Vitamin D in skeletal health: Facts, myths and clinical pearls

Abstract

Vitamin D is very important for maintaining calcium homeostasis and for bone remodeling. However, random use of vitamin D analysis and vitamin D supplements is causing confusion about the clinically significant threshold, optimal dosage, and efficacy in preventing fractures. The objective of this presentation is to review the latest literature and evidence in relation to vitamin D and formulate clinically relevant recommendations. The presentation will focus on differentiating the truth from the myth in the field of vitamin D and skeletal health. An overview of the evidence related to serum 25(OH)D thresholds and the role of vitamin D and calcium in fracture prevention will be discussed. Particular emphasis will be placed on understanding serum 25(OH)D thresholds, high-dose or single-bolus therapy, and the role of vitamin D in the management of osteoporosis. The talk will highlight key aspects of vitamin D assessment, interpretation of results, and actions based on results, as well as the rationale behind using 25(OH)D thresholds and the concept of chasing arbitrary values. Bangladesh, despite being a tropical country, has frequently reported low 25 (OH) D concentrations. However, population-specific data establishing cutoff values for serum 25(OH)D in this region remain limited. This raises the question of extrapolating data from population-based studies to depict the true picture of vitamin D status and its impact on the general health of the people in the country. Thus, the presentation will provide insight into the application of the evidence in a clinical setting. Vitamin D remains an important factor for skeletal health. However, a smart plan needs an assessment, finding a genuinely low level while avoiding unnecessary high-dose pills, and combining vitamin D status with calcium balance in alignment with the way the parathyroid regulates overall bone health.

[J Assoc Clin Endocrinol Diabetol Bangladesh, 2026;5(Suppl 1): S16]