Recomendações da Sociedade Brasileira de Endocrinologia e Metabologia (SBEM) para o diagnóstico e tratamento da hipovitaminose D

Abstract

Objective: The objective is to present an update on the diagnosis and treatment of hypovitaminosis D, based on the most recent scientific evidence. Materials and methods: The Department of Bone and Mineral Metabolism of the Brazilian Society of Endocrinology and Metabology (SBEM) was invited to generate a document following the rules of the Brazilian Medical Association (AMB) Guidelines Program. Data search was performed using PubMed, Lilacs and SciELO and the evidence was classified in recommendation levels, according to the scientific strength and study type. Conclusion: A scientific update regarding hypovitaminosis D was presented to serve as the basis for the diagnosis and treatment of this condition in Brazil.

Vitamin D and Diabetes Mellitus: A Review

“…The calcidiol is the metabolite which circulates in large quantity and has half-life of 2 weeks, therefore is considered the best indicator to evaluate vitamin D status [9] [13] [14].…”

“…There is no consensus about the exact cutoff level that should define a "sufficiency" regarding vitamin D levels [14]. There is a reverse correlation between PTH and 25-hydroxy vitamin D values, that means an increase in PTH as a biomarker reflects a low physiologic level of vitamin D. Therefore, to prevent vitamin D deficiency or to maintain a calcium homeostasis, it was suggested that the best cutoff of 25-hydroxy vitamin D would be 30 ng/mL (75 nmol/L), that means, the qualitative fundament is to consider as appropriate a level of vitamin D capable of maintaining the PTH in normal concentrations [12].…”

“…In order to obtain nmol/L from ng/mL it is necessary to multiply the value in ng/mL by 2.5 times [14]. The maximum limit of normality was not defined yet, but some literature reports in the literature show intoxication by vitamin D based on hypercalciuria, regarding levels above 140 ng/mL of vitamin D [5].…”

“…Those who would benefit from supplementation are patients at risk for hipovitaminosis D, as described before, and those with clinic contraindications to sun exposure, such as patients with skin cancer, transplanted or those with lupus [14]. There are still uncertainties about the ideal dosage to maximize the skeletal muscle health, and the formation of bone mass, as well as the exact dose to be used in order to increase the serum vitamin D levels above 30 ng/mL [4].…”

“…Calcitriol and other active analogues of vitamin D, such as paricalcitol and dexercalciferol are used only in special cases, such as in acquired and genetic disorders of vitamin D, phosphate metabolism extreme bad absorption and IRC [14].…”