A new study published in Lancet Diabetes & Endocrinology [
[1]
], in strengthening findings from the authors’ previous work, may signal the end to
further trials of vitamin D for skeletal outcomes in persons who have not been shown
to be vitamin D deficient. However, measuring vitamin D status is technically difficult
[
[2]
], and the best assays are often not available to clinicians due to cost. Even when
measured accurately, vitamin D levels can be challenging to interpret given seasonal
changes that vary from person to person reflecting sun habits, skin type and diet.
Add to this that vitamin D supplements are eminently affordable and safe to most people
across a broad dose range. Taken together, this has led to a culture looking to provide
universal supplementation which falls short of evidence based medicine. Despite vitamin
D being a threshold nutrient for adult bone health, most doctors have experienced
the temptation or pressure to use a one dose fits all approach for vitamin D. Health
professionals are generally not thanked for repeated vitamin D measurements to tailor
the exact dose required in the individual person.To read this article in full you will need to make a payment
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References
- Effects of vitamin D supplementation on musculoskeletal health: a systematic review, meta-analysis, and trial sequential analysis.Lancet Diabetes Endocrinol. 2018; 8587: 1-12
- Screening for vitamin D deficiency: defining vitamin D deficiency, target thresholds of treatment and estimating the benefits of treatment.Pathology. 2012; 44: 160-165
- The role of vitamin D supplementation in patients with rheumatic diseases.Nat. Rev. Rheumatol. 2013; 9: 411-422
- IOM Dietary Reference Intakes for Calcium and Vitamin D.The National Academies Press, Washington DC2011
- Patient level pooled analysis of 68 500 patients from seven major vitamin D fracture trials in US and Europe.BMJ. 2010; 340: 139
- Vitamin D and vitamin D analogues for preventing fractures in post-menopausal women and older men.Cochrane Database Syst. Rev. 2014; 4 (p. CD000227)
- Vitamin D supplementation and falls: a trial sequential meta-analysis.Lancet Diabetes Endocrinol. 2014; 2: 573-580
- The effect of vitamin D supplementation on skeletal, vascular, or cancer outcomes: a trial sequential meta-analysis.Lancet Diabetes Endocrinol. 2014; 2: 307-320
- Calcium intake and bone mineral density: systematic review and meta-analysis.BMJ. 2015; 351 (p. h4183)
- Calcium intake and risk of fracture: systematic review.BMJ. 2015; 351 (p. h4580)
Article info
Publication history
Published online: October 25, 2018
Received:
October 19,
2018
Identification
Copyright
© 2018 Elsevier B.V. All rights reserved.
