Context-dependent effects of vitamin D supplementation on bone mineral density and fracture risk: a narrative review across clinical and athletic populations
Abstract
Background: Vitamin D plays a well-established role in calcium absorption and bone metabolism, yet its effectiveness as a supplementation strategy has been increasingly questioned, with fractures representing the most serious complication of deficiency-related bone loss. These questions are particularly relevant in athletic populations, where vitamin D insufficiency is widespread and has been linked to bone stress injuries despite high levels of physical activity.
Objective: This narrative review synthesises evidence from both clinical and athletic populations to identify when and for whom vitamin D supplementation is most likely to confer measurable skeletal benefit.
Results: In athletic populations, vitamin D deficiency is widespread yet does not consistently impair bone mineral density, most likely because mechanical loading compensates for its effects. In genuinely deficient athletes, targeted supplementation may help reduce stress fracture risk, though randomised trial evidence remains limited. In clinical populations, vitamin D alone does not reliably reduce fracture risk or improve bone mineral density in unselected individuals. More consistent benefits emerge when calcium is combined with vitamin D, particularly in postmenopausal women, institutionalised elderly, and patients on pharmacological osteoporosis treatment, which provides useful comparative context for understanding the conditions under which supplementation is most likely to benefit athletes and active…
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