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Endocrine Society publishes clinical practice guidelines for vitamin D deficiency
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The Endocrine Society published guidelines for the evaluation, treatment and prevention of vitamin D deficiencies.
Screening is recommended for individuals at risk for vitamin D deficiency. Population screening or screening of those not at risk is contraindicated.
The serum circulating 25-hydroxyvitamin D level should be used to evaluate high-risk individuals for deficiency, which is defined as a 25-(OH)D <20 ng/mL. Deficiency also may include insufficiency, which is defined as 25-(OH)D of 21 ng/mL to 29 ng/mL.
Recommended dosing
Infants younger than 1 year should receive at least 400 IU/day vitamin D. Children older than 1 year should receive 600 IU/day. The investigators said these dosing levels may not protect children from all potential risks or provide all potential benefits. A minimum of 600 IU/day is recommended for those aged 19 to 50 years, adults aged 50 to 70 years, and pregnant and lactating women. This recommended dose is increased to 800 IU/day for adults older than 70 years. Whether these doses have a true, consistent, protective effect in these population subgroups is unknown.
Clinicians should consult the recommendations for doses that will maintain 25-(OH)D >30 ng/mL in various population subgroups.
Obese children and adults should be given at least twice or three times the vitamin D requirements previously specified, as should all individuals taking anticonvulsant medications, glucocorticoids, antifungals such as ketoconazole and medications for AIDS.
Maximum tolerable limits include 1,000 IU/day for infants to age 6 months; 1,500 IU/day for those aged 6 months to 1 year, at least 2,500 IU for children aged 1 to 3 years, 3,000 IU for children aged 4 to 8 years and 4,000 IU for anyone older than 8 years. The investigators said limits may be exceeded in individuals with deficiencies but should not be exceeded without supervision from a health care professional.
Deficiencies may be treated with vitamin D2 or vitamin D3. Deficient infants may receive 2,000 IU/day or as much as 50,000 IU/week of one of the recommended vitamin D types. This also is the upper limit for deficient adults. Clinicians should view the full document for dosing information in vitamin D-deficient patients, obese individuals, those with malabsorption syndromes and individuals taking medications that may affect the body’s metabolism of vitamin D. The goal of treatment of deficiency should be a 25-(OH)D level of 30 ng/mL.
Close monitoring of 25-(OH)D may prevent hyperglycemia in those with extra-renal production of 1,25-(OH)D.
During vitamin D treatment for primary hyperparathyroidism and vitamin D deficiency, serum calcium levels should be monitored.
Vitamin D may be used to prevent falls but is not recommended for preventing cardiovascular disease, death or improving quality of life.
USPSTF recommendations
Just more than 1 year after the Endocrine Society published its guidelines for vitamin D deficiency, the U.S. Preventative Services Task Force (USPSTF) issued its own review and recommendation, agreeing that people who are not at risk should not be screened.
The USPSTF researchers found no direct evidence that vitamin D screening had any effect on clinical outcomes, and that treating asymptomatic vitamin D deficiency had no benefits in terms of cancer and type 2 diabetes.
While there was some evidence that treating vitamin D deficiency outside of an institutional setting could reduce fall risks, it still would not do the same for fracture or mortality risks.
The researchers concluded that their recommendations show the need for further investigation into vitamin D.
For more information, visit:
LeBlanc ES, et al. Ann Intern Med. 2014;doi:10.7326/M14-1659.
LeFevre ML, et al. Ann Intern Med. 2014;doi:10.7326/M14-2450.