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Screening for Vitamin D Deficiency in Adults: U.S. Preventive Services Task Force Recommendation Statement | Ten Points to Remember
- Authors:
- LeFevre ML, on behalf of the U.S. Preventive Services Task Force.
- Citation:
- Ann Intern Med 2014;Nov 25:[Epub ahead of print].
The following are 10 points to remember about screening for vitamin D deficiency in adults:
1. Persons with low vitamin D intake, decreased vitamin D absorption, and little or no sun exposure may be at increased risk for vitamin D deficiency. In addition, obesity and dark skin color are associated with low serum 25-hydroxyvitamin D (25-[OH]D).
2. Testing rates for vitamin D levels seem to be increasing, despite the uncertainty about the definition of deficiency. A recent study evaluating data from the National Ambulatory Medical Care Survey and the National Hospital Ambulatory Medical Care Survey found that the annual rate of outpatient visits associated with a diagnosis code for vitamin D deficiency more than tripled between 2008 and 2010.
3. Currently, the U.S. Preventive Services Task Force (USPSTF) finds no consensus regarding the definition of vitamin D deficiency or the optimal level of total serum 25-(OH)D (the major form of vitamin D that circulates in the body). Definitions vary by study; however, some studies have observed an association with low levels of vitamin D and risk for fractures, functional limitations, cancer, diabetes, cardiovascular disease, depression, and mortality.
4. In addition to variation in definitions of vitamin D deficiency, testing methods may vary in accuracy of testing. The USPSTF concluded there are a lack of studies that use an internationally recognized reference standard and the lack of consensus on the laboratory values that define vitamin D deficiency.
5. Screening may misclassify persons with a vitamin D deficiency because of the uncertainty about the cut point for defining deficiency and the variability of available testing assays. A rare but potential harm of treatment with oral vitamin D is toxicity, which may lead to hypercalcemia, hyperphosphatemia, suppressed parathyroid hormone, and hypercalciuria.
6. Treatment with vitamin D plus calcium may also be associated with increased risk for kidney stones; vitamin D alone does not seem to increase this risk. In general, treatment with oral vitamin D does not seem to be associated with serious harms. Treatment with increased sun exposure (specifically ultraviolet B [UVB] radiation) may increase risk for skin cancer.
7. Oral vitamin D is the most common treatment for vitamin D deficiency; available forms include vitamin D3 (cholecalciferol) and vitamin D2 (ergocalciferol). Other treatment options include increasing dietary vitamin D intake or sun exposure, although sun exposure is not generally recommended because it can increase the risk for skin cancer.
8. The USPSTF found no studies that evaluated the direct benefit of screening for vitamin D deficiency in adults. The USPSTF found adequate evidence that treatment of asymptomatic vitamin D deficiency has no benefit on cancer, type 2 diabetes mellitus, risk for death in community-dwelling adults, and risk for fractures in persons not selected on the basis of being at high risk for fractures.
9. The current evidence is insufficient to assess the balance of benefits and harms of screening for vitamin D deficiency in asymptomatic adults. The USPSTF has recommendations on the use of vitamin D supplementation for the prevention of falls and fractures, and vitamin supplementation for the prevention of cardiovascular disease or cancer. These recommendations are available on the USPSTF Web site (www.uspreventiveservicestaskforce.org).
10. In summary, among community-dwelling, nonpregnant, asymptomatic adults ages ≥18 years, the USPSTF makes no recommendation for supplementation of vitamin D due to insufficient evidence.
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1. Persons with low vitamin D intake, decreased vitamin D absorption, and little or no sun exposure may be at increased risk for vitamin D deficiency. In addition, obesity and dark skin color are associated with low serum 25-hydroxyvitamin D (25-[OH]D).
2. Testing rates for vitamin D levels seem to be increasing, despite the uncertainty about the definition of deficiency. A recent study evaluating data from the National Ambulatory Medical Care Survey and the National Hospital Ambulatory Medical Care Survey found that the annual rate of outpatient visits associated with a diagnosis code for vitamin D deficiency more than tripled between 2008 and 2010.
3. Currently, the U.S. Preventive Services Task Force (USPSTF) finds no consensus regarding the definition of vitamin D deficiency or the optimal level of total serum 25-(OH)D (the major form of vitamin D that circulates in the body). Definitions vary by study; however, some studies have observed an association with low levels of vitamin D and risk for fractures, functional limitations, cancer, diabetes, cardiovascular disease, depression, and mortality.
4. In addition to variation in definitions of vitamin D deficiency, testing methods may vary in accuracy of testing. The USPSTF concluded there are a lack of studies that use an internationally recognized reference standard and the lack of consensus on the laboratory values that define vitamin D deficiency.
5. Screening may misclassify persons with a vitamin D deficiency because of the uncertainty about the cut point for defining deficiency and the variability of available testing assays. A rare but potential harm of treatment with oral vitamin D is toxicity, which may lead to hypercalcemia, hyperphosphatemia, suppressed parathyroid hormone, and hypercalciuria.
6. Treatment with vitamin D plus calcium may also be associated with increased risk for kidney stones; vitamin D alone does not seem to increase this risk. In general, treatment with oral vitamin D does not seem to be associated with serious harms. Treatment with increased sun exposure (specifically ultraviolet B [UVB] radiation) may increase risk for skin cancer.
7. Oral vitamin D is the most common treatment for vitamin D deficiency; available forms include vitamin D3 (cholecalciferol) and vitamin D2 (ergocalciferol). Other treatment options include increasing dietary vitamin D intake or sun exposure, although sun exposure is not generally recommended because it can increase the risk for skin cancer.
8. The USPSTF found no studies that evaluated the direct benefit of screening for vitamin D deficiency in adults. The USPSTF found adequate evidence that treatment of asymptomatic vitamin D deficiency has no benefit on cancer, type 2 diabetes mellitus, risk for death in community-dwelling adults, and risk for fractures in persons not selected on the basis of being at high risk for fractures.
9. The current evidence is insufficient to assess the balance of benefits and harms of screening for vitamin D deficiency in asymptomatic adults. The USPSTF has recommendations on the use of vitamin D supplementation for the prevention of falls and fractures, and vitamin supplementation for the prevention of cardiovascular disease or cancer. These recommendations are available on the USPSTF Web site (www.uspreventiveservicestaskforce.org).
10. In summary, among community-dwelling, nonpregnant, asymptomatic adults ages ≥18 years, the USPSTF makes no recommendation for supplementation of vitamin D due to insufficient evidence.
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