How Much Vitamin D Do We Need for Skeletal Health?

Abstract

Background Vitamin D is critical for musculoskeletal health and has been implicated in the risk of extraskeletal diseases, including cancer, cardiovascular diseases, and autoimmune diseases, as well as overall mortality. Although numerous studies deal and have dealt with vitamin D deficiency and its consequences, experts cannot agree on the right 25-hydroxyvitamin D levels. This survey aims to shed light on the ongoing vitamin D controversy from different angles. Questions/purposes We discuss the minimum threshold for the 25-hydroxyvitamin D level to guarantee optimal health, why vitamin is D critical to musculoskeletal and extraskeletal functions, and new evidence for the success of prevention measures such as food fortification. Methods We searched PubMed, Google Scholar, and reference lists of articles using several keywords. The most recent search was in February 2011. Results While the use of parathyroid hormone as a surrogate measure did not lead to a consensus concerning the required 25-hydroxyvitamin D serum level, the combined analysis of bone mineralization and vitamin D status has established minimum levels of more than 75 nmol/L (30 ng/mL) to guarantee at least skeletal health. An effective measure to approach this status is food fortification, which has been demonstrated by countries such as Canada, the United States, and Finland. Conclusions Given the health economic implications of failure to maintain a balanced vitamin D status, action is recommended to integrate current scientific knowledge on vitamin D into physicians' treatment of patients and governmental policies on food fortification.

Vitamin D Insufficiency in Patients With THA: Prevalence and Effects on Outcome

“…Although the primary function of vitamin D is to maintain serum calcium homeostasis, it has also been associated with disease and poor results after surgery [8,[18][19][20][21]26]. Controversy exists on the actual prevalence of vitamin D insufficiency worldwide in large measure because of the lack of consensus on how to define adequate serum levels of 25-hydroxyvitamin-D3 [22].…”

“…It has also been implicated in the risk of overall mortality [26], cancer [19,21,26], diabetes [21,26], musculoskeletal disorders [16,26], hypertension [21,26], heart disease [21,26], multiple sclerosis [19], stroke [21], and even falls [4,8,20]. Recent epidemiologic data suggest a widespread deficiency of vitamin D [13,18].…”

“…Even though hypovitaminosis D is the accepted term for insufficient or deficient levels [18], in view of the current lack of consensus on what level defines the low end of the normal range (and much more on the derived terms), we will refer to all patients with subnormal levels as patients with insufficiency for the sake of simplicity. What appears clear is that this vitamin is associated with a number of diseases [16,18,26] and, in some reports, with poorer results after surgery [14,15,18]; however, findings on the latter point have varied among studies [24,25].…”

Carência de Vitamina D numa População Hospitalar: Uma Fotografia pela Perspetiva Laboratorial

“…Trata-se de um problema transversal a todas as idades nos países ocidentais, mas também na Ásia e Médio Oriente, e que tem vindo a aumentar. 6,[8][9][10] Mesmo em países tropicais as populações urbanas têm elevada prevalência de hipovitaminose D. 4 Em Portugal, não existem estudos epidemiológicos acerca da prevalência de valores inadequados de vitamina D. Todavia, vários estudos europeus mostram proporções importantes de carência de vitamina D, sendo expectável que a realidade portuguesa seja semelhante.…”

Bone Repair and Regeneration: Editorial Comment

“…If so, treatment modalities should specifically address the distinct aspects of the immune responses after injury. Finally and from a completely different perspective, von Domarus et al [6] describe the relevance of vitamin D for skeletal health and cancer prevention. Such a link is important to understand since a substantial portion of the global population suffers from a vitamin D deficit.…”