International Journal of Molecular Medical Science, 2025, Vol.15, No.4, 185-194 http://medscipublisher.com/index.php/ijmms 190 statements and comprehensive analyses have shown that supplementing vitamin D alone is not sufficient to reduce the number of fractures in the elderly. However, when vitamin D is supplemented together with calcium, the risk of fractures is significantly reduced, especially among those living in nursing homes or with a high risk of fractures. This situation of better effect when supplemented together is because calcium plays a role in bone mineral formation and preventing parathyroid dysfunction. When calcium is supplemented together with sufficient vitamin D, it can make bones healthier and reduce the occurrence of falls and fractures (Giustina et al., 2022). Figure 2 Skeletal effects of vitamin Ddeficiency in the elderly and role of vitamin D in preventing them (Adopted from Giustina et al., 2022) The impact of this calcium supplementation indicates that in clinical practice, the strategy of simultaneously supplementing vitamin D and calcium is very important. The guideline suggests that elderly people at risk of fractures, especially those with low calcium intake in their daily diet or living in care institutions, should take both vitamin D and calcium simultaneously to achieve the best fracture prevention effect (Giustina et al., 2022). 6 Clinical and Public Health Implications of the Findings 6.1 Scientific basis for fracture prevention strategies in the elderly Current evidence shows that for elderly people who are generally healthy and have sufficient vitamin D in their bodies, merely supplementing vitamin D does not significantly reduce the risk of fractures. Neither large-scale randomized controlled trials nor comprehensive analyses have found significant benefits for this group of people in preventing fractures. This indicates that it is not scientifically reasonable to supplement vitamin D to many people in the absence of vitamin D deficiency. However, it is widely believed that correcting severe vitamin D deficiency (serum 25 (OH) D<30 nanomoles per liter) is necessary, as vitamin D deficiency increases the risk of fractures, bone loss and other health problems (Amrein et al., 2020; Bouillon et al., 2021). For elderly people at high risk of fractures, such as those who are cared for in institutions, get little sun exposure, or are already known to be deficient in vitamin D, supplementing vitamin D (especially when taken together with calcium) remains a scientifically based method for preventing fractures and maintaining bone health (Amrein et al., 2020). The guideline suggests supplementing vitamin D for these high-risk groups rather than for all elderly people (Bouillon et al., 2021; Demay et al., 2024). 6.2 Feasibility and safety of vitamin D supplementation in clinical practice Vitamin D supplements are generally regarded as safe, inexpensive and easy to use. When taken at the recommended dosage, they have a wide safety range and rarely cause side effects (Amrein et al., 2020). Clinical guidelines recommend giving priority to a daily dose regimen, as taking a large dose of supplements occasionally (such as one large pill) does not show more benefits and may even increase the risk in certain populations (Grant et al., 2020; Demay et al., 2024). It is not recommended to conduct routine vitamin D tests for the general public. On the contrary, supplements should be given priority to those with clear risk factors or clinical needs (Demay et al., 2024). At standard doses, the risk of toxic reactions is very low. However, excessive intake (such as consuming 1 million international units
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