Vitamin D deficiency
In medicine, vitamin D deficiency is "a nutritional condition produced by a deficiency of vitamin D in the diet, insufficient production of vitamin D in the skin, inadequate absorption of vitamin D from the diet, or abnormal conversion of vitamin D to its bioactive metabolites. It is manifested clinically as rickets in children and osteomalacia in adults."[1]
Recommended serum levels are 20 ng/mL (50 nmol/L) according to the Institute of Medicine (IOM)[2] and 30 ng/mL (75 nmol/L) according to the International Osteoporosis Foundation and National Osteoporosis Foundation.[3]
Institute of Medicine states (page 13):
- Levels over 20 ng/ml: "Practically all persons are sufficient"
- Levels 12-20 ng/ml: "Some, but not all, persons are potentially at risk for inadequacy."
- Levels below 12 ng/ml: "persons are at risk of deficiency."
The IOM based their recommendations in part on a prior systematic review by the Agency for Healthcare Research and Quality.[4]
Epidemiology and prevalence
About a quarter of older adults have levels below 20 ng/mL.[5]
Low levels of vitamin D are common in medical inpatients.[6]
Diagnosis
Symptoms
Vitamin D was reported to be associated with widespread musculoskeletal pain like fibromyalgia[7].[8] However, this was an uncontrolled study and more recent studies make the associated between Vitamin D and non-specific pain doubtful[9] and suggest that earlier recommendations[7] to screen patients with musculoskeletal pain for deficiency of vitamin D may not be justified.
Laboratory test
The serum level of 25-hydroxyvitamin D is the best metabolize to assay.[10][11] Assay method influences the result.[12]
Treatment
Clinical practice guidelines direct treatment.[13] Treatment of adults can be either 50,000 IU of D2 or D3 once a week for eight weeks or 6,000 IU daily. This is followed by 1,500 to 2,000 IU per day. Some populations may require higher doses.
A more recent randomized controlled trial showed that, among white women with vitamin D insufficiency and deficiency, a dose of 600 to 800 IU per day of vitamin D3 will raise the level above Institute of Medicine recommendations (20 ng/mL or 50 nmol/L) in 97% of women.[14]
Screening
Clinical practice guidelines suggest screening of special populations with the 25-hydroxyvitamin D [25(OH)D] assay.[13]
References
- ↑ Anonymous (2024), Vitamin D deficiency (English). Medical Subject Headings. U.S. National Library of Medicine.
- ↑ Committee to Review Dietary References Intakes for Vitamin D and Calcium. Ross AC et al., editors. (2010) Dietary References Intakes for Calcium and Vitamin D. Institute of Medicine.
- ↑ Dawson-Hughes B, Mithal A, Bonjour JP, Boonen S, Burckhardt P, Fuleihan GE et al. (2010). "IOF position statement: vitamin D recommendations for older adults.". Osteoporos Int 21 (7): 1151-4. DOI:10.1007/s00198-010-1285-3. PMID 20422154. Research Blogging.
- ↑ Chung M, Balk EM, Brendel M, Ip S, Lau J, Lee J et al. (2009). "Vitamin D and calcium: a systematic review of health outcomes.". Evid Rep Technol Assess (Full Rep) (183): 1-420. PMID 20629479. [e]
- ↑ Orwoll E, Nielson CM, Marshall LM, et al (April 2009). "Vitamin D deficiency in older men". J. Clin. Endocrinol. Metab. 94 (4): 1214–22. DOI:10.1210/jc.2008-1784. PMID 19174492. Research Blogging.
- ↑ Thomas MK, Lloyd-Jones DM, Thadhani RI, et al (1998). "Hypovitaminosis D in medical inpatients". N. Engl. J. Med. 338 (12): 777–83. PMID 9504937. [e]
- ↑ 7.0 7.1 Plotnikoff GA, Quigley JM (2003). "Prevalence of severe hypovitaminosis D in patients with persistent, nonspecific musculoskeletal pain". Mayo Clin. Proc. 78 (12): 1463–70. PMID 14661675. [e]
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<ref>tag; name "pmid14661675" defined multiple times with different content - ↑ Hicks GE, Shardell M, Miller RR, et al (May 2008). "Associations between vitamin D status and pain in older adults: the Invecchiare in Chianti study". J Am Geriatr Soc 56 (5): 785–91. DOI:10.1111/j.1532-5415.2008.01644.x. PMID 18331295. Research Blogging.
- ↑ Warner AE, Arnspiger SA (February 2008). "Diffuse musculoskeletal pain is not associated with low vitamin D levels or improved by treatment with vitamin D". J Clin Rheumatol 14 (1): 12–6. DOI:10.1097/RHU.0b013e31816356a9. PMID 18431091. Research Blogging.
- ↑ Rosen, Clifford J. (2011-01-20). "Vitamin D Insufficiency". New England Journal of Medicine 364 (3): 248-254. DOI:10.1056/NEJMcp1009570. ISSN 0028-4793. Research Blogging.
- ↑ Pearce SH, Cheetham TD (2010). "Diagnosis and management of vitamin D deficiency.". BMJ 340: b5664. DOI:10.1136/bmj.b5664. PMID 20064851. Research Blogging.
- ↑ Barake M, Daher RT, Salti I, Cortas NK, Al-Shaar L, Habib RH et al. (2012). "25-hydroxyvitamin d assay variations and impact on clinical decision making.". J Clin Endocrinol Metab 97 (3): 835-43. DOI:10.1210/jc.2011-2584. PMID 22238386. Research Blogging.
- ↑ 13.0 13.1 Holick MF, Binkley NC, Bischoff-Ferrari HA, Gordon CM, Hanley DA, Heaney RP et al. (2011). "Evaluation, Treatment, and Prevention of Vitamin D Deficiency: an Endocrine Society Clinical Practice Guideline.". J Clin Endocrinol Metab. DOI:10.1210/jc.2011-0385. PMID 21646368. Research Blogging.
- ↑ Gallagher JC, Sai A, Templin T, Smith L (2012). "Dose response to vitamin d supplementation in postmenopausal women: a randomized trial.". Ann Intern Med 156 (6): 425-37. DOI:10.1059/0003-4819-156-6-201203200-00005. PMID 22431675. Research Blogging.