MINIMUM recommended vitamin D by 25 experts was higher than the 20 ng/ml proclamation of the Institute of Medicine
Vitamin D and musculoskeletal health, cardiovascular disease, autoimmunity and cancer: Recommendations for clinical practice
Volume 9, Issue 11, September 2010, Pages 709-715; doi:10.1016/j.autrev.2010.06.009
Jean-Claude Souberbielle a, Jean-Jacques Body b, Joan M. Lappe c, Mario Plebani d, Yehuda Shoenfeld e, Thomas J. Wang f, Heike A. Bischoff-Ferrari g, Etienne Cavalier h, Peter R. Ebeling i, Patrice Fardellone j, Sara Gandini k, Damien Gruson l, Alain P. Guérin m, Lene Heickendorff n, Bruce W. Hollis o, Sofia Ish-Shalom p, Guillaume Jean q, Philipp von Landenberg r, Alvaro Largura s, Tomas Olsson t, Charles Pierrot-Deseilligny u, Stefan Pilz v, Angela Tincani w, Andre Valcour x and Armin Zittermann y
a Laboratoire de Physiologie, CHU Necker, Paris, France jean-claude.souberbielle at nck.aphp.fr
b Department of Medicine, CHU Brugmann, Université Libre de Bruxelles, Brussels, Belgium
c Internal Medicine, Creighton University, Omaha NE, USA
d Laboratory Medicine, University of Padova, Leonardo Foundation, Abano Terme General Hospital, Italy
e Department of Medicine B', Zabludowizc Center for Autoimmune Diseases, Sheba Medical Center, Tel-Hasomer, Sackler Faculty of Medicine, Tel-Aviv University, Israel
f Division of Cardiology, Massachusetts General Hospital, Harvard Medical School, Boston, USA
g Centre on Aging and Mobility, University of Zurich; Dept. of Rheumatology and Institute of Physical Medicine, University Hospital, Zurich , Switzerland
h Department of Clinical Chemistry, University of Liège, CHU de Liège, Liège, Belgium
i Medicine (RMH/WH), The University of Melbourne, Footscray, Victoria 3011, Australia
j Rheumatology, CHU Amiens, INSERM ERI 12, Amiens, France
k Division of Epidemiology and Biostatistics, European Institute of Oncology, Milan, Italy
l Department of Laboratory Medicine, Cliniques Universitaires St-Luc, Brussels, Belgium
m Nephrology, Centre Hospitalier Manhes, Fleury Mérogis, France
n Department of Clinical Chemistry, Aarhus University Hospital, Aarhus, Denmark
o Pediatrics, Medical University of South Carolina, Charleston, SC, USA
p Bone and Mineral Metabolism Unit, Rambam Health Care Campus, Technion Faculty of Medicine, Haifa, Israel
q Dialysis, Centre de Rein Artificiel, Tassin, France
r Solothurner Spitäler AG, Institut für Labormedizin (IFLM), Olten, Switzerland
s Clinical Chemistry, Alvaro Center of Analysis and Clinical Research/DASA, Cascavel, Brazil
t Neuroimmunology Unit, Center for Molecular Medicine, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
u Service de Neurologie 1, Hôpital de la Salpêtrière, Paris, France
v Department of Internal Medicine, Division of Endocrinology and Nuclear Medicine, Medical University of Graz, Graz, Austria
w Rheumatology and Clinical Immunology, Spedali Civili and University of Brescia, Brescia, Italy
x Center for Esoteric Testing, Laboratory Corporation of America, Burlington, NC, USA
y Clinic for Thoracic and Cardiovascular Surgery, Heart Center North Rhine-Westphalia, Bad Oeynhausen, Germany
Meeting was held in Paris Nov, 2009, paper received 20 June 2010; ; accepted 23 June 2010. Available online 1 July 2010.
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.
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.
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)D2 and 25(OH)D3 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.
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