---
title: Meta-analysis Investigates Efficacy of Vitamin D Supplementation on Bone Health
description: A meta-analysis of 42 trials found vitamin D lowered bone turnover markers, with the largest gains in older adults and those with liver or kidney disease.
---

[Evidence-based Wellness Education](https://www.casi.org/articles)

# [Meta-analysis Investigates Efficacy of Vitamin D Supplementation on Bone Health](https://www.casi.org/articles/efficacy-vitamin-d-supplementation-on-bone-health)

 Written by [Cory Ambrose, ND, MAT](https://www.casi.org/articles/author/cory-ambrose-nd-mat) | Oct 27, 2023, 4:00:00 AM

Changes to [bone integrity](https://www.dynamed.com/condition/osteoporosis-causes-and-risk-factors) may occur throughout adulthood as a result of some modifiable and nonmodifiable risk factors; these include aging, certain concurrent illnesses, and genetics. [Lifestyle factors](https://www.dynamed.com/condition/osteoporosis-causes-and-risk-factors) such as physical activity and nutritional intake are thought to play a critical role in bone health, influencing as much as 20% to 40% (as measured in mean variance of adult peak bone mass). Vitamin D status is one of the key lifestyle factors that may help maintain bone health and integrity. 

A recently published systematic review and meta-analysis by [Sohouli and colleagues](https://pubmed.ncbi.nlm.nih.gov/37314058/) explored the efficacy of vitamin D supplementation on bone health. A total of 42 randomized controlled trials (RCTs) were included in this study. Bone turnover markers were evaluated in these RCTs, with study durations ranging from 4 to 144 weeks. Upon [subgroup analysis](https://pubmed.ncbi.nlm.nih.gov/37314058/), the authors report notable reductions in alkaline phosphatase (ALP) levels in studies that lasted longer than 12 weeks. ALP is a nonspecific marker used to assess [bone turnover](https://pubmed.ncbi.nlm.nih.gov/37314058/). Reductions in ALP levels were greater in individuals with kidney or liver diseases. The liver and kidneys are involved in critical steps in vitamin D metabolism and lowered vitamin D status is common in these populations. 

The bone turnover marker procollagen type 1 N-terminal propeptide (P1NP) has been recommended as a reference marker for [fracture risk evaluation](https://pubmed.ncbi.nlm.nih.gov/37314058/) by the International Osteoporosis Foundation. In their meta-analysis, [Sohouli and colleagues](https://pubmed.ncbi.nlm.nih.gov/37314058/) reported that the greatest improvements in serum P1NP levels occurred in individuals over the age of 50. As we age, our ability to metabolize [vitamin D](https://pubmed.ncbi.nlm.nih.gov/32554862/) efficiently decreases. When compared to younger adults, elderly individuals have been shown to experience 50% reductions in the skin’s ability to convert vitamin D to its [bioactive form](https://pubmed.ncbi.nlm.nih.gov/32554862/).

Other [bone turnover markers](https://pubmed.ncbi.nlm.nih.gov/37314058/) such as cross-linked C-telopeptide (CTX) and osteocalcin were not reported to change significantly upon meta-analysis. Osteocalcin is a relatively unstable molecule with a short half-life and may generally be difficult to assess. In addition, other factors including [vitamin K status](https://pubmed.ncbi.nlm.nih.gov/37314058/) and kidney function may also influence osteocalcin levels. 

A drawback to this study is the inclusion of RCTs involving both vitamin D2 and D3 as interventions. [Vitamin D3](https://ods.od.nih.gov/factsheets/VitaminD-HealthProfessional/), also known as cholecalciferol, is the most active form of supplemental vitamin D. Evidence suggests that supplementation with vitamin D3 can be more effective at [raising and maintaining vitamin D levels](https://ods.od.nih.gov/factsheets/VitaminD-HealthProfessional/) in the body than vitamin D2.

Vitamin D can be obtained from sun exposure, supplementation, and [dietary sources](https://ods.od.nih.gov/factsheets/VitaminD-HealthProfessional/) such as fatty fish including salmon, beef liver, egg yolks, mushrooms, and fortified foods.

[View full post](https://www.casi.org/articles/efficacy-vitamin-d-supplementation-on-bone-health)

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