Vitamin D Deficiency: Widespread Effects in Postmenopausal Women

Estrogen levels drop significantly as women go through menopause, and a lack of estrogen weakens bones. Vitamin D helps the body absorb and use calcium to maintain bone structure.

Thus, vitamin D is an important vitamin for postmenopausal women. Globally, approximately 70% of postmenopausal women reported vitamin D deficiency and older women have an even higher risk for vitamin D deficiency.

Besides skeletal effects, increasing evidence has demonstrated that vitamin D impacts cardiovascular disease, cancer, infection, and neurodegenerative diseases. Vitamin D supplementation is a vital and inexpensive way to prevent and treat vitamin D deficiency; however, its use in preventing and treating other conditions is less clear.

A review published in Maturitas updates an evidence-based position statement about the association between vitamin D deficiency and the skeletal and non-skeletal aspects of menopausal health. Vitamin D deficiency is associated with skeletal and non-skeletal adverse outcomes in postmenopausal women; however, the authors indicate they cannot establish causality.

Vitamin D supplementation exerts no or modest efficacy in specific conditions, which usually require high doses with prolonged intervention. And those data are not robust, as most studies did not consider whether people were vitamin D deficient at baseline, the high heterogeneity of studied populations, vitamin D dosage, calcium coadministration, and the intervention duration.

Skeletal health

Vitamin D deficiency is associated with low bone mass and increased fracture risks. Vitamin D supplementation may have modest anti-fracture benefits in elderly populations with severe vitamin D deficiency at a maintenance dose of 800 to 2000 IU/day and co-administered with calcium at 1000 to 1200 mg/day with strict compliance for more than 3 years.

Cardiovascular disease

Vitamin D deficiency is associated with increased cardiovascular risk factors, mainly metabolic syndrome, type 2 diabetes, and dyslipidemia. Vitamin D deficiency, especially its severe form, is associated with an increased risk of cardiovascular events, such as coronary heart disease, stroke, and mortality, independent of traditional risk factors.

Vitamin D supplementation may modestly benefit lipid profile and glucose homeostasis, especially in obese individuals or those older than 60 years of age and at doses of at least 2000 IU/day. Vitamin D supplementation does not affect the incidence of cardiovascular events.

Cancer

Vitamin D deficiency is associated with increased incidence and mortality from colorectal, lung, and breast cancer. No confirmative association has been established in gynecological cancers. Vitamin D supplementation does not affect cancer incidence, although it modestly reduces cancer-related mortality.

Infections

Vitamin D deficiency is associated with increased risks of acute respiratory tract infection, including COVID-19. Vitamin D supplementation may modestly decrease the risk of infection and the severity of COVID-19.

Menopausal symptomatology

Vitamin D deficiency may increase the risk of menopausal symptoms, i.e., hot flashes, sleep disturbances, depression, and sexual function. But supplementation helps none of those symptoms, except for vulvovaginal atrophy, when given at relatively high doses, i.e., 40,000–60,000 IU/week orally or 1000 IU/day as a vaginal suppository.

The authors suggest that more clarification is needed from future studies. Such studies should determine whether universal vitamin D deficiency screening is needed, the optimal 25(OH)D cutoff at which to initiate supplementation, and discriminate between vitamin D replacement and vitamin D supplementation.

About the Author

Mirina (Yangzhou) Li, PharmD, is a regulatory medical writing scientist at the Janssen Pharmaceutical Companies of Johnson & Johnson based in Boston. MA.

Reference

Anagnostis P, Livadas S, Goulis DG, et al. EMAS position statement: Vitamin D and menopausal health [published online ahead of print, 2022 Dec 21]. Maturitas. 2022;169:2-9. doi:10.1016/j.maturitas.2022.12.006