Role of Vitamin D and Calcium in Bone Cancer

  • 29 Aug, 2020
  • By UHAPO
  • 568

Bone cancer is not common cancer compared to many other types of cancer. It mainly includes two types; primary and secondary bone cancer. In primary bone cancer or bone sarcoma, cancer develops in the cells of the bone. Secondary bone cancer occurs when cancer somewhere else in the body spreads or metastasizes to the bones.[1]


According to the National Cancer Institute, primary bone cancer is rare, accounting for less than 1% of all cancers. Secondary bone cancer is much more common than primary bone cancer.[1] Because cancer has spread from its original location, doctors classify secondary bone cancer as advanced or stage 4 cancer. When cancer cells metastasize to the bone, they can cause changes to the bone by the process of osteolysis. Such lytic lesions can weaken the bones and increase the risk of breakage or other problems. It is also common for bone metastasis patients to experience pain with lesions.[2]


Several cancers can spread to the bones but prostate, colorectal, breast, and lung cancers are most likely to spread to the bone and accumulating evidence from epidemiological studies suggests that vitamin D deficiency might be a causal risk factor for several types of cancer such as colorectal, breast, ovarian and prostate which raises the further risk of incidence, morbidity, and mortality.[2],[3]


Vitamin D deficiency is the most common nutritional deficiency worldwide, included Indian prevalence ranging from 50% to 94%.[4]


The most important risk factors for developing vitamin D deficiency include low annual sunlight exposure, darker skin tone, and heavy sunscreen use, as Vitamin D is produced endogenously in the skin via a UVB-dependent mechanism.[5]


According to statistics,[6] 


  • Breast cancer death rates tended to be higher in areas with low winter sunlight levels and lower in sunny areas.

  • Individuals with 25(OH)D levels below 30 ng/mL also had a higher incidence of colonic adenomas.

  • People with 25(OH)D levels below 16 ng/mL had a 70% higher incidence rate of prostate cancer than those with levels above 16 ng/mL.


Therefore, supplementation with Vitamin D or Calcitriol [1, 25(OH)2D3], an active form of vitamin D is very essential to prevent the risk of various cancers which may eventually cause bone metastasis. Both in-vitro and in-vivo studies have indicated its potential in the prevention and regression of colorectal, prostate, and breast cancers. 


  • Basically, bone resorption is crucial for cancer cell metastasis and survival and it is proven that this resorption can be modulated by 1, 25(OH)2D3, and calcium supplements.[7] 

  • The vitamin has also been found to interfere with the transduction pathways of various growth factors-activated receptors thereby modulating transcription and alteration of genomic functions resulting in inhibition of cell proliferation and angiogenesis and facilitation of cell differentiation and apoptosis. (Figure)[7],[8]

  • It also increases the level of an endogenous protein - cystatin D, which possesses antitumor and anti-metastatic property, by facilitation of the expression of the gene coding for it. 


Long-term studies have demonstrated the efficacy of moderate intake of vitamin D in reducing cancer risk and, when administered with calcium, in reducing the incidence of fractures.[6]


Generally, Vitamin D is produced endogenously when ultraviolet rays from sunlight strike the skin and trigger its synthesis but it can be supplemented through certain foods. 

Dietary sources include a few foods that naturally contain vitamin D, such as fatty fish, fish liver oil, and eggs. However, most dietary vitamin D comes from foods fortified with vitamin D, such as milk, juices, and breakfast cereals.[9] 


Indian Council of Medical Research (ICMR) recommends 400IU (10μg) vitamin D as a daily supplement under situations of minimal exposure to sunlight.[10]


ICMR also includes recommended daily allowance of calcium as per gender and every age group. (Table)[10]


Group and categories

Calcium (mg/Day)





Pregnant Woman


Lactating women <6 months and 6-12 months




Children (1-9 years)


Boys and Girls (10-17 years)



Though not as a primary anti-cancer agent, vitamin D and calcium may be used for the prevention of cancer and included as an adjuvant in combination chemotherapy for the treatment of cancer.




  1. What to know about bone cancer available at https://www.medicalnewstoday.com/articles/171372, last accessed on 22nd July, 202


  1. Bone Metastasis, https://www.rogelcancercenter.org/bone-metastasis, last accessed on 22nd July 2020 


  1. http://ar.iiarjournals.org/content/35/2/1171.full Juzeniene A, Porojnicu AC, Baturaite Z, et al. Vitamin D levels and dietary intake among patients with benign soft tissue tumors and sarcomas. Anticancer Res. 2015;35(2):1171-1180 


  1. http://www.jfmpc.com/article.asp?issn=2249-4863;year=2018;volume=7;issue=2;spage=324;epage=330;aulast=Aparna Aparna P, Muthathal S, Nongkynrih B, Gupta SK. Vitamin D deficiency in India. J Family Med Prim Care. 2018;7(2):324-330


  1. https://europepmc.org/article/med/26504063 Maier GS, Horas K, Kurth AA, Lazovic D, Seeger JB, Maus U. Prevalence of Vitamin D Deficiency in Patients with Bone Metastases and Multiple Myeloma. Anticancer Res. 2015;35(11):6281-6285.


  1. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1470481/ Garland CF, Garland FC, Gorham ED, et al. The role of vitamin D in cancer prevention. Am J Public Health. 2006;96(2):252-261


  1. https://pubmed.ncbi.nlm.nih.gov/21872801/ Vanoirbeek E, Krishnan A, Eelen G, et al. The anti-cancer and anti-inflammatory actions of 1,25(OH)D. Best Pract Res Clin Endocrinol Metab. 2011;25(4):593-604.


  1. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3081446/ Chakraborti CK. Vitamin D as a promising anticancer agent. Indian J Pharmacol.2011;43(2):113-120


  1. What are the health benefits of vitamin D?, https://www.medicalnewstoday.com/articles/161618, last accessed on 22nd July 2020


  1. Note related to Recommended Dietary Allowance, FSSAI https://archive.fssai.gov.in/dam/jcr:651fb6ae-d530-4162-be1a-8bf38c3743c7/Note_Dietary_Allowance_27_02_2019.pdf, last accessed on 22nd July 2020