Unipolar orthogonal frequency division multiplexing (U-OFDM) appears as an attractive optical OFDM solution for emerging visible light communication (VLC) systems. This paper proposes spectral efficiency improvement for U-OFDM systems by applying adaptive transmission over realistic VLC links. This adaptive transmission includes switching among a number of multiple-input multiple-output (MIMO) modes combined with appropriate modulation size selection. The considered MIMO modes are repetition coding, spatial modulation, and spatial multiplexing, where each mode supports different modulation sizes. The selection of the corresponding MIMO mode and its modulation size is based on the received signal-to-noise ratio and target bit error rate. The proposed U-OFDM system is applied over different VLC MIMO setups with realistic channel models for 8 × 8, 4 × 4 and 2 × 2 MIMO systems. Our simulation results show that the proposed adaptive system provides a significant spectral efficiency improvement over stand-alone U-OFDM MIMO modes/setups.