Vitamin D deficiency laboratory findings: Difference between revisions
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There is no consensus on the serum 25-hydroxyvitamin D levels, "25(OH)D", considered "normal". 12 ng per milliliter (50 nmol per liter) ihas been proposed.<ref name="pmid27959647">{{cite journal| author=Manson JE, Brannon PM, Rosen CJ, Taylor CL| title=Vitamin D Deficiency - Is There Really a Pandemic? | journal=N Engl J Med | year= 2016 | volume= 375 | issue= 19 | pages= 1817-1820 | pmid=27959647 | doi=10.1056/NEJMp1608005 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=27959647 }} </ref> However, "a common misconception is that the RDA functions as a “cut point” and that nearly the entire population must have a serum 25(OH)D level above 20 ng per milliliter to achieve good bone health. The reality is that the majority (about 97.5%) of the population has a requirement of 20 ng per milliliter or less. Moreover, by definition of an average requirement, approximately ''half the population has a requirement of 16 ng per milliliter'' (the EAR) or less. " (italics added)<ref name="pmid27959647"/> Previous opinions suggested a value equal or less than 20 ng per milliliter (50 nmol per liter) is in the deficient range.<ref name="pmid9504937">{{cite journal |author=Thomas MK, Lloyd-Jones DM, Thadhani RI, ''et al'' |title=Hypovitaminosis D in medical inpatients |journal=N. Engl. J. Med. |volume=338 |issue=12 |pages=777–83 |year=1998 |pmid=9504937 |doi= |url=http://content.nejm.org/cgi/pmidlookup?view=short&pmid=9504937&promo=ONFLNS19}}</ref><sup>,</sup> <ref name="pmid16529140">{{cite journal |author=Holick MF |title=High prevalence of vitamin D inadequacy and implications for health |journal=Mayo Clin. Proc. |volume=81 |issue=3 |pages=353-73 | year=2006 | pmid=16529140 |doi= |url=http://www.mayoclinicproceedings.com/cgi/pmidlookup?view=long&pmid=16529140}}</ref><sup>,</sup> <ref name="pmid16825677">{{cite journal |author=Bischoff-Ferrari HA, Giovannucci E, Willett WC, Dietrich T, Dawson-Hughes B |title=Estimation of optimal serum concentrations of 25-hydroxyvitamin D for multiple health outcomes |journal=Am. J. Clin. Nutr. |volume=84 |issue=1 |pages=18–8 |year=2006 |pmid=16825677 |doi= |url=http://www.ajcn.org/cgi/pmidlookup?view=long&pmid=16825677}}</ref><sup>,</sup> <ref name="pmid9519960">{{cite journal |author=Malabanan A, Veronikis IE, Holick MF |title=Redefining vitamin D insufficiency |journal=Lancet |volume=351 |issue=9105 |pages=805–6 |year=1998 |pmid=9519960 |doi= |url=}}</ref> | |||
There is no consensus on the serum 25-hydroxyvitamin D levels, "25(OH)D", considered "normal". 12 ng per milliliter (50 nmol per liter) ihas been proposed.<ref name="pmid27959647">{{cite journal| author=Manson JE, Brannon PM, Rosen CJ, Taylor CL| title=Vitamin D Deficiency - Is There Really a Pandemic? | journal=N Engl J Med | year= 2016 | volume= 375 | issue= 19 | pages= 1817-1820 | pmid=27959647 | doi=10.1056/NEJMp1608005 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=27959647 }} </ref> However, "a common misconception is that the RDA functions as a “cut point” and that nearly the entire population must have a serum 25(OH)D level above 20 ng per milliliter to achieve good bone health. The reality is that the majority (about 97.5%) of the population has a requirement of 20 ng per milliliter or less. Moreover, by definition of an average requirement, approximately ''half the population has a requirement of 16 ng per milliliter'' (the EAR) or less. " (italics added)<ref | |||
The definition can be based on the point at which the parathyroid hormone (PTH) levels off as the cutoff point, which may be at 12 ng per milliliter (30 nmol per liter)<ref name="pmid28379394">{{cite journal| author=Shah S, Chiang C, Sikaris K, Lu Z, Bui M, Zebaze R et al.| title=Serum 25-Hydroxyvitamin D Insufficiency in Search of a Bone Disease. | journal=J Clin Endocrinol Metab | year= 2017 | volume= | issue= | pages= | pmid=28379394 | doi=10.1210/jc.2016-3189 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=28379394 }} </ref> or is close to 30 ng per milliliter (75 nmol per liter). <ref name="pmid15776217">{{cite journal |author=Dawson-Hughes B, Heaney RP, Holick MF, Lips P, Meunier PJ, Vieth R |title=Estimates of optimal vitamin D status |journal=Osteoporos Int |volume=16 |issue=7 |pages=713–6 |year=2005 |pmid=15776217 |doi=10.1007/s00198-005-1867-7 |url=}}</ref> | The definition can be based on the point at which the parathyroid hormone (PTH) levels off as the cutoff point, which may be at 12 ng per milliliter (30 nmol per liter)<ref name="pmid28379394">{{cite journal| author=Shah S, Chiang C, Sikaris K, Lu Z, Bui M, Zebaze R et al.| title=Serum 25-Hydroxyvitamin D Insufficiency in Search of a Bone Disease. | journal=J Clin Endocrinol Metab | year= 2017 | volume= | issue= | pages= | pmid=28379394 | doi=10.1210/jc.2016-3189 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=28379394 }} </ref> or is close to 30 ng per milliliter (75 nmol per liter). <ref name="pmid15776217">{{cite journal |author=Dawson-Hughes B, Heaney RP, Holick MF, Lips P, Meunier PJ, Vieth R |title=Estimates of optimal vitamin D status |journal=Osteoporos Int |volume=16 |issue=7 |pages=713–6 |year=2005 |pmid=15776217 |doi=10.1007/s00198-005-1867-7 |url=}}</ref> | ||
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There is no consensus on the serum 25-hydroxyvitamin D levels, "25(OH)D", considered "normal". 12 ng per milliliter (50 nmol per liter) ihas been proposed.[1] However, "a common misconception is that the RDA functions as a “cut point” and that nearly the entire population must have a serum 25(OH)D level above 20 ng per milliliter to achieve good bone health. The reality is that the majority (about 97.5%) of the population has a requirement of 20 ng per milliliter or less. Moreover, by definition of an average requirement, approximately half the population has a requirement of 16 ng per milliliter (the EAR) or less. " (italics added)[1] Previous opinions suggested a value equal or less than 20 ng per milliliter (50 nmol per liter) is in the deficient range.[2], [3], [4], [5]
The definition can be based on the point at which the parathyroid hormone (PTH) levels off as the cutoff point, which may be at 12 ng per milliliter (30 nmol per liter)[6] or is close to 30 ng per milliliter (75 nmol per liter). [7]
The Institute of Medicine states (page 13): [8]* Levels over 20 ng/ml: "Practically all persons are sufficient"
- Levels 12-20 ng/ml (<50 nmol/L): "Some, but not all, persons are potentially at risk for inadequacy."
- Levels below 12 ng/m (< 30 nmol/L): "persons are at risk of deficiency."
References
- ↑ 1.0 1.1 Manson JE, Brannon PM, Rosen CJ, Taylor CL (2016). "Vitamin D Deficiency - Is There Really a Pandemic?". N Engl J Med. 375 (19): 1817–1820. doi:10.1056/NEJMp1608005. PMID 27959647.
- ↑ Thomas MK, Lloyd-Jones DM, Thadhani RI; et al. (1998). "Hypovitaminosis D in medical inpatients". N. Engl. J. Med. 338 (12): 777–83. PMID 9504937.
- ↑ Holick MF (2006). "High prevalence of vitamin D inadequacy and implications for health". Mayo Clin. Proc. 81 (3): 353–73. PMID 16529140.
- ↑ Bischoff-Ferrari HA, Giovannucci E, Willett WC, Dietrich T, Dawson-Hughes B (2006). "Estimation of optimal serum concentrations of 25-hydroxyvitamin D for multiple health outcomes". Am. J. Clin. Nutr. 84 (1): 18–8. PMID 16825677.
- ↑ Malabanan A, Veronikis IE, Holick MF (1998). "Redefining vitamin D insufficiency". Lancet. 351 (9105): 805–6. PMID 9519960.
- ↑ Shah S, Chiang C, Sikaris K, Lu Z, Bui M, Zebaze R; et al. (2017). "Serum 25-Hydroxyvitamin D Insufficiency in Search of a Bone Disease". J Clin Endocrinol Metab. doi:10.1210/jc.2016-3189. PMID 28379394.
- ↑ Dawson-Hughes B, Heaney RP, Holick MF, Lips P, Meunier PJ, Vieth R (2005). "Estimates of optimal vitamin D status". Osteoporos Int. 16 (7): 713–6. doi:10.1007/s00198-005-1867-7. PMID 15776217.
- ↑ Committee to Review Dietary References Intakes for Vitamin D and Calcium. Ross AC et al., editors. (2010) Dietary References Intakes for Calcium and Vitamin D. Institute of Medicine.