How can Anyone Know if Vitamin D Status is Optimal without Measurement?
Everyone should have an annual physical assessment. In addition to routine measurements (weight, height, blood pressure, reflexes, prostate exam for men, breast examination for women), blood and urinary samples are important tools to assess disease risk. Preventive medicine should be more than disease assessment and subsequent management. Maintaining healthy nutrition levels is important for longevity.
Huang and colleagues reviewed 292 individual outpatient visitor records from the National Ambulatory Medical Care Survey and National Hospital Ambulatory Medical Care Survey to assess vitamin D deficiency diagnoses between 2007 and 2010. Mean patient age was 57y. Women were 2.6 times more likely to be vitamin D deficient than men. The prevalence vitamin D deficiency was 2.9 times higher in those over 65y than <65y.
Differing definitions of vitamin D deficiency exist. The Endocrine Society defines vitamin D sufficiency as 75 nmol/L (30 ng/mL) or higher. The Institute of Medicine recommends maintaining vitamin D concentrations above 50 nmol/L (20 ng/mL). These inconsistencies partially account for the unwillingness of health care providers to embrace routine vitamin D screening, e.g. British Columbia Ministry of Health, Royal College of Pathologists of Australasia, US Preventive Services Task Force, and Southern Derbyshire Hospitals. Some medical organizations are endorsing large scale screening.
Bones are not unique in their need for vitamin D. Numerous cell types express the vitamin D receptor and insufficiency may have profound consequences: diabetes and cancer. Thinking only about the relationship between vitamin D and bone health, Frost and Sullivan estimated that 1.2 million fracture events occurred in the US in 2012 with an average treatment cost of $11,020 in women >55 y. Total US health care expenditure managing and treating osteoporosis-attributed bone fractures was over $14 billion. If all US women over 55y were to use vitamin D and calcium dietary supplements at preventive daily intakes, an average of $1.87 billion per year could be saved. One point eight seven billion dollars!
Wouldn’t it make sense to know individual vitamin D status? Wouldn’t it be valuable to know if more (or less) vitamin D is needed to maintain safe healthy concentrations of serum 25(OH)D3? Be an advocate for vitamin D screening.
Huang KE, Milliron B-J, Davis SA, Feldman SR. Surge in US outpatient vitamin D deficiency diagnoses: National Ambulatory Medical Care Survey Analysis. 2014 South Med J doi: 10.1097/SMJ.0000000000000085
Holick MF, Binkley NC, Bischoff-Ferrari HA, Gordon CM, Hanley DA, Heaney RP, Murad MH, Weaver CM. Evaluation, treatment, and prevention of vitamin D deficiency: an Endocrine Society clinical practice guideline. J Clin Endocrinol Metab 2011;96:1911–1930 doi: 10.1210/jc.2011-0385
Institute of Medicine. Dietary Reference Intakes for Calcium and Vitamin D. Washington, DC: The National Academies Press, 2011:260–262.