Vitamin D status correction in Saudi Arabia: an experts’ consensus under the auspices of the European Society for Clinical and Economic Aspects of Osteoporosis, Osteoarthritis, and Musculoskeletal Diseases (ESCEO)

Abstract

BackgroundVitamin D deficiency is common in the Middle East and in Saudi Arabia, in particular. While several international recommendations on the management of vitamin D deficiency have been documented and practiced globally, these recommendations should be adapted to the conditions of the Middle Eastern region. To address this challenge, the Prince Mutaib Chair for Biomarkers of Osteoporosis (PMCO) in King Saud University (KSU), Riyadh, KSA, together with local experts and in cooperation with the European Society for Clinical and Economic Aspects of Osteoporosis and Osteoarthritis (ESCEO), organized a panel that formulated unified recommendations in the diagnosis and treatment of vitamin D deficiency in the region.MethodsThe selection of local and international experts commenced during the 2nd International Vitamin D Symposium conducted in Riyadh, Saudi Arabia, last January 20-–21, 2016. Reviews of the most recent literature were done, and face-to-face meetings were conducted for revisions and final recommendations.Results: Vitamin D sufficiency is defined as circulating serum 25(OH)D ≥50 nmol (≥20 ng/ml) for the general population and vitamin D adequacy as serum 25(OH)D >75 nmol/L l (>30 ng/ml) for the frail and osteoporotic elderly. Despite overwhelming prevalence of vitamin D deficiency, universal screening is not recommended. Recommendations for the general population, children, pregnant/lactating women, post-menopausal women, the elderly, and those with subsequent metabolic diseases were provided.ResultsVitamin D sufficiency is defined as circulating serum 25(OH)D ≥50 nmol (≥20 ng/ml) for the general population and vitamin D adequacy as serum 25(OH)D >75 nmol/L l (>30 ng/ml) for the frail and osteoporotic elderly. Despite overwhelming prevalence of vitamin D deficiency, universal screening is not recommended. Recommendations for the general population, children, pregnant/lactating women, post-menopausal women, the elderly, and those with subsequent metabolic diseases were provided.ConclusionVitamin D supplementation/correction is advised in all persons whose serum 25(OH)D falls below 50 nmol/l (20 ng/ml), and achieving a target of 75 nmol/l (30 ng/ml) is particularly suited for frail, osteoporotic, and older patients. Conducting well-designed clinical trials in the region that will address economic implications and investigations on the treatment persistence and compliance to vitamin D treatment in the region are encouraged.

Gender-specific differences in the awareness and intake of vitamin D among adult population in Qassim region

“…Since these reasons are difficult to modify and since supplementation was very low in both genders, the current findings further highlight the critical importance of Vitamin D supplementation, especially in Saudi females and other at-risk groups. [ 23 24 ] In support of this recommendation, we note that <20% of the participants in this study were taking Vitamin D supplementations or multivitamins. Furthermore, stricter regulations to ensure that dairy products, cereals, and orange juice are fortified may also be required in Saudi Arabia to counter the negligible dietary intake of Vitamin D.[ 25 ]…”

Extremely High Prevalence of Maternal and Neonatal Vitamin D Deficiency in the Arab Population

“…Current national guidelines do not recommend universal screening of vitamin D levels in mothers and neonates [6]. The authors are currently conducting a multicenter survey based in the capital city on the prevalence of vitamin D deficiency in a large sample of pregnant Saudi women.…”

“…The tests included bone profile (serum calcium, phosphate, and alkaline phosphatase), a complete blood cell count, and parathyroid and thyroid hormone levels, which were measured using routine clinical laboratory methods. During the delivery period, the neonate's cord blood was sampled to measure 25(OH)D. Vitamin D status was defined according to the recommendations for vitamin D status correction in Saudi Arabia, which defined vitamin D deficiency as a serum level of 25(OH)D <50 nmol/L, sufficiency as 50-75 nmol/L, and adequate levels as >75 nmol/L (Table 1) [6]. …”

Association between standardized vitamin 25(OH)D and dyslipidemia: a community-based study in Riyadh, Saudi Arabia

“…Further details and the correlation graphs between the original and true values are available in a prior publication [28]. A cutoff level of < 50 nmol, as recommended by the Endocrine Society, was utilized to identify vitamin D deficiency, whereas vitamin D levels of > 50 nmol (insufficiency and above) were classified as normal [29].…”