title: Vitamin D and musculoskeletal health, cardiovascular disease, autoimmunity and cancer: Recommendations for clinical practice.
abstract: 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.
authors.affiliation: Laboratoire de Physiologie, CHU Necker, Paris, France. jean-claude.souberbielle@nck.aphp.fr
authors.forename: Jean-Claude
authors.initials: JC
authors.lastname: Souberbielle
authors.forename: Jean-Jacques
authors.initials: JJ
authors.lastname: Body
authors.forename: Joan M
authors.initials: JM
authors.lastname: Lappe
authors.forename: Mario
authors.initials: M
authors.lastname: Plebani
authors.forename: Yehuda
authors.initials: Y
authors.lastname: Shoenfeld
authors.forename: Thomas J
authors.initials: TJ
authors.lastname: Wang
authors.forename: Heike A
authors.initials: HA
authors.lastname: Bischoff-Ferrari
authors.forename: Etienne
authors.initials: E
authors.lastname: Cavalier
authors.forename: Peter R
authors.initials: PR
authors.lastname: Ebeling
authors.forename: Patrice
authors.initials: P
authors.lastname: Fardellone
authors.forename: Sara
authors.initials: S
authors.lastname: Gandini
authors.forename: Damien
authors.initials: D
authors.lastname: Gruson
authors.forename: Alain P
authors.initials: AP
authors.lastname: Guérin
authors.forename: Lene
authors.initials: L
authors.lastname: Heickendorff
authors.forename: Bruce W
authors.initials: BW
authors.lastname: Hollis
authors.forename: Sofia
authors.initials: S
authors.lastname: Ish-Shalom
authors.forename: Guillaume
authors.initials: G
authors.lastname: Jean
authors.forename: Philipp
authors.initials: P
authors.lastname: von Landenberg
authors.forename: Alvaro
authors.initials: A
authors.lastname: Largura
authors.forename: Tomas
authors.initials: T
authors.lastname: Olsson
authors.forename: Charles
authors.initials: C
authors.lastname: Pierrot-Deseilligny
authors.forename: Stefan
authors.initials: S
authors.lastname: Pilz
authors.forename: Angela
authors.initials: A
authors.lastname: Tincani
authors.forename: Andre
authors.initials: A
authors.lastname: Valcour
authors.forename: Armin
authors.initials: A
authors.lastname: Zittermann
mesh_terms: 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
chemical_list: D014807:Vitamin D; C104450:25-hydroxyvitamin D; D002118:Calcium