Why USPSTF Still Finds Insufficient Evidence to Support Screening for Vitamin D Deficiency

Abstract

In 2014, the United States Preventive Services Task Force (USPSTF) concluded that among community-dwelling asymptomatic adults aged 18 years and older, there was insufficient evidence (ie, I statement) to assess the balance of benefits and harms of screening for vitamin D deficiency in asymptomatic adults. 1 Over the past 7 years, many randomized clinical trials (RCTs) have evaluated vitamin D supplementation for improving primary or secondary outcomes of cardiovascular disease, cancer, diabetes, depression, bone health, and falls, 2-8 necessitating a reevaluation of whether screening for vitamin D insufficiency might be worthwhile. The evidence is still not there to inform this decision. 9,10 Screening is the routine evaluation of an asymptomatic population with the goal of detection of a disease, when the natural course of that disease can be altered by early intervention. The benefits of screening in a population need to outweigh any potential harms that might arise from false positive tests, inappropriate downstream testing, and overtreatment of so-called pseudodisease. 11Open Access. This is an open access article distributed under the terms of the CC-BY License.

The Relationship of Falls With Achieved 25-Hydroxyvitamin D Levels From Vitamin D Supplementation: The STURDY Trial

“…In light of the growing evidence showing lack of benefit with vitamin D supplementation [ 16 ] or potential for harm [ 17-19 , 33 , 34 ] for musculoskeletal outcomes, in 2018 the US Preventive Services Task Force reversed its recommendations from 2012, which had previously advised vitamin D supplementation for falls prevention in older adults [ 35 ], and it currently does not recommend vitamin D supplementation for falls prevention in older persons without osteoporosis or vitamin D deficiency [ 1 ]. Additionally, an updated US Preventive Services Task Force recommendation found insufficient evidence to balance the benefits vs harms of screening for vitamin D deficiency among asymptomatic adults [ 36 , 37 ].…”

The association between vitamin D serum levels, supplementation, and suicide attempts and intentional self-harm

“…Notably, all of these trials, including those of mortality and incident depression, included subjects whose 25(OH) levels were above the level (<20ng/mL) defined by the National Academies of Medicine as deficient. Due to insufficient evidence [28][29][30], the US Preventive Services Task Force (USPSTF) was unable to make a recommendation for or against Vitamin D supplementation in the general adult population in 2021 [2]. The USPSTF has since called for research to more clearly define serum level cut-offs for insufficiency and deficiency as well as associations between vitamin D blood serum levels and diseases, including psychiatric disorders [2,27,29].…”