USPSTF lacks evidence to recommend vitamin D deficiency screening in asymptomatic adults

The U.S. Preventive Services Task Force said there is not enough evidence to assess the balance of benefits and harms of vitamin D deficiency screening in nonpregnant, asymptomatic adults.

The “I” statement, which mirrors the USPSTF’s 2014 recommendation in this clinical area, also applies to nonpregnant adults who do not have conditions or diseases for which vitamin D treatment is recommended, the USPSTF said.

The authors of a corresponding evidence report wrote that the statement is based on a review of 46 studies including 16,205 participants. The review failed to demonstrate a significant benefit of vitamin D treatment on mortality, incident fractures, falls, diabetes, cancer, cardiovascular events, depression, physical functioning and infection in asymptomatic adults with low vitamin D levels, according to the authors.

“Before we can know if screening for vitamin D deficiency helps prevent negative health outcomes such as falls, cancer or heart problems, we need to understand the level of vitamin D that is too low,” John Wong, MD, task force member, chief of the division of clinical decision making and a primary care clinician at Tufts Medical Center, said in a press release. “Once the ideal level of vitamin D is identified, then research on whether screening for vitamin D deficiency can improve health outcomes will be helpful.”

The USPSTF wrote that most Americans’ risk for vitamin D deficiency as it pertains to bone health starts at less than 12 ng/mL to 20 ng/mL. The task force added that 5% of the U.S. population aged older than 1 year had vitamin D levels of 12 ng/mL or lower, while 18% of this population group had levels between 12 ng/mL and 19 ng/mL.

Racial, ethnic and disease fluctuations in what constitutes an adequate vitamin D level presents “challenges” to clinicians trying to decide who to screen for vitamin D deficiency, Sherri-Ann M. Burnett-Bowie MD, MPH, a clinical investigator in Massachusetts General Hospital’s Endocrine Unit, and Anne R. Cappola, MD, ScM, a professor of medicine in the division of endocrinology, diabetes and metabolism at the Perelman School of Medicine at the University of Pennsylvania, wrote in a related editorial.

“One approach might be to not measure vitamin D levels and to ensure that all individuals consume the age-based recommended daily allowance of vitamin D,” the pair continued. “Individuals at increased risk for vitamin D deficiency (those who have limited sun exposure, increased skin pigmentation, body mass index of greater than 30, malabsorption or altered gastrointestinal anatomy, chronic kidney disease, chronic liver disease, or who have rickets, osteomalacia, or osteoporosis) could be empirically prescribed a higher dose of vitamin D (eg, 2000 IU/d) that is still below the upper daily limit.”

Burnett-Bowie and Cappola added that until an optimal vitamin D biomarker is identified, clinicians should carefully consider “the balance between investigation and pragmatism” when deciding which patients to screen for vitamin D deficiency.

*Editor’s note: The title was updated on April 20, 2021, to clarify that the USPSTF was unable to make a recommendation for or against vitamin D deficiency screening in asymptomatic adults.

References:

Burnett-Bowie SM, Cappola AR. JAMA. 2021;doi:10.1001/jama.2021.2227.

Kahwati LC, et al. JAMA. 2021;doi:10.1001/26498.

Krist AH, et al. JAMA. 2021;doi:10.1001/jama.2021.3069.