Italian Association of Clinical Endocrinologists (AME) and Italian Chapter of the American Association of Clinical Endocrinologists (AACE) Position Statement: Clinical Management of Vitamin D Deficiency in Adults

Abstract

Vitamin D deficiency is very common and prescriptions of both assay and supplementation are increasing more and more. Health expenditure is exponentially increasing, thus it is timely and appropriate to establish rules. The Italian Association of Clinical Endocrinologists appointed a task force to review literature about vitamin D deficiency in adults. Four topics were identified as worthy for the practicing clinicians. For each topic recommendations based on scientific evidence and clinical practice were issued according to the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) System. (1) What cut-off defines vitamin D deficiency: even though 20 ng/mL (50 nmol/L) can be considered appropriate in the general population, we recommend to maintain levels above 30 ng/mL (75 nmol/L) in categories at risk. (2) Whom, when, and how to perform screening for vitamin D deficiency: categories at risk (patients with bone, liver, kidney diseases, obesity, malabsorption, during pregnancy and lactation, some elderly) but not healthy people should be screened by the 25-hydroxy-vitamin D assay. (3) Whom and how to treat vitamin D deficiency: beyond healthy lifestyle (mostly sun exposure), we recommend oral vitamin D (vitamin D2 or vitamin D3) supplementation in patients treated with bone active drugs and in those with demonstrated deficiency. Dosages, molecules and modalities of administration can be profitably individually tailored. (4) How to monitor the efficacy of treatment with vitamin D: no routine monitoring is suggested during vitamin D treatment due to its large therapeutic index. In particular conditions, 25-hydroxy-vitamin D can be assayed after at least a 6-month treatment. We are confident that this document will help practicing clinicians in their daily clinical practice.

Hypovitaminosis D and Aging: Is There a Role in Muscle and Brain Health?

“…In order to understand these conflicting results, it is important to highlight that the subjects included in those papers were not affected by hypovitaminosis D and were treated with doses much higher than the ones recommended in clinic [19]. Hence, the conclusions from those papers can only be that too much vitamin D, if it is not needed, may be detrimental for unknown reasons.…”

Dietary Antioxidants: Micronutrients and Antinutrients in Physiology and Pathology

“…The EFSA Panel stated that it should be clearly specified if certain subgroups of the population are excluded from the intended uses (e.g., pregnant and lactating women, infants) [6]. Rizzo et al [8] concluded that evidence from clinical trials is inadequate to draft any definitive conclusion regarding vitamin D supplementation in pregnant women and there are still unanswered questions regarding vitamin D supplementation and target levels also for the general population [9,10].…”

Towards a personalized assessment of vitamin D status

“…However, the interpretation of 25(OH)D and 24,25(OH) 2 D results is still a matter of intensive debate. Previous studies have established reference intervals [17,18] and clinical cut-offs [19][20][21][22]. However, the close relationship between 25(OH)D and 24,25(OH) 2 D implies that a meaningful interpretation is only possible when both metabolites are considered together.…”

“…Cavalier et al suggest that in clinical practice the concentrations of 24,25(OH) 2 D and 25(OH)D should be reported together with the probability that this constellation occurs in healthy subjects. This information would help physicians judging their patients' metabolic status in a more dynamic fashion and leave the historical concept of vitamin D deficiency on the basis of a universal 25(OH)D cut-off [19][20][21][22]. With the established 25(OH)D cut-offs a large portion of the population has vitamin D deficiency or at least insufficiency,…”

“…When one measurand has a much lower concentration than the other, calculating the ratio between the two enhances the intrinsic meas- be reported together with the probability that this constellation occurs in healthy subjects. This information would help physicians judging their patients' metabolic status in a more dynamic fashion and leave the historical concept of vitamin D deficiency on the basis of a universal 25(OH)D cut-off [19][20][21][22]. With the established 25(OH)D cut-offs a large portion of the population has vitamin D deficiency or at least insufficiency, which, in many cases, would trigger vitamin D supplementation even in the absence of risk factors for metabolic bone disease or manifest osteoporosis [20,28,29].…”