Experts issue vitamin D screening, treatment guidelines

Kathleen Blanchard's picture
vitamin D deficiency

An expert panel from the Endocrine Society has issued new screening and treatment guideline for individuals at high risk for vitamin D deficiency that they emphasize as important for physicians and other health care providers, following a comprehensive review of literature pointing to the widespread incidence of low levels of the vitamin in the general population.

Deficiency of vitamin D is prevalent in all age groups from lack of sunshine and vitamin D in foods. Low levels can lead to calcium, phosphorus and bone metabolism abnormalities and bone deformities in children from rickets.

Identifying those at risk for vitamin D deficiency

Children, pregnant and nursing women, obese individuals, those with inflammatory bowel disease or other malapsorption syndromes, Hispanics, blacks and other dark skinned ethnic groups, elders, individuals with osteoporosis, chronic kidney or live disease, patients in medications for AIDS, seizure disorders and diabetes are all considered at high risk for vitamin D deficiency and should be screened with a blood test.

Supplementation with vitamin D is a good idea for everyone says Michael F. Holick, PhD, MD, of the Boston University School of Medicine who headed the task force issuing the Clinical Practice Guidelines.

Screening with blood tests is especially important for anyone at high risk for vitamin D insufficiency or deficiency that the group says should not be lower than 30 ng/mL. Currently, the IOM recommends serum vitamin D levels 20 to 30 ng/mL; something that many experts believe is too low for health maintenance.

Treatment guidelines for vitamin D deficiency

How much vitamin D do we need then? Holick said in an online news conference, “The committee decided that 30 ng/mL is the minimum level, and recommended 40 to 60 ng/mL for both children and adults.”


Vitamin D levels can be boosted by taking either vitamin D2 or D3, in addition to focusing on vitamin fortified foods that include milk, cereals, orange juice, salmon and mackerel.

Clinical guidelines for daily intake

What that boils down to is daily intake of 400IU of vitamin D for infants and children age 0 to 1, 600IU over age one and possibly up to 1000IU daily to keep levels consistently above 30 ng/mL.

For adults, the Endocrine Society is recommending up to 2000 IU of vitamin D daily between age 19 and 50, but at least 600IU daily.

Adults age 50 to 70 should be taking in 600IU of the vitamin daily and over age 70, the new clinical guideline recommendations are to boost vitamin D intake to 600IU daily and possibly 1500 to 2000IU’s to keep circulating vitamin D levels consistently at the lowest recommended 30ng/mL.

Vitamin D insufficiency and deficiency is linked to a variety of potential health problems, but no definite evidence exists to show boosting intake will stop diseases like cancer, heart disease or infections. Conversely, boosting levels to at least 30ng/mL has not been shown to cause harm, and is shown to help the body maintain calcium balance needed for bone health and improve muscle function.

The new Clinical Practice Guidelines from the Endocrine Society are an effort to help physicians and other health care providers identify vitamin D deficiency that can lead to osteoporosis, thinning of the bones known as osteopenia and muscle weakness. Dr. Holick says at there is not enough evidence to suggest screening for vitamin D levels among those who are not at high risk for deficiency.

JCEM: doi:10.1210/jc.2011-0385
“Evaluation, Treatment, and Prevention of Vitamin D Deficiency: an Endocrine Society Clinical Practice Guideline”
Holick et al

Image credit: Morguefile