International Journal of Molecular Medical Science, 2025, Vol.15, No.4, 185-194 http://medscipublisher.com/index.php/ijmms 191 per day) may lead to hypercalcemia and other adverse conditions, so overintake should be avoided (Amrein et al., 2020; Feige et al., 2020). 6.3 Reference value for public health intervention and decision-making From a public health perspective, the research results support targeted intervention measures rather than supplementing vitamin D for everyone. Measures such as food fortification and supplement promotion programs should focus on people at risk of deficiency, including the elderly living in care facilities, those with little sun exposure, and those with poor absorption or chronic diseases (Amrein et al., 2020; Bouillon et al., 2021; Demay et al., 2024). The policy recommendation emphasizes that it is important to prevent severe vitamin D deficiency, which can reduce the burden of fractures and related diseases in the elderly. Among high-risk populations, systematic food fortification and vitamin D supplementation is a cost-effective and feasible approach. However, current evidence does not support routine vitamin D supplementation for those with adequate vitamin D levels (Bouillon et al., 2021). Further research and well-designed trials are still needed to determine the optimal dose and identify other population subgroups that may benefit from the intervention measures (Amrein et al., 2020; Rebelos et al., 2023; Demay et al., 2024). 7 Concluding Remarks This meta-analysis demonstrates that merely supplementing vitamin D does not significantly reduce the risk of fractures in ordinary elderly people, especially those with adequate vitamin D levels in their bodies. There is evidence suggesting that targeted supplementation for those who have been confirmed to be deficient in vitamin D or at high risk of fractures is more likely to bring benefits in terms of bone health and fracture prevention. At present, high-quality evidence does not support universal vitamin D supplementation for the elderly population that has not been screened. When supplementing vitamin D reasonably, three types of elderly people should be given special attention: the first type has relatively low serum 25 (OH) D levels from the very beginning; The second type is those who live in institutions; The third type is those who get little sun exposure. Because these people are most likely to benefit from supplementation. The goal of supplementing vitamin D should be to maintain the serum 25 (OH) D concentration above 50 nanomoles per liter. For those who lack vitamin D or have a high risk of fractures, it is recommended to supplement both vitamin D and calcium simultaneously. For the elderly living in the community, it is unnecessary to supplement vitamin D regularly. Future research should address the main shortcomings of past trials. Specifically, this can be achieved by recruiting participants with low vitamin D levels at the beginning, using a uniform dosing regimen, and ensuring a sufficient sample size and a long enough follow-up period. The research should group participants based on their initial vitamin D levels and responses to supplementation, and also consider personalized supplementation plans to identify the subgroups of the population that are likely to gain the greatest benefits. In addition, future trials should incorporate comprehensive outcome measurement indicators-including both bone-related and extra-bone detection endpoints - and, through mechanism research and genetic research methods, clarify the role of vitamin D in preventing fractures and maintaining overall health. Acknowledgments The authors extend their sincere thanks to MedSci Publisher for their feedback on the initial draft of this study. Conflict of Interest Disclosure The authors affirm that this research was conducted without any commercial or financial relationships that could be construed as a potential conflict of interest. Reference Amrein K., Scherkl M., Hoffmann M., Neuwersch-Sommeregger S., Köstenberger M., Berisha A., Martucci G., Pilz S., and Malle O., 2020, Vitamin D deficiency 2.0: an update on the current status worldwide, European Journal of Clinical Nutrition, 74: 1498-1513. https://doi.org/10.1038/s41430-020-0558-y
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