Association between 25-hydroxy vitamin D levels and risk of frailty and pre-frailty in elderly adults: a systematic review and dose-response meta-analysis of epidemiologic studies with GRADE assessment
Abstract
Background: A growing number of studies investigated vitamin D and frailty have led to conflicting results. This systematic review and meta-analysis aimed to summarize and update the current evidence surrounding the association between vitamin D and risk of frailty and pre-frailty in elderly adults.
Methods: MEDLINE (PubMed), Scopus, Institute for Scientific Information (ISI) Web of Science databases, and Google Scholar were searched for all published articles up to January 2025. All observational studies that reported odds ratios (ORs) or relative risks (RRs) with 95% confidence intervals (CIs) for the association between 25-hydroxy vitamin D (as independent variable) and frailty (as dependent variable) were included. Maximally adjusted effect sizes were pooled. Certainty of evidence was assessed by the GRADE approach.
Results: A total of 41 studies (6 cohorts, 31 cross-sectionals and 4 studies with information of baseline and longitudinal) were included. Highest (vs. lowest) level of vitamin D in prospective cohort studies (with 14,153 participants and 2,137 cases with frailty) was significantly related to a 29% reduction in risk of frailty (pooled RR: 0.71; 95% CI: 0.60, 0.84). Also, a significant inverse association was found in cross-sectional studies with 42,936 cases out of 500,826 participants (OR: 0.50; 95% CI: 0.44, 0.56). Based on linear dose-response analysis, each 10 ng/mL (or 25 nmol/L) increase in serum vitamin D level was inversely related to risk of frailty…
How strong is the evidence?
Evidence Hub reads this as a meta-analysis, done in people. Its evidence level is 1 of 5 (Highest · pooled evidence). Pooled evidence from several studies sits at the top of the evidence pyramid. Reported size: 500,826 participants or records.
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