July 2011, 96(7):1911–1930
Title: Evaluation, Treatment, and Prevention of Vitamin D Deficiency: an Endocrine Society Clinical Practice Guideline
Objective: The objective was to provide guidelines to clinicians for the evaluation, treatment, and prevention of vitamin D deficiency with an emphasis on the care of patients who are at risk for deficiency.
Participants: The Task Force was composed of a Chair, six additional experts, and a methodologist. The Task Force received no corporate funding or remuneration.
Consensus Process: Consensus was guided by systematic reviews of evidence and discussions during several conference calls and email communications. The draft prepared by the Task Force was reviewed successively by The Endocrine Society’s Clinical Guidelines Subcommittee, Clinical Affairs Core Committee, and cosponsoring associations, and it was posted on The Endocrine Society website for member review. At each stage of review, the Task Force received written comments and incorporated needed changes.
Conclusions: 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 D2 or vitamin D3 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.
Who is at risk?
Individuals with a history of...
- Chronic kidney disease
- Hepatic failure
- Malabsorption syndromes
- Cystic fibrosis
- Inflammatory bowel disease
- Crohn’s disease
- Bariatric surgery
- Radiation enteritis
- Granuloma-forming disorders
- Some lymphomas
Populations at risk include...
- African-American and Hispanic children and adults
- Pregnant and lactating women
- Older adults with history of falls
- Older adults with history of nontraumatic fractures
- Obese children and adults (BMI 30 kg/m2)
Individuals on the following medications...
- Antiseizure medications
- AIDS medications
What is deficiency?
Using the serum circulating 25-hydroxyvitamin D [25(OH)D] level:
- Vitamin D deficiency is defined as a 25(OH)D below 20 ng/ml (50 nmol/liter)
- Vitamin D insufficiency as a 25(OH)D of 21–29 ng/ml (525–725 nmol/liter)
Paper suggests using either vitamin D2 or vitamin D3 for the treatment and prevention of vitamin D deficiency.