{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,18]],"date-time":"2026-08-18T04:51:03Z","timestamp":1787028663730,"version":"build-2736575974"},"reference-count":55,"publisher":"MDPI AG","issue":"22","license":[{"start":{"date-parts":[[2025,11,13]],"date-time":"2025-11-13T00:00:00Z","timestamp":1762992000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Background\/Objectives: Vitamin D deficiency contributes to pathological vertebral fragility (path-VF), including fragility fractures and early pedicle screw loosening after posterior instrumented spinal fusion (PISF). Supplementation practices remain inconsistent. This retrospective study evaluated whether patients with path-VF receive appropriate vitamin D3 (Vit.D3) supplementation and assessed the dose\u2013response relationship between daily intake and path-VF risk, particularly in older adults. Methods: A total of 210 patients treated with kyphoplasty or PISF (2022\u20132023) were classified into a path-VF or control group. Daily oral Vit.D3 intake was categorised as Zero- (0 IU), Low- (&lt;2000 IU), or High-Dose (\u22652000 IU). Statistical analyses were performed for each dosage group, including subgroup analyses for patients aged \u226567.5 years. Vertebral BMD was estimated using mean Hounsfield Units (HU) from T11\u2013L5. Results: Patients in the path-VF group received significantly lower Vit.D3 doses than controls (1431.4 \u00b1 1055.7 vs. 2366.7 \u00b1 1186.7 IU\/day, p &lt; 0.001). Low-dose supplementation was associated with a markedly increased risk of path-VF compared with high-dose in the overall cohort (OR = 6.5, p = 0.003) and in patients aged \u226567.5 years (OR = 8.6, p = 0.008). Logistic regression identified a threshold of 1900 IU\/day (AUC = 0.805). Mean vertebral HU values were significantly lower in the path-VF group than in controls (71.9 \u00b1 29.1 vs. 133.5 \u00b1 52.6, p &lt; 0.001), and no consistent HU gains were observed with increasing Vit.D3 dosage. Conclusions: Low-dose Vit.D3 supplementation was associated with increased path-VF risk, especially in patients aged &gt;67.5 years. Patients without path-VF had received significantly higher doses, suggesting broader benefits of adequate Vit.D3 beyond bone density. A daily intake above 1900 IU may serve as a practical threshold for at-risk elderly patients.<\/jats:p>","DOI":"10.3390\/jcm14228052","type":"journal-article","created":{"date-parts":[[2025,11,14]],"date-time":"2025-11-14T16:46:22Z","timestamp":1763138782000},"page":"8052","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["Low-Dose Vitamin D3 Supplementation: Associations with Vertebral Fragility and Pedicle Screw Loosening"],"prefix":"10.3390","volume":"14","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-7050-2792","authenticated-orcid":false,"given":"Jun","family":"Li","sequence":"first","affiliation":[{"name":"Spine Center for Neuroorthopaedics, Spinal Cord Injuries, and Scoliosis, RKH Orthopedic Clinic Markgr\u00f6ningen, 71706 Markgr\u00f6ningen, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2385-9582","authenticated-orcid":false,"given":"Andr\u00e9","family":"Strahl","sequence":"additional","affiliation":[{"name":"Department of Psychosomatic Medicine and Psychotherapy, Centre for Internal Medicine, University Medical Center Hamburg-Eppendorf, 20246 Hamburg, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Beate","family":"Kunze","sequence":"additional","affiliation":[{"name":"Spine Center for Neuroorthopaedics, Spinal Cord Injuries, and Scoliosis, RKH Orthopedic Clinic Markgr\u00f6ningen, 71706 Markgr\u00f6ningen, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stefan","family":"Krebs","sequence":"additional","affiliation":[{"name":"Spine Center for Neuroorthopaedics, Spinal Cord Injuries, and Scoliosis, RKH Orthopedic Clinic Markgr\u00f6ningen, 71706 Markgr\u00f6ningen, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1232-2878","authenticated-orcid":false,"given":"Martin","family":"Stangenberg","sequence":"additional","affiliation":[{"name":"Department of Spinal Surgery and Neurosurgery, Tabea Hospital Hamburg, 22587 Hamburg, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lennart","family":"Viezens","sequence":"additional","affiliation":[{"name":"Department of Trauma and Orthopaedic Surgery, Division of Spine Surgery, University Medical Center Hamburg-Eppendorf, 20246 Hamburg, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Patrick","family":"Strube","sequence":"additional","affiliation":[{"name":"Department of Orthopaedics, Jena University Hospital, Campus Waldkliniken Eisenberg, 07607 Eisenberg, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marc","family":"Dreimann","sequence":"additional","affiliation":[{"name":"Spine Center for Neuroorthopaedics, Spinal Cord Injuries, and Scoliosis, RKH Orthopedic Clinic Markgr\u00f6ningen, 71706 Markgr\u00f6ningen, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2025,11,13]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"89","DOI":"10.1302\/0301-620X.97B1.34558","article-title":"The prevalence of vitamin D deficiency in patients with vertebral fragility fractures","volume":"97","author":"Maier","year":"2015","journal-title":"Bone Jt. 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