New Guidelines Recommend Against Routine Vitamin D Testing and Treatment for Healthy Adults – J Clin Endocrinol Metab

Introduction: The Endocrine Society has developed new clinical practice guidelines focused on the use of vitamin D for the prevention of various diseases. These guidelines were created by a multidisciplinary panel, including experts in adult and pediatric endocrinology, internal medicine, obstetrics and gynecology, nutrition, and epidemiology.

Key Points:

1 – Empiric Vitamin D Supplementation in Children and Adolescents:

– Recommended to prevent nutritional rickets.

– May lower the risk of respiratory tract infections.

– Dosage in trials ranged from 300 to 2000 IU daily, with an average of about 1200 IU per day.

2 – Empiric Vitamin D Supplementation or Testing in Adults Under 75:

– Not recommended for generally healthy adults without specific indications.

3 – Empiric Vitamin D Supplementation in Adults Over 75:

– Suggested due to its potential to lower the risk of mortality.

– Treatment should be empirical, no testing recommended if there are no established indications for testing (e.g., hypocalcemia).

– Recommended daily rather than intermittent high doses. Dosage in clinical trials ranged from 400 to 3333 IU daily equivalent.

4 – Vitamin D Supplementation During Pregnancy:

– Suggested to lower the risk of preeclampsia, intrauterine mortality, preterm birth, small-for-gestational-age birth, and neonatal mortality.

– Empiric supplementation recommended without routine 25(OH)D testing unless there are established indications for testing.

– Dosages in trials ranged from 600 to 5000 IU daily equivalent, with an average of about 2500 IU per day.

5 – Vitamin D and High-Risk Prediabetes:

– Suggested to reduce the progression to diabetes.

– In clinical trials, vitamin D dosages ranged from 842 to 7543 IU daily. The estimated weighted average was approximately 3500 IU per day.

6 – Routine 25(OH)D Testing:

– Not recommended for the general population, including those with obesity or dark complexion.

– No clear evidence defining optimal target levels for disease prevention.

Conclusion: These guidelines emphasize the importance of targeted vitamin D supplementation for specific age groups and conditions, while advising against routine testing for vitamin D levels in the general population. Empiric supplementation is considered beneficial, particularly in children, pregnant women, and older adults, and is feasible, cost-effective, and generally acceptable.

Guideline Reference: Demay, M. B., et al. (2024). Vitamin D for the Prevention of Disease: An Endocrine Society Clinical Practice Guideline. The Journal of Clinical Endocrinology & Metabolism, 109, 1907-1947. Available at: https://doi.org/10.1210/clinem/dgae290