Vit D Guidelines

New Clinical Practice Guidelines for Vitamin D Deficiency

 

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The Endocrine Society has released new clinical practice guidelines calling for circulating vitamin D concentrations of 30 to 60 ng/mL (75-150 nmol/L). The guidelines were designed to help you evaluate, treat, and prevent vitamin D deficiency with an emphasis on the care of patients who are at risk for deficiency. Vitamin D deficiency is very common in all age groups, so it is important that you have the latest evidence-based recommendations for evaluating, treating and preventing vitamin D deficiency in patients at highest risk.

Although the Institute of Medicine published new general guidelines in November 2010, its recommendations were not intended to direct healthcare providers on care of patients. The Endocrine Society presented its new guidelines at the Endocrine Society’s new Clinical Practice Guidelines for Vitamin D at the 93rd annual meeting of the association in Boston, MA, June 4-7, 2011 and simultaneously published in the June 2011 issue of Journal of Clinical Endocrinology and Metabolism.

The major source of vitamin D for children and adults is exposure to natural sunlight as very few foods naturally contain or are fortified with vitamin D. However, vitamin D synthesis from sunlight is unreliable as a sole source of vitamin D as exposure can vary widely depending on geographic location, season of the year, and even skin color.

Vitamin D deficiency is common throughout the world and results in abnormalities of calcium, phosphorus and bone metabolism which can lead to muscle weakness, osteomalacia, osteopenia and osteoporosis. In children, vitamin D deficiency can result in skeletal deformities known as rickets.

According to these guidelines, people at high risk for vitamin D deficiency (eg, Hispanics, blacks, pregnant women, obese individuals) should be screened for low vitamin D levels, but general population screening is not recommended.

The guidelines also feature recommendations for dietary intake of vitamin D in patients at risk of vitamin D deficiency. These recommendations include—

  • Infants and children ages 0 through 1: at least 400 IU/day (IU=25 ng) of vitamin D; children 1 year and older require at least 600 IU/day to mL to maximize bone health. To raise the blood level of vitamin D consistently above 30 ng/mL may require at least 1,000 IU/day of vitamin D
  • Adults aged 19 through 50 years: at least 600 IU/day of vitamin D to maximize bone health and muscle function; at least 1,500 to 2,000 IU/day of vitamin D may be needed to maintain blood level of vitamin D above 30 ng/mL
  • Adults aged 50 through 70 years: at least 600 IU/day of vitamin D; at least 1,500-2,000 IU/day of vitamin D may be needed to maintain blood level of vitamin D above 30 ng/mL
  • Adults older than 70: at least 800 IU/day of vitamin D; at least 1,500-2,000 IU/day of vitamin D may be needed to maintain blood level of vitamin D above 30 ng/mL
  • Pregnant and lactating women: at least 600 IU/day of vitamin D and at least 1,500 IU/day of vitamin D may be needed to maintain blood level of vitamin D above 30 ng/mL

Circulating serum levels of 25-hydroxyvitamin D below 20 ng/mL should be considered deficient, the society says. The society also offers recommended dietary intakes for at-risk groups, as well as guidance on using vitamin D2 or D3 supplements for treatment and the guidelines recommend against using supplementation with vitamin D to prevent cardiovascular disease or to enhance quality of life.

Jill Shuman, MS, ELS
Published on June 21, 2011


Source: Holick MF, Binkley NC, Bischoff-Ferrari HA, et al. Evaluation, treatment and prevention of vitamin D deficiency: an endocrine society clinical practice guideline [published online ahead of print June 6, 2011]. J Clin Endo Metab. http://www.ncbi.nlm.nih.gov/pubmed/21646368