Vitamin D: not one size, type, form, route for all
Vitamin D: Dosing, levels, form, and route of administration: Does one approach fit all?
Reviews in Endocrine and Metabolic Disorders (2021) 22:1201-1218 https://doi.org/10.1007/s11154-021-09693-7
John P. Bilezikian • Anna Maria Formenti • Robert A. Adler • Neil Binkley • Roger Bouillon Marise Lazaretti-Castro • Claudio Marcocci • Nicola Napoli8 • Rene Rizzoli9 • Andrea Giustina2 Division of Endocrinology, Escola Paulista de Medicina - Universidade Federal de Sao Paulo (EPM-UNIFESP), Sao Paulo, Brazil
Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
Unit of Endocrinology and Diabetes, Campus Bio-Medico University of Rome, Rome, Italy
Service of Bone Diseases, Geneva University Hospitals and Faculty of Medicine, Geneva, Switzerland
- Andrea Giustina giu stina.andrea @ hsr. it
Department of Medicine, Endocrinology Division, Vagelos College of Physicians and Surgeons, Columbia University, New York, NY, USA
Institute of Endocrine and Metabolic Sciences, San Raffaele, Vita-Salute University and IRCCS Hospital, Milano, Italy
McGuire Veterans Affairs Medical Center and Virginia Commonwealth University School of Medicine, Richmond, VA, USA
University of Wisconsin, Madison, WI, USA
Laboratory of Clinical and Experimental Endocrinology,Department of chronic diseases, metabolism and ageing,Leuven, KU, Belgium
The 4th International Conference on Controversies in Vitamin D was held as a virtual meeting in September, 2020, gathering together leading international scientific and medical experts in vitamin D. Since vitamin D has a crucial role in skeletal and extra-skeletal systems, the aim of the Conference was to discuss improved management of vitamin D dosing, therapeutic levels and form or route of administration in the general population and in different clinical conditions. A tailored approach, based on the specific mechanisms underlying vitamin D deficiency in different diseases that were discussed, was recommended. Specifically, in comparison to healthy populations, higher levels of vitamin D and greater amounts of vitamin D were deemed necessary in osteoporosis, diabetes mellitus, obesity (particularly after bariatric surgery), and in those treated with glucocorticoids. Emerging and still open issues were related to target vitamin D levels and the role of vitamin D supplementation in COVID-19 since low vitamin D may predispose to SARS-CoV-2 infection and to worse COVID-19 outcomes. Finally, whereas oral daily cholecalciferol appears to be the preferred choice for vitamin D supplementation in the general population, and in most clinical conditions, active vitamin D analogs may be indicated in patients with hypoparathyroidism and severe kidney and liver insufficiency. Parenteral vitamin D administration could be helpful in malabsorption syndromes or in states of vitamin D resistance. Specific guidelines for desired levels of vitamin D should be tailored to the different conditions affecting vitamin D metabolism with the goal to define disease-specific normative values.
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Study says vitamin D needed varies with
Obesity
Bariatric surgery
Exogenous and endogenous glucocorticoid excess
Gastrointestinal diseases
rimaryHyperparathyroidism
Osteoporosis
Chronic kidney disease
Diabetes mellitus
Malignancy (Cancer)
Infections
Multiple sclerosis
COVID-19
Daily dosing vs weekly vs monthly
Vitamin D IU needed varies with
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