An expert who helped craft guidelines for vitamin D supplementation more than a decade ago, reviews the updated guidance published last year by the Endocrine Society, influenced by a substantial body of research conducted in recent years.
These new recommendations included limiting vitamin D supplementation beyond the daily recommended intake to specific risk groups, and advised against routine 25-hydroxyvitamin D [25(OH)D] testing in healthy individuals.
In a recent review article in the journal Endocrine Practice, Michael Holick, PhD, MD, professor of medicine, pharmacology, physiology & biophysics and molecular medicine at Boston University Chobanian & Avedisian School of Medicine, compares and contrasts the 2024 Endocrine Society’s Clinical Guidelines on vitamin D with those he helped design in 2011.
“The 2011 guidelines provided clinicians with guidance for how to evaluate and treat patients with vitamin D deficiency and prevent recurrence, whereas the 2024 guidelines made recommendations for the general healthy population for skeletal and extra skeletal health benefits of vitamin D,” he wrote.
“I believe this will cause great confusion for physicians and healthcare professionals on how to determine if their patient who is at risk for vitamin D deficiency is vitamin D deficient, as screening children and adults for this status is not recommended in the new guidelines.”
Among the major differences:
• The 2011 Guidelines provided physicians and healthcare professionals with guidance for when to evaluate a patient for their vitamin D status while the 2024 Guidelines do not.
• The 2011 Guidelines provided information on how much vitamin D is required to treat and prevent deficiency in all age groups. The 2024 Guidelines recommends vitamin D supplementation as proposed by the Institute of Medicine in 2010. However, the 2024 Guidelines only put forward the amount of vitamin D needed for anyone one year and older, and provides no information for younger infants.
• While the 2024 Guidelines acknowledge that increased vitamin D supplementation with a daily average intake of 2500 IUs may be of value in reducing risk of poor birth outcomes, including pre-eclampsia, preterm births, small-for-gestational age births, neonatal mortality and Caesarean section, it does not recommend monitoring vitamin D status in pregnant women and doesn’t propose increased vitamin D intake above 600 IUs daily that is the dietary reference intakes for all adults.
Holick says the 2024 Guidelines ignored association studies and other studies and relied on randomised controlled trials, most of which were not placebo-controlled, for their recommendations.
“As a result, they do not provide guidance for the many healthful benefits of vitamin D including: reducing cancer mortality by more than 25%; the incidence of metastatic and fatal cancer by 38%; autoimmune disorders by 39%, including type 1 diabetes by 88%; advancement of prediabetes to type 2 diabetes by 76%, peripheral vascular disease by 88%, and lowering risk of respiratory tract infections by 58%. In terms of Covid-19 infection, hospitalisations and mortality were reduced by as much as 74%, 22% and 45% respectively, and accelerating Covid positive patients to Covid negativity by 66%; reducing risk of pre-term birth by 62% and pre-eclampsia, and need for a Caesarean section by more than 50%.”
Study details
Revisiting Vitamin D Guidelines: A Critical Appraisal of the Literature.
Published in Endocrine Practice in December 2024
Abstract
Background/Objective
The goal of this review is to compare the 2024 and 2011 Endocrine Society’s Clinical Practice Guidelines on vitamin D2 or vitamin D3 (vitamin D). The 2024 Guideline made recommendations for the general healthy population for skeletal and extra skeletal health benefits of vitamin D. This contrasts with the 2011 Guidelines, which provided clinicians with guidance on how to evaluate and treat patients with vitamin D deficiency and prevent recurrence.
Discussion
The 2024 Guideline focused on randomised controlled trials and ignored association studies and other studies that have supported the skeletal and extra skeletal health benefits of vitamin D. The 2024 Guideline recommended empiric vitamin D in children and adolescents aged 1 to 18 years to reduce risk of upper respiratory tract infections, pregnant women to improve pregnancy-related outcomes, prediabetic patients to reduce risk of diabetes, and to improve mortality in those over 75 years.
Conclusion
These guidelines do not apply to individuals with abnormalities in calcium, phosphate, vitamin D, and bone metabolism which were provided in the 2011 Guidelines. For non-pregnant women up to the age of 75, they recommend the Dietary Reference Intakes of 600 IUs (international units; 1 IU = 25 ng of vitamin D), and 800 IUs as recommended by The Institute of Medicine. Association studies have suggested that to obtain maximum extraskeletal benefits from vitamin D including reducing risk of upper respiratory tract infection for children and adults, autoimmune disorders, pre-eclampsia, low birth weight, neonatal dental caries, and deadly cancers, circulating concentrations of 25-hydroxyvitamin D should be at least 30 ng/mL with a preferred range of 40-60 ng/mL as recommended by the 2011 Guidelines.
Guidelines 2024 – Vitamin D for the Prevention of Disease Guideline Resources (Open access)
See more from MedicalBrief archives:
US study flags high vitamin D deficiency rates
Vitamin D slashes diabetes risk in prediabetes cases – US meta-analysis
High vitamin D levels may protect against COVID-19, especially for black people
Vitamin D deficiency may raise risk of coronavirus infection — retrospective study