Vitamin D and musculoskeletal health, cardiovascular disease, autoimmunity and cancer: Recommendations for clinical practice.
BACKGROUND
There is increasing evidence that, in addition to the well-known effects on musculoskeletal health, vitamin D status may be related to a number of non-skeletal diseases. An international expert panel formulated recommendations on vitamin D for clinical practice, taking into consideration the best evidence available based on published literature today. In addition, where data were limited to smaller clinical trials or epidemiologic studies, the panel made expert-opinion based recommendations.


METHODS
Twenty-five experts from various disciplines (classical clinical applications, cardiology, autoimmunity, and cancer) established draft recommendations during a 2-day meeting. Thereafter, representatives of all disciplines refined the recommendations and related texts, subsequently reviewed by all panelists. For all recommendations, panelists expressed the extent of agreement using a 5-point scale.


CONCLUSIONS
Recommendations were restricted to clinical practice and concern adult patients with or at risk for fractures, falls, cardiovascular or autoimmune diseases, and cancer. The panel reached substantial agreement about the need for vitamin D supplementation in specific groups of patients in these clinical areas and the need for assessing their 25-hydroxyvitamin D (25(OH)D) serum levels for optimal clinical care. A target range of at least 30 to 40 ng/mL was recommended. As response to treatment varies by environmental factors and starting levels of 25(OH)D, testing may be warranted after at least 3 months of supplementation. An assay measuring both 25(OH)D(2) and 25(OH)D(3) is recommended. Dark-skinned or veiled individuals not exposed much to the sun, elderly and institutionalized individuals may be supplemented (800 IU/day) without baseline testing.
Souberbielle
Jean-Claude
JC
Laboratoire de Physiologie, CHU Necker, Paris, France. jean-claude.souberbielle@nck.aphp.fr
Body
Jean-Jacques
JJ
Lappe
Joan M
JM
Plebani
Mario
M
Shoenfeld
Yehuda
Y
Wang
Thomas J
TJ
Bischoff-Ferrari
Heike A
HA
Cavalier
Etienne
E
Ebeling
Peter R
PR
Fardellone
Patrice
P
Gandini
Sara
S
Gruson
Damien
D
Guérin
Alain P
AP
Heickendorff
Lene
L
Hollis
Bruce W
BW
Ish-Shalom
Sofia
S
Jean
Guillaume
G
von Landenberg
Philipp
P
Largura
Alvaro
A
Olsson
Tomas
T
Pierrot-Deseilligny
Charles
C
Pilz
Stefan
S
Tincani
Angela
A
Valcour
Andre
A
Zittermann
Armin
A
D000328:Adult; D000368:Aged; D015551:Autoimmunity; D001842:Bone and Bones / Q000502:physiology; D002118:Calcium / Q000378:metabolism; D002318:Cardiovascular Diseases / Q000209:etiology / Q000517:prevention & control; D005260:Female; D050723:Fractures, Bone / Q000209:etiology / Q000517:prevention & control; D006801:Humans; D007107:Immune System / Q000502:physiology; D008297:Male; D008875:Middle Aged; D009140:Musculoskeletal Diseases / Q000209:etiology / Q000517:prevention & control; D009369:Neoplasms / Q000209:etiology / Q000517:prevention & control; D014807:Vitamin D / Q000008:administration & dosage* / Q000031:analogs & derivatives* / Q000097:blood / Q000494:pharmacology; D014808:Vitamin D Deficiency / Q000150:complications; D055815:Young Adult
D014807:Vitamin D; C104450:25-hydroxyvitamin D; D002118:Calcium