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Vitamin D Supplementation in Community-Dwelling Adults

Raman Nohria, MD
Pauline Bagatelas, MD, MSc
Sara Martin, MD, MSc

American Family Physician. 2026;114(4):381-386.

Author Disclosure: No relevant financial relationships.

This clinical content conforms to AAFP criteria for CME.

Vitamin D testing is commonly performed in adults. Evidence is lacking to support vitamin D screening or supplementation in the general population, regardless of baseline serum 25-hydroxyvitamin D levels. The National Academy of Medicine recommends that individuals 70 years and younger consume 600 IU of vitamin D daily and that individuals older than 70 years consume 800 IU daily. This can be achieved through dietary sources, supplements, or both. Achieving the recommended intake prevents serum 25-hydroxyvitamin D levels from decreasing to less than 12 ng/mL in 97.5% of the general population. Randomized controlled trials of vitamin D supplementation in the general population, including patients with low baseline serum 25-hydroxyvitamin D levels, do not demonstrate reduced all-cause mortality or improvement in cardiovascular health. Some patients with prediabetes may benefit from taking at least 3 years of vitamin D supplementation that exceeds the recommended dietary intake to reduce the risk of progression to type 2 diabetes. Randomized controlled trials of vitamin D supplementation for reducing the risk of falls and fractures, cancer, dementia, respiratory infections, and depression; for symptoms of fatigue, hair loss, and chronic pain; and during pregnancy and menopause do not show consistent benefit, including in patients with low baseline serum 25-hydroxyvitamin D levels.

According to the 2001–2018 National Health and Nutrition Examination Surveys, 2.6% of the US population has a serum 25-hydroxyvitamin D (25[OH]D) level of less than 10 ng/mL (25 nmol/L), 22% has a level of 10 to 20 ng/mL (25–50 nmol/L), 40.9% has a level of 21 to 30 ng/mL (50–75 nmol/L), and 34.5% has a level of more than 30 ng/mL.1 Despite a lack of consensus on the definition and clinical implications of vitamin D deficiency, vitamin D testing is commonly performed in adults.

WHAT'S NEW ON THIS TOPIC

Vitamin D Supplementation
Citing a lack of evidence to support vitamin D supplementation in the general population regardless of baseline serum 25(OH)D levels, the 2024 Endocrine Society guidelines no longer define levels less than a specific value as deficient.
Vitamin D supplementation may reduce recurrence of benign paroxysmal positional vertigo, particularly for patients with serum 25(OH)D levels less than 30 ng/mL (75 nmol/L).

25(OH)D = 25-hydroxyvitamin D.

SORT: KEY RECOMMENDATIONS FOR PRACTICE

Clinical recommendation Evidence rating Comments
Evidence does not support screening for vitamin D deficiency in the general population.2,10,23,24 B Consistent results from RCTs that do not demonstrate prolonged life, decreased incidence of cancer or cardiovascular disease, or decreased falls or fractures
Individuals 70 years and younger should consume 600 IU (15 mcg) of vitamin D daily, and individuals older than 70 years should consume 800 IU (20 mcg) daily. This can be achieved through dietary sources, supplements, or both.2,3,12 C Consistent results from studies with disease-oriented outcomes
Vitamin D supplementation of 1,000–4,000 IU (25–100 mcg) daily for 3 years reduces the risk of progression from high-risk prediabetes to diabetes in patients with a body mass index > 30 kg/m2 and at least one of the following: average A1C of at least 5.9%, fasting glucose of 100–120 mg/dL (5.55–6.66 mmol/L), or 2-hour glucose of 140–199 mg/dL (7.77–11.04 mmol/L) after a 75-g load.2,15 B Consistent results from meta-analyses of RCTs that demonstrate reduced progression from prediabetes to diabetes; post hoc analysis suggests that achieving higher 25-hydroxyvitamin D levels (ie, 50 ng/mL [125 nmol/L]) leads to lower risk of diabetes

RCT = randomized controlled trial.

A = consistent, good-quality patient-oriented evidence; B = inconsistent or limited-quality patient-oriented evidence; C = consensus, disease-oriented evidence, usual practice, expert opinion, or case series. For information about the SORT evidence rating system, go to https://www.aafp.org/afpsort.

RAMAN NOHRIA, MD, is an assistant professor in the Department of Family Medicine and Community Health at Duke University, Durham, North Carolina.

PAULINE BAGATELAS, MD, MSc, is a clinical assistant professor in the Department of Family Medicine at the Warren Alpert Medical School of Brown University, Providence, Rhode Island.

SARA MARTIN, MD, MSc, FAAFP, is an assistant professor in the Department of Family Medicine and Community Health at Duke University, Durham.

Address correspondence to Raman Nohria, MD, at raman.nohria@duke.edu.

Author Disclosure: No relevant financial relationships.

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