EMAS Position Statement: Use of Vitamin D Among Postmenopausal Women

SUMMARY:

EMAS, an international society that promotes health in women and men at midlife and beyond, has produced a position statement targeting the use of vitamin D in postmenopausal women. The literature suggests “an association between vitamin D deficiency and adverse health outcomes in postmenopausal women, although they cannot establish causality.” The document includes an extensive literature review.

‘Vitamin D’ Overview

What is it?

• Group of lipophilic hormones
• Regulates calcium homeostasis via kidney, gastrointestinal tract, skeleton and parathyroid
• Critical for skeletal health but impacts multiple tissues
• Two major forms
  • Vitamin D2 (ergocalciferol)
  • Vitamin D3 (cholecalciferol)
    • Major source through cutaneous synthesis through exposure to sunlight
    • Small amount from animal diet (fatty fish, eggs and milk)

Measurement

• Vitamin D status: Measure serum 25-hydroxyvitamin D levels
  • <20 ng/ml (<50 nmol/l): Vitamin D deficiency
  • <10 ng/ml (<25 nmol/l): Severe Vitamin D deficiency

Vitamin D Deficiency and Associated Health Outcomes

• Skeletal
  • Increased fracture risk
• Menopausal Symptomatology  
  • Evidence is inconsistent
  • Some studies have demonstrated increased risk
    • Hot flashes | Depression | Sexual dysfunction | Sleep disturbances
• Cardiac
  • Increased prevalence for CVD risk factors
    • Metabolic syndrome | Type 2 diabetes | Atherogenic dyslipidemia
  • Increased incidence for CVD events
• Cancer
  • Increased risk for cancers: Colorectal | Lung | Breast
  • Overall and cancer-specific mortality rates are increased in postmenopausal women
  • No evidence for ovarian or other gyn cancers
• Infections and Inflammation
  • Increased risk for respiratory infection
  • Increased risk for autoimmune disorders

Vitamin D Supplementation Recommendations for Postmenopausal Women

Skeletal Health

• No vitamin D deficiency or low fracture risk
  • No evidence to support vitamin D supplementation
• Vitamin D deficiency with osteoporosis and/or high fracture risk (FRAX model)
  • Vitamin D: 2000 to 4000 IU (4000 to 6000 IU in obese patients)
  • Calcium: 1000 to 1200 mg of calcium (dietary or supplements)
  • Encourage Vitamin D and calcium use for minimum 3 to 5 years
  • Check vitamin D levels 3 to 6 months with target above 20 ng/ml (<50 nmol/l)

Menopausal Symptomatology

• Vitamin D supplementation is not recommended to improve menopausal symptoms

Cardiovascular Disease

• No effect of vitamin D supplementation on decreasing CVD risk

Cancer

• No effect of vitamin D supplementation on cancer incidence although some studies identified a small reduction in cancer-related mortality

Infections and Inflammation

• Vitamin D supplementation may ‘modestly’ decrease the risk for acute respiratory tract infections including COVID-19
• Concerns regarding study design such as “heterogeneity in design, duration, population and vitamin D dosage among studies must be underscored”

KEY POINTS:

• Typical daily dose of 1000 to 1200 mg of calcium is not associated with increased risk for cardiovascular disease or nephrolithiasis
• Studies on vitamin D supplementation have significant limitations due to heterogeneity regarding dose, inclusion of calcium and baseline vitamin D status
• More research needed to
  • Discriminate between vitamin D replacement and supplementation
  • Determine the need for universal vitamin D screening in postmenopausal women

Learn More – Primary Sources:

EMAS position statement: Vitamin D and menopausal health