis and Musculoskeletal Diseases (ESCEO) working group convened, carefully reviewed, and analyzed the meta-analyses of randomized controlled trials on the effects of vitamin D on fracture risk, falls or osteoarthritis, and came to the conclusion that 1000 IU daily should be recommended in patients at increased risk of vitamin D deficiency. The group also addressed the identification of patients possibly benefitting from a vitamin D loading dose to achieve early 25-hydroxyvitamin D therapeutic level or from calcifediol administration.

Keywords: Falls; Fragility fracture; Osteoarthritis; Vitamin D.

Publication types

  • Review

MeSH terms

  • Aged
  • Bone Density Conservation Agents* / therapeutic use
  • Calcifediol
  • Dietary Supplements / adverse effects
  • Fractures, Bone* / prevention & control
  • Humans
  • Osteoarthritis* / drug therapy
  • Osteoporosis* / drug therapy
  • Vitamin D
  • Vitamin D Deficiency* / epidemiology
  • Vitamins / therapeutic use


  • Calcifediol
  • Vitamin D
  • Vitamins
  • Bone Density Conservation Agents