June 6, 2011 The Endocrine Society has released "Evaluation, Treatment, and Prevention of Vitamin D Deficiency: An Endocrine Society Clinical Practice Guideline." The clinical practice guideline (CPG) is published in the July 2011 issue of the Journal of Clinical Endocrinology & Metabolism (JCEM), a publication of The Endocrine Society.
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. 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.
"Vitamin D deficiency is very common in all age groups and it is important that physicians and health care providers have the best evidence-based recommendations for evaluating, treating and preventing vitamin D deficiency in patients at highest risk," said Michael F. Holick, PhD, MD, of the Boston University School of Medicine and chair of the task force that authored the CPG. "The Society's new Clinical Practice Guideline was developed by experts in the field who carefully reviewed the current literature and features the latest and most comprehensive recommendations available on the prevention and treatment of vitamin D deficiency."
Recommendations from the CPG include:
- Screening for vitamin D deficiency in individuals at risk for deficiency;
- Measurement of vitamin D level by a reliable assay as the initial diagnostic test in patients at risk for deficiency; and
- Treatment with either vitaminD2 or vitamin D3 for deficient patients.
The CPG also features recommendations for dietary intake of vitamin D in patients at risk for vitamin D deficiency. These recommendations include:
- Infants and children ages 0-1 year require at least 400 IU/day (IU=25 ng) of vitamin D and children 1 year and older require at least 600 IU/day 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 19-50 years require at least 600 IU/day of vitamin D to maximize bone health and muscle function and 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 aged 50-70 years and adults older than 70 years require at least 600 IU/day and 800 IU/day respectively 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; and
- Pregnant and lactating women require 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.
"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 non-calcemic benefit for cardiovascular protection," said Holick.
Other members of The Endocrine Society task force that developed this CPG include: Neil Binkley of the University of Wisconsin; Heike Bischoff-Ferrari of University Hospital Zurich in Switzerland; Catherine Gordon of Children's Hospital Boston; David Hanley of the University of Calgary Facility of Medicine in Canada; Robert Heaney of Creighton University in Omaha, Neb.; M. Hassan Murad of Mayo Clinic in Rochester, Minn.; and Connie Weaver of Purdue University in West Lafayette, Ind.
The Society established the Clinical Practice Guideline (CPG) Program to provide endocrinologists and other clinicians with evidence-based recommendations in the diagnosis and treatment of endocrine-related conditions. Each CPG is created by a task force of topic-related experts in the field. Task forces rely on scientific reviews of the literature in the development of CPG recommendations. The Endocrine Society does not solicit or accept corporate support for its CPGs. All CPGs are supported entirely by Society funds.
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- M. E. Molitch, D. R. Clemmons, S. Malozowski, G. R. Merriam, M. L. Vance. Evaluation and Treatment of Adult Growth Hormone Deficiency: An Endocrine Society Clinical Practice Guideline. Journal of Clinical Endocrinology & Metabolism, 2011; 96 (6): 1587 DOI: 10.1210/jc.2011-0179
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