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Eur J Endocrinol. 2018 Oct 12;179(5):R239-R259. doi: 10.1530/EJE-18-0151.

MANAGEMENT OF ENDOCRINE DISEASE: Therapeutics of Vitamin D.

Author information

1
Department of Medicine, School of Clinical Sciences, Monash University, Clayton, Victoria, Australia.
2
McGuire Veterans Affairs Medical Center and Virginia Commonwealth University School of Medicine, Richmond, Virginia, USA.
3
Department of Biomedical and Molecular Sciences in the School of Medicine, Queen's University, Kingston, Ontario, Canada.
4
Department of Physiology and Pharmacology and The Felsenstein Medical Research Center, Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.
5
Endocrine Unit, ASST Carlo Poma, Mantua, Italy.
6
'Sapienza' Rome University, Rome, Italy.
7
Department of Paediatrics, Westmead Children's Hospital, The University of Sydney, Westmead, New South Wales, Australia.
8
Unit of Endocrinology and Diabetes, Department of Medicine, Università Campus Bio-Medico di Roma, Rome, Italy.
9
IRCCS, Istituto Ortopedico Galeazzi, Milan, Italy.
10
Division of Endocrinology, Tufts Medical Center, Boston, Massachusetts, USA.
11
Vita-Salute, San Raffaele University, Milan, Italy.
12
Division of Endocrinology, College of Physicians & Surgeons, Columbia University, New York, New York, USA.
13
Divison of Bone Diseases, Geneva University Hospitals and Faculty of Medicine, Geneva, Switzerland.

Abstract

Objective:

The central role of vitamin D in bone health is well recognized. However, controversies regarding its clinical application remain. We therefore aimed to review the definition of hypovitaminosis D, the skeletal and extra-skeletal effects of vitamin D and the available therapeutic modalities.

Design:

Narrative and systematic literature review.

Methods:

An international working group that reviewed the current evidence linking bone and extra-skeletal health and vitamin D therapy to identify knowledge gaps for future research.

Results:

Findings from observational studies and randomized controlled trials (RCTs) in vitamin D deficiency are discordant, with findings of RCTs being largely negative. This may be due to reverse causality with the illness itself contributing to low vitamin D levels. The results of many RCTs have also been inconsistent. However, overall evidence from RCTs shows vitamin D reduces fractures (when administered with calcium) in the institutionalized elderly. Although controversial, vitamin D reduces acute respiratory tract infections (if not given as bolus monthly or annual doses) and may reduce falls in those with the lowest serum 25-hydroxyvitamin D (25OHD) levels. However, despite large ongoing RCTs with 21 000–26 000 participants not recruiting based on baseline 25OHD levels, they will contain a large subset of participants with vitamin D deficiency and are adequately powered to meet their primary end-points.

Conclusions:

The effects of long-term vitamin D supplementation on non-skeletal outcomes, such as type 2 diabetes mellitus (T2DM), cancer and cardiovascular disease (CVD) and the optimal dose and serum 25OHD level that balances extra-skeletal benefits (T2DM) vs risks (e.g. CVD), may soon be determined by data from large RCTs.

PMID:
30131372
DOI:
10.1530/EJE-18-0151
[Indexed for MEDLINE]

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