![]() What a patient perceives as an unfortunate accident may be seen as a sentinel event indicative of bone fragility and increased future fracture risk even when the result of considerable trauma. Any new fracture in an adult aged 50 years or older signifies imminent elevated risk for subsequent fractures, particularly in the year following the initial fracture. These fractures place an enormous medical and personal burden on individuals who suffer from them and take a significant economic toll. ![]() It is a subclinical condition until complicated by fracture(s). ![]() Two main factors discussed in this review may help public health efforts to ensure desirable vitamin D levels for fall and fracture prevention, including (1) a sufficient dose of vitamin D and (2) improved adherence to supplementation.Osteoporosis is the most common metabolic bone disease in the USA and the world. Today, desirable serum 25(OH)D levels of at least 75 nmol/l may only be reached in about one third of US older individuals and even fewer European older individuals. Based on a recent expert panel and supportive evidence presented in this review, serum concentrations of at least 75 nmol/l 25(OH)D will be referred to as desirable. However, bone density, strength, and function benefits with vitamin D include active and inactive subgroups of community-dwelling older men and women. Fall and fracture prevention with vitamin D is especially appealing in the treatment of older individuals at risk for fall-related fractures. Vitamin D supplementation in the management of osteoporosis holds a significant public health potential because of its low cost, excellent tolerability, and combined musculo-skeletal benefits. Higher intermittent oral doses of vitamin D may overcome low adherence. An optimal dose of vitamin D should raise serum concentrations of 25(OH)D to the desirable range of at least 75 nmol/l. The dose of vitamin D in the management of osteoporosis should be no less than 700-800 IU per day.
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