Evaluation, Treatment, and Prevention of Vitamin D Deficiency: an Endocrine Society Clinical Practice Guideline

Abstract

Considering that vitamin D deficiency is very common in all age groups and that few foods contain vitamin D, the Task Force recommended supplementation at suggested daily intake and tolerable upper limit levels, depending on age and clinical circumstances. The Task Force also suggested the measurement of serum 25-hydroxyvitamin D level by a reliable assay as the initial diagnostic test in patients at risk for deficiency. Treatment with either vitamin D(2) or vitamin D(3) was recommended for deficient patients. At the present time, there is not sufficient evidence to recommend screening individuals who are not at risk for deficiency or to prescribe vitamin D to attain the noncalcemic benefit for cardiovascular protection.

Vitamin D and risk of CVD: a review of the evidence

“…Migrants with darker skin moving to northern latitudes are particularly at risk of developing vitamin D deficiency (19) . The use of a sunscreen or clothing/ headscarves which cover the skin can also reduce skin synthesis of vitamin D (20)(21)(22) . Older age may lead to a decrease in 25(OH)D concentrations as ageing has been shown to be associated with decreased concentrations of 7-dehydrocholesterol in the skin (21) and older people may be less likely to spend time outdoors, particularly if they are institutionalised.…”

Oral supplementation with 25(OH)D3 versus vitamin D3: Effects on 25(OH)D levels, lower extremity function, blood pressure, and markers of innate immunity

“…Although the 2010 Institute of Medicine (IOM) recommendations support a 25(OH)D threshold of 20 ng/mL for bone health, (1) the International Osteoporosis Foundation, in their 2010 position paper on vitamin D, recommends a threshold of 30 ng/mL for optimal fall and fracture reduction, (2) consistent with the most recent recommendations by the U.S. Endocrine Society published in June 2011. (3) The recommendations by the International Osteoporosis Foundation (IOF) and the Endocrine Society are based on two meta-analyses of double-blind randomized controlled trials that suggested fall reduction required a threshold of at least 24 ng/mL (4) and fracture reduction a threshold of at least 30 ng/mL. (5) Regarding general health endpoints, the Endocrine Society states that while evidence from randomized controlled trials is lacking, numerous epidemiological studies have suggested that a 25(OH)D blood level of 30 ng/mL and above may have additional health benefits in reducing the risk of common cancers, autoimmune diseases, type 2 diabetes, cardiovascular disease, and infectious diseases.…”

“…(11) Although no consensus has been achieved as to whether 20 ng/mL or 30 ng/mL is the optimal threshold of vitamin D, as reflected in these most recent recommendations, most agree that many people are vitamin D-deficient and need vitamin D supplements to meet their vitamin D requirement. (12) The most common form of dietary supplementation used today is cholecalciferol or vitamin D 3 and most healthy adults reach a target range of 20 ng/mL with 600 to 800 IU vitamin D per day. However, the target range of at least 30 ng/mL may require 1800 IU to 4000 IU vitamin D 3 per day.…”

Reliability of self-reported sun exposure in Canadian women and estimation of lifetime exposure to vitamin D from sun and diet

“…Similar to our results on an individual level, these large surveys also found that total dietary and supplement intake of vitamin D increased with age on a cross-sectional level (44) . At face value, these results seem reasonable because the recommended daily intakes of Ca and vitamin D for older individuals increase for bone health (45,46) . These results suggest that vitamin D intakes are not consistent over adult life and that measurement of intake in a 1-year period (such as that in FFQ in cohort studies) may not adequately capture vitamin D intakes that may be relevant to chronic disease diagnoses many years later.…”

“…Also in 2011, a US-directed international task force published similar recommendations for adults at risk for vitamin D deficiency (46) . Only 12?4 % and 58?3 % of women in our study (depending on age period) would have met these new recommendations based on dietary and supplement intake.…”