Optimal Vitamin D Status: A Critical Analysis on the Basis of Evidence-Based Medicine

Bouillon, Roger; Schoor, Natasja M. van; Gielen, Evelien; Boonen, Steven; Mathieu, Chantal; Vanderschueren, Dirk; Lips, Paul

doi:10.1210/jc.2013-1195

Cited by 250 publications

(241 citation statements)

References 263 publications

(198 reference statements)

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“…The optimal levels of 25(OH)D and the definition of vitamin D insufficiency remain controversial both for the general population and for patients with CKD 153, 154. Whereas KDIGO and the US Society of Endocrinology favour maintaining 25(OH)D levels between 30 to 50 ng/mL (75 to 125 nmol/L),154, 155 the Institute of Medicine and the World Health Organisation favour the range 20 to 40 ng/mL (50 to 100 nmol/L) 156, 157.…”

Section: Controversies In the Definition Of Vitamin D Insufficiency Imentioning

confidence: 99%

“…In non‐CKD population, vitamin D supplementation to achieve the 25(OH)D target concentration of 28 to 40 ng/mL (70 to 100 nmol/L) lowered fracture risk 164, 165, 166. However, cross‐sectional studies do not agree on the 25(OH)D threshold level needed to maximize BMD and even suggest that BMD may not improve with vitamin D supplementation once baseline levels of 25(OH)D are >20 ng/mL 153. Moreover, chronic 25(OH)D levels >40 ng/mL (100 nmol/L) after a single annual dose of 500 000 IU of cholecalciferol increased the risk of fractures 167.…”

Section: Controversies In the Definition Of Vitamin D Insufficiency Imentioning

confidence: 99%

“…There are currently insufficient data to determine the safe upper limit of serum 25(OH)D 153. Although the safety margin to minimize the risk of hypercalcaemia as 25(OH)D equal to 100 ng/mL (250 nmol/L), there are some concerns at serum 25(OH)D levels above 50 ng/mL (125 nmol/L).…”

Section: Controversies In the Definition Of Vitamin D Insufficiency Imentioning

confidence: 99%

See 2 more Smart Citations

Vitamin D, a modulator of musculoskeletal health in chronic kidney disease

Molina

Carrero

Bover

et al. 2017

J cachexia sarcopenia muscle

102

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The spectrum of activity of vitamin D goes beyond calcium and bone homeostasis, and growing evidence suggests that vitamin D contributes to maintain musculoskeletal health in healthy subjects as well as in patients with chronic kidney disease (CKD), who display the combination of bone metabolism disorder, muscle wasting, and weakness. Here, we review how vitamin D represents a pathway in which bone and muscle may interact. In vitro studies have confirmed that the vitamin D receptor is present on muscle, describing the mechanisms whereby vitamin D directly affects skeletal muscle. These include genomic and non‐genomic (rapid) effects, regulating cellular differentiation and proliferation. Observational studies have shown that circulating 25‐hydroxyvitamin D levels correlate with the clinical symptoms and muscle morphological changes observed in CKD patients. Vitamin D deficiency has been linked to low bone formation rate and bone mineral density, with an increased risk of skeletal fractures. The impact of low vitamin D status on skeletal muscle may also affect muscle metabolic pathways, including its sensitivity to insulin. Although some interventional studies have shown that vitamin D may improve physical performance and protect against the development of histological and radiological signs of hyperparathyroidism, evidence is still insufficient to draw definitive conclusions.

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Section: Controversies In the Definition Of Vitamin D Insufficiency Imentioning

confidence: 99%

Section: Controversies In the Definition Of Vitamin D Insufficiency Imentioning

confidence: 99%

See 1 more Smart Citation

Vitamin D, a modulator of musculoskeletal health in chronic kidney disease

Molina

Carrero

Bover

et al. 2017

J cachexia sarcopenia muscle

102

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“…A large number of people around the world have low serum 25(OH)D concentrations which may increase their risk for skeletal and possibly also for extra-skeletal diseases and risks (18,19 Although several groups confirmed low DBP levels in African Americans (21-24) using the monoclonal R&D assay, questions were rapidly raised as to whether the monoclonal R&D assay used in these studies could be relied upon to measure polymorphic DBP as present in the serum of subjects of different races or DBP/GC genotypes (25). …”

Section: Introductionmentioning

confidence: 99%

Vitamin D metabolites in captivity? Should we measure free or total 25(OH)D to assess vitamin D status?

Bikle

Bouillon

Thadhani

et al. 2017

The Journal of Steroid Biochemistry and Molecular Biology

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145

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“…This cannot be compensated by promoting natural vitamin D-rich food as there is simply not enough fatty fish in the ocean. Therefore vitamin D supplementation (either as vitamin D enriched food or by intake of supplements) will remain necessary for all infants and young children, for most elderly subjects and for other risk groups [2,3]. The major remaining questions are the overall health implications of vitamin D beyond bone health, the precise requirements (and thus the definition of vitamin D deficiency and the associated serum 25OHD concentrations) and the practical modalities to implement and maintain this supplementation for many years or for a lifetime to millions or even billions of people in a cost efficient way.…”

mentioning

confidence: 99%

Optimal vitamin D supplementation strategies

Bouillon

2017

Endocrine

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Humans survived evolution without vitamin D-rich food or without vitamin D supplementation until vitamin D deficiency, rickets, became a major health problem from the 17th century onwards [1]. During the 20 th century, it became clear that exposure to sunlight and UVB should be avoided (infants and young children), or limited because of life time risks of skin damage or skin cancers. Moreover, voluntary avoidance (e.g. for cultural or religious reasons) of sun exposure or mismatch between skin color and climate (dark skinned immigrants living in Northern or Southern latitudes) severely limits the endogenous production of vitamin D well below the normal vitamin D requirements. This cannot be compensated by promoting natural vitamin D-rich food as there is simply not enough fatty fish in the ocean. Therefore vitamin D supplementation (either as vitamin D enriched food or by intake of supplements) will remain necessary for all infants and young children, for most elderly subjects and for other risk groups [2,3]. The major remaining questions are the overall health implications of vitamin D beyond bone health, the precise requirements (and thus the definition of vitamin D deficiency and the associated serum 25OHD concentrations) and the practical modalities to implement and maintain this supplementation for many years or for a lifetime to millions or even billions of people in a cost efficient way. Vitamin D is rapidly cleared from the circulation after its oral intake but it has nevertheless a long biological life time and its major metabolite, 25OHD, has a half-life of about 2 weeks [4]. As to enhance compliance, high dose intermittent therapy (once every 6-12 months) has been introduced in the past but several recent studies documented either transient hypercalcemia in children [5] or transient increased risks of falls or fractures [6,7] and therefore this strategy is no longer a valid option. Daily, weekly or monthly use of vitamin D (in equivalent cumulative dosage) could enhance long term compliance depending on the behavior or preference of the target groups. Whether such intermittent therapy generates the same vitamin D status has been studied by a group of Hungarian scientists [8]. They randomized modestly vitamin D deficient adults (mean age 53 years; mean baseline 25OHD of~13 ng/ml) to receive either daily (1000 IU), weekly (7000 IU) or monthly (30,000 IU) doses of vitamin D 3 and found very similar increase in the serum 25OHD after 3 months. This conclusion was essentially the same whether or not the data were corrected for several potentially confounding factors. The increase in serum 25OHD was about 1.3 ng/100 IU, in line with most previous studies in subjects with a similarly low baseline vitamin D status. The results confirm a previous (equally small) study in elderly subjects (mean age of 80 years [9]), whereas others found a slightly lower efficacy of monthly compared to daily or weekly doses [10]. Collectively, however, these reports confirm that these strategies yield essentially similar results ...

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Optimal Vitamin D Status: A Critical Analysis on the Basis of Evidence-Based Medicine

Cited by 250 publications

References 263 publications

Vitamin D, a modulator of musculoskeletal health in chronic kidney disease

Vitamin D, a modulator of musculoskeletal health in chronic kidney disease

Vitamin D metabolites in captivity? Should we measure free or total 25(OH)D to assess vitamin D status?

Optimal vitamin D supplementation strategies

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