Question

1) A 50-year-old woman with obesity and limited sun exposure asks whether taking Vitamin D will prevent fractures. Which statement reflects current evidence for disease prevention?
Vitamin D plus calcium offers modest fracture risk reduction in select high-risk patients
Vitamin D prevents all-cause mortality and should be prescribed for all those aged 50+
Vitamin D prevents type 2 diabetes in all patients presenting with prediabetes
Vitamin D reduces peripheral lower extremity fracture risk by 20% after 3 months.
2) An interprofessional team is meeting to reduce fracture risk and is deciding whether to screen asymptomatic adults for Vitamin D deficiency. Which patient is likely appropriate for screening?
A 28-year-old pregnant woman with adequate prenatal care and normal dietary intake
A 32-year-old marathon runner undergoing many hours of outdoor training
A 70-year-old man in a nursing home with frequent falls, limited sun exposure, and a diagnosis of osteoporosis
A 25-year-old roofer asking for a Vitamin D test out of curiosity because his coworker fell off a ladder
3) Which supplementation strategy is most appropriate in advanced chronic kidney disease?
High-dose cholecalciferol
Active Vitamin D analogs with monitoring
Intermittent bolus dosing
Avoid Vitamin D entirely

Answer 1

1) Correct answer: Vitamin D plus calcium offers modest fracture risk reduction in select high‑risk patients.
- Evidence from randomized trials and meta‑analyses shows a small reduction in fracture risk mainly when vitamin D is given together with calcium in older, institutionalized or otherwise high‑risk patients; routine vitamin D for fracture prevention in all adults is not supported.

2) Correct answer: A 70‑year‑old man in a nursing home with frequent falls, limited sun exposure, and a diagnosis of osteoporosis.
- Screening is recommended only for people at increased risk of deficiency (older institutionalized adults, malabsorption, advanced CKD, certain meds, etc.). The other patients are low‑risk and do not warrant routine screening.

3) Correct answer: Active Vitamin D analogs with monitoring.
- In advanced CKD the kidney’s ability to make 1,25(OH)2D is impaired, so treatment of secondary hyperparathyroidism often requires active vitamin D analogs (e.g., calcitriol, paricalcitol) with careful monitoring of calcium and phosphate. High‑dose bolus dosing and blanket avoidance are inappropriate.