Vitamin D deficiency: Difference between revisions

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==Drug toxicity==
==Drug toxicity==
Daily intake of 1000 mg of elemental calcium as calcium carbonate with 400 IU of vitamin D3 may increase [[urolithiasis]].<ref name="pmid16481635">{{cite journal| author=Jackson RD, LaCroix AZ, Gass M, Wallace RB, Robbins J, Lewis CE et al.| title=Calcium plus vitamin D supplementation and the risk of fractures. | journal=N Engl J Med | year= 2006 | volume= 354 | issue= 7 | pages= 669-83 | pmid=16481635 | doi=10.1056/NEJMoa055218 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=16481635  }}  [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=16813354 Review in: ACP J Club. 2006 Jul-Aug;145(1):4-5]  [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=17076014 Review in: Evid Based Nurs. 2006 Oct;9(4):114] </ref>
Daily intake of 1000 mg of elemental calcium as calcium carbonate with 400 IU of vitamin D3 may increase [[urolithiasis]] according to the [[Women's Health Initiative]] [[randomized controlled trial]].<ref name="pmid16481635">{{cite journal| author=Jackson RD, LaCroix AZ, Gass M, Wallace RB, Robbins J, Lewis CE et al.| title=Calcium plus vitamin D supplementation and the risk of fractures. | journal=N Engl J Med | year= 2006 | volume= 354 | issue= 7 | pages= 669-83 | pmid=16481635 | doi=10.1056/NEJMoa055218 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=16481635  }}  [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=16813354 Review in: ACP J Club. 2006 Jul-Aug;145(1):4-5]  [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=17076014 Review in: Evid Based Nurs. 2006 Oct;9(4):114] </ref>
 
 
{| class="wikitable" border="1" align="right"
|+ Absolute rates of outcomes<ref name="pmid16481635">{{cite journal| author=Jackson RD, LaCroix AZ, Gass M, Wallace RB, Robbins J, Lewis CE et al.| title=Calcium plus vitamin D supplementation and the risk of fractures. | journal=N Engl J Med | year= 2006 | volume= 354 | issue= 7 | pages= 669-83 | pmid=16481635 | doi=10.1056/NEJMoa055218 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=16481635  }}  [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=16813354 Review in: ACP J Club. 2006 Jul-Aug;145(1):4-5]  [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=17076014 Review in: Evid Based Nurs. 2006 Oct;9(4):114] </ref>
! &nbsp!! Vitamin D plus calcium<br/>(18,176 patients)!! Placebo<br/>(18,106 patients)!!Absolute difference !!Number needed<ref name="pmid16813354">{{cite journal| author=Fletcher RH| title=Calcium plus vitamin D did not prevent hip fracture or colorectal cancer in postmenopausal women. | journal=ACP J Club | year= 2006 | volume= 145 | issue= 1 | pages= 4-5 | pmid=16813354 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=16813354  }} </ref>
|-
| [[Hip fracture]]s||175|| 199 ||24 less in supplementation group||1986 to treat*
|-
| [[Urolithiasis]]|| 449|| 381 ||68 more in supplementation group|| 284 to harm
|-
| colspan=5|* Among compliant patients. There was no significant benefit among all patients (absolute rate difference of 0.02 would indicate a number needed to treat of 5000 if the value were significant in a larger study).
|}


==Screening==
==Screening==

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In medicine, vitamin D deficiency is "a nutritional condition produced by a deficiency of vitamin D in the diet, insufficient production of vitamin D in the skin, inadequate absorption of vitamin D from the diet, or abnormal conversion of vitamin D to its bioactive metabolites. It is manifested clinically as rickets in children and osteomalacia in adults."[1]

Recommended serum levels are 20 ng/mL (50 nmol/L) according to the Institute of Medicine (IOM)[2] and 30 ng/mL (75 nmol/L) according to the International Osteoporosis Foundation and National Osteoporosis Foundation.[3]

Institute of Medicine states (page 13):

  • Levels over 20 ng/ml: "Practically all persons are sufficient"
  • Levels 12-20 ng/ml: "Some, but not all, persons are potentially at risk for inadequacy."
  • Levels below 12 ng/ml: "persons are at risk of deficiency."

The IOM based their recommendations in part on a prior systematic review by the Agency for Healthcare Research and Quality.[4]

Epidemiology and prevalence

About a quarter of older adults have levels below 20 ng/mL.[5]

Low levels of vitamin D are common in medical inpatients.[6]

"The FokI, BsmI, ApaI, and TaqI VDR polymorphisms are not associated with BMD or with fractures, but the Cdx2 polymorphism may be associated with risk for vertebral fractures" according to an observational study.[7] However, TaqI and FokI polymorphisms of the vitamin D receptor may be important to treatment of Mycobacterium tuberculosis.[8]

Diagnosis

Symptoms

Vitamin D was reported to be associated with widespread musculoskeletal pain like fibromyalgia[9].[10] However, this was an uncontrolled study and more recent studies make the associated between Vitamin D and non-specific pain doubtful[11] and suggest that earlier recommendations[9] to screen patients with musculoskeletal pain for deficiency of vitamin D may not be justified.

Laboratory test

The serum level of 25-hydroxyvitamin D is the best metabolize to assay.[12][13] Assay method influences the result.[14]

Treatment

Clinical practice guidelines direct treatment.[15] Treatment of adults can be either 50,000 IU of D2 or D3 once a week for eight weeks or 6,000 IU daily. This is followed by 1,500 to 2,000 IU per day. Some populations may require higher doses.

A more recent randomized controlled trial showed that, among white women with vitamin D insufficiency and deficiency, a dose of 600 to 800 IU per day of vitamin D3 will raise the level above Institute of Medicine recommendations (20 ng/mL or 50 nmol/L) in 97% of women.[16]

Drug toxicity

Daily intake of 1000 mg of elemental calcium as calcium carbonate with 400 IU of vitamin D3 may increase urolithiasis according to the Women's Health Initiative randomized controlled trial.[17]


Absolute rates of outcomes[17]
&nbsp Vitamin D plus calcium
(18,176 patients)		 Placebo
(18,106 patients)		 Absolute difference Number needed[18]
Hip fractures 175 199 24 less in supplementation group 1986 to treat*
Urolithiasis 449 381 68 more in supplementation group 284 to harm
* Among compliant patients. There was no significant benefit among all patients (absolute rate difference of 0.02 would indicate a number needed to treat of 5000 if the value were significant in a larger study).

Screening

Clinical practice guidelines suggest screening of special populations with the 25-hydroxyvitamin D [25(OH)D] assay.[15]

References

  1. ↑ Anonymous (2024), Vitamin D deficiency (English). Medical Subject Headings. U.S. National Library of Medicine.
  2. ↑ Committee to Review Dietary References Intakes for Vitamin D and Calcium. Ross AC et al., editors. (2010) Dietary References Intakes for Calcium and Vitamin D. Institute of Medicine.
  3. ↑ Dawson-Hughes B, Mithal A, Bonjour JP, Boonen S, Burckhardt P, Fuleihan GE et al. (2010). "IOF position statement: vitamin D recommendations for older adults.". Osteoporos Int 21 (7): 1151-4. DOI:10.1007/s00198-010-1285-3. PMID 20422154. Research Blogging.
  4. ↑ Chung M, Balk EM, Brendel M, Ip S, Lau J, Lee J et al. (2009). "Vitamin D and calcium: a systematic review of health outcomes.". Evid Rep Technol Assess (Full Rep) (183): 1-420. PMID 20629479. [e]
  5. ↑ Orwoll E, Nielson CM, Marshall LM, et al (April 2009). "Vitamin D deficiency in older men". J. Clin. Endocrinol. Metab. 94 (4): 1214–22. DOI:10.1210/jc.2008-1784. PMID 19174492. Research Blogging.
  6. ↑ Thomas MK, Lloyd-Jones DM, Thadhani RI, et al (1998). "Hypovitaminosis D in medical inpatients". N. Engl. J. Med. 338 (12): 777–83. PMID 9504937. [e]
  7. ↑ Uitterlinden AG, Ralston SH, Brandi ML, Carey AH, Grinberg D, Langdahl BL et al. (2006). "The association between common vitamin D receptor gene variations and osteoporosis: a participant-level meta-analysis.". Ann Intern Med 145 (4): 255-64. PMID 16908916. [e]
  8. ↑ Martineau AR, Timms PM, Bothamley GH, Hanifa Y, Islam K, Claxton AP et al. (2011). "High-dose vitamin D(3) during intensive-phase antimicrobial treatment of pulmonary tuberculosis: a double-blind randomised controlled trial.". Lancet 377 (9761): 242-50. DOI:10.1016/S0140-6736(10)61889-2. PMID 21215445. Research Blogging.
  9. ↑ 9.0 9.1 Plotnikoff GA, Quigley JM (2003). "Prevalence of severe hypovitaminosis D in patients with persistent, nonspecific musculoskeletal pain". Mayo Clin. Proc. 78 (12): 1463–70. PMID 14661675. [e] Cite error: Invalid <ref> tag; name "pmid14661675" defined multiple times with different content
  10. ↑ Hicks GE, Shardell M, Miller RR, et al (May 2008). "Associations between vitamin D status and pain in older adults: the Invecchiare in Chianti study". J Am Geriatr Soc 56 (5): 785–91. DOI:10.1111/j.1532-5415.2008.01644.x. PMID 18331295. Research Blogging.
  11. ↑ Warner AE, Arnspiger SA (February 2008). "Diffuse musculoskeletal pain is not associated with low vitamin D levels or improved by treatment with vitamin D". J Clin Rheumatol 14 (1): 12–6. DOI:10.1097/RHU.0b013e31816356a9. PMID 18431091. Research Blogging.
  12. ↑ Rosen, Clifford J. (2011-01-20). "Vitamin D Insufficiency". New England Journal of Medicine 364 (3): 248-254. DOI:10.1056/NEJMcp1009570. ISSN 0028-4793. Research Blogging.
  13. ↑ Pearce SH, Cheetham TD (2010). "Diagnosis and management of vitamin D deficiency.". BMJ 340: b5664. DOI:10.1136/bmj.b5664. PMID 20064851. Research Blogging.
  14. ↑ Barake M, Daher RT, Salti I, Cortas NK, Al-Shaar L, Habib RH et al. (2012). "25-hydroxyvitamin d assay variations and impact on clinical decision making.". J Clin Endocrinol Metab 97 (3): 835-43. DOI:10.1210/jc.2011-2584. PMID 22238386. Research Blogging.
  15. ↑ 15.0 15.1 Holick MF, Binkley NC, Bischoff-Ferrari HA, Gordon CM, Hanley DA, Heaney RP et al. (2011). "Evaluation, Treatment, and Prevention of Vitamin D Deficiency: an Endocrine Society Clinical Practice Guideline.". J Clin Endocrinol Metab. DOI:10.1210/jc.2011-0385. PMID 21646368. Research Blogging.
  16. ↑ Gallagher JC, Sai A, Templin T, Smith L (2012). "Dose response to vitamin d supplementation in postmenopausal women: a randomized trial.". Ann Intern Med 156 (6): 425-37. DOI:10.1059/0003-4819-156-6-201203200-00005. PMID 22431675. Research Blogging.
  17. ↑ 17.0 17.1 Jackson RD, LaCroix AZ, Gass M, Wallace RB, Robbins J, Lewis CE et al. (2006). "Calcium plus vitamin D supplementation and the risk of fractures.". N Engl J Med 354 (7): 669-83. DOI:10.1056/NEJMoa055218. PMID 16481635. Research Blogging. Review in: ACP J Club. 2006 Jul-Aug;145(1):4-5 Review in: Evid Based Nurs. 2006 Oct;9(4):114
  18. ↑ Fletcher RH (2006). "Calcium plus vitamin D did not prevent hip fracture or colorectal cancer in postmenopausal women.". ACP J Club 145 (1): 4-5. PMID 16813354. [e]
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