vitamin D

Introduction

400 IU (10 ug) infants^[40]
- older recommendation of 200 IU (5 ug)/day (infants)*^[2]
600 IU (15 ug) (children & adults) Institute of Medicine^[40]
1600 IU (40 ug) (elderly)^[68]
- 600 IU (15 ug) appears to be adequate for elderly white women^[49]
800-2000 (20-50 ug) IU (adults)^[11]^[40]
600 IU daily age 18-70 years, then 800 IU daily after age 70 years^[149]

*Breast milk does NOT contain sufficient vitamin D; supplementation recommended^[2]; use children's multivitamin

Indications

vitamin D deficiency*
- hypocalcemia
  - hypocalcemic tetany^[63]
- hypophosphatemia^[63]
- hypoparathyroidism
- osteomalacia
- prevention of preterm delivery^[62]
- prevention & treatment of osteoporosis
  - in combination with Ca+2 supplementation
  - diminishes risk of vertebral & hip fractures at dose of 800 IU (20 ug)/day^[4]^[44]
  - 30% reduction in risk of hip fracture at a dose of 800-2000 IU (20-50 ug)/day^[50]
chronic renal failure^[63]
- renal osteodystrophy
- end-stage renal disease
chronic heart failure
- may improve LV ejection fraction & LV end diastolic volume
- no benefit for 6 minute walk^[87]
psoriasis^[63]
may reduce risk of cutaneous melanoma^[137]
fall prevention in the elderly ?^[2]^[14]^[59]^[68]
- all healthy adults without year-round regular sun exposure
- controversial, but bulk of evidence seems to suggest not (see contraindications)
- benefit may be restricted to vitamin D deficient elderly women also supplemented with calcium^[43]
- doses of > 800 IU (20 ug) /day may be needed for benefit^[43]
- 800 IU-1000 IU/day reduces falls in the elderly
  - lower or higher doses do not^[147]
- benefit may be via increased muscle strength
  - seems controversial (see contraindications)
  - also increases muscle strength in adolescent girls
  - increases muscle strength & balance in older adults^[58]
  - improves handgrip strength in postmenopausal women with or without calcium^[134]
in combination with calcium, may reduce risk of vertebral fracture^[67]
vitamin D supplementation may reduce LDL cholesterol in postmenopausal women^[70]
risk reduction of multiple sclerosis^[7]
may reduce risk of respiratory tract infections^[91]
vitamin D supplementation during pregnancy is associated with improved neonatal outcomes^[99]
may reduce risk for recurrent wheeze among black preterm infants^[98]
may reduce progression of mild cognitive impairment^[102]
vitamin D supplementation reduces risk of dementia (40%)^[140]
may reduce all-cause mortality in the elderly^[68]
may reduce risk of cancer-related mortality but not all-cause mortality^[109]
- supplementation with vitamin D 1000 IU/day in adults > 50 years may reduce cancer deaths by 13%^[120]
data neither support nor refute recommendations for calcium & higher dose vitamin D supplementation to reduce mortality^[146]
high-dose vitamin D may reduce toxic erythema of chemotherapy^[136]
may reduce risk of diabetes mellitus type 2 at dose of > 1000 IU/day if BMI < 30 (RR=0.88) or if severe insulin resistance^[112]
may reduce Covid-19 ICU admission/mortality (RR=0.32-0.41) when administered after diagnosis (dose, duration, & mode of administration unknown)^[122]^[145]
may reduce risk of Covid-19 infection (RR=0.40-0.59)^[145]
vitamin D supplementation may reduce 5 year risk of autoimmune disease (RR=0.78)
- coadministration of omega-3 fatty acids may further reduce risk (RR=0.69)^[125]
vitamin D supplementation improves quality of life in patients with irritable bowel syndrome^[133]
Endocrine Society recommends vitamin D supplementation for all children & adolescents^[149]
1000 IU vitamin D supplement is reasonable^[149]

* for most adults, diet does not provide adequate amounts of vitamin D^[68]

* unless exposed to adequate sunlight (10-30 minutes of midday sunlight several times/week), adults should take supplemental vitamin D^[68]

* studies on vitamin D, calcium, or both & health outcomes are inconsistent^[30]^[31]^[71]

Contraindications

does not diminish risk of hypertension^[10]^[75] or lower blood pressure [79, 116]
does not improve diffuse musculoskeletal pain^[26]
no effect on wintertime respiratory tract infections^[38]^[95]
no clear evidence that vitamin D supplementation prevents cardiovascular disease^[44]^[75]^[78]^[107]^[143]
- cardiovascular risk reduction ?^[23]^[24]^[28]^[129]
- does not improve lipid panel, blood pressure, or serum C-reactive protein^[54]
- supplementation with vitamin D of no benefit for reducing risk for major cardiovascular events in adults > 60 years of age^[143]
- monthly vitamin D (100,000 IU) does not reduce risk of cardiovascular events^[93]
- 2000 IU/day of vitamin D3 does not reduce cardiovascular risk^[103]
- 1600 or 3200 IU/day of vitamin D3 does not reduce cardiovascular risk^[129]
- does not prevent stroke^[131]
conflicting findings on whether vitamin D might decrease (or even increase) the risk for cancer^[44]
- lymphoma, prostate cancer?, lung cancer, skin cancer colon cancer (& colorectal adenomatous polyps)^[8]
- breast cancer^[25]
  - may lower risk of in-situ breast cancer
- relative risk 43% in post-menopausal women with 1100 IU (27.5 ug)/day vitamin D3^[15]
- neither vitamin D nor calcium supplements affect cancer incidence or mortality or overall mortality^[45]^[78]^[103]
- no effect on colon cancer^[67]
- vitamin D & calcium supplementation does not help prevent cancer in healthy elderly women^[92]
- high-dose oral vitamin D 100,000 IU monthly does not prevent cancer (3.3 year trial)^[100]
no therapeutic benefit patients with colorectal cancer
does not prevent common cold^[52] or other upper respiratory tract infections^[64]^[86]
does not reduce risk of childhood pneumonia^[53]
not useful for treatment of asthma^[74]
- not useful for prevention of severe asthma exacerbations^[114]
- high-dose vitamin D during pregnancy does not lower risk for asthmma in offspring^[111]
in combination with calcium, does not improve muscle strength in young women with low serum 25-OH vitamin D^[56]
- supplementation does not improve any measure of physical conditioning in elderly black women^[105]
of no benefit for osteoarthritis of the knee^[57]
although low serum 25-OH vitamin D is associated with an increase in all cause mortality, a mortality benefit with supplementation has not been proven^[23]
does not reduce risk of falls in the elderly or risk of fracture^[68]^[101]^[130]
- vitamin D + calcium supplementation associated with a small but statistically significant absolute reduction in hip fractures or any fractures^[127]
  - reduction not observed when analyses limited to community-dwelling elders^[127]
  - supplementation with vitamin D alone not associated with reductions in hip fractures or any fractures in any population^[127]
- insufficient data to recommend calcium plus vitamin D supplementation for primary prevention of bone fractures (USPSTF)^[78]
- USPSTF recommends against vitamin D supplementation to prevent falls in community-dwelling adults >= 65 years (GRS11)^[68]^[96]
- vitamin D supplementation does not reduce the risk of falls in older adults (GRS11)^[68]^[72]
- vitamin D supplementation reduces risk of falls in care facilities^[110]
- does not reduce risk of hip fracture^[67]
- calcium supplements &/or vitamin D does not reduce fracture risk in community-dwelling older adults^[97]^[130]^[141]
- supplementation does not improve bone mineral density in the absence of vitamin D deficiency^[62]
- 2000 IU of vitamin D3 daily did not lower incidence of falls in community-dwelling adults
- vitamin D3 supplementation at doses of 1000-4000 IU/day does not prevent falls compared with doses of 200 IU/day in elderly with elevated fall risk & low serum 25-OH vitamin D levels (10-29 ng/mL)^[117]
  - vitamin D3 doses of 2000 IU & 4000 IU/day associated with increased fall risk vs 200 IU or 1000 IU/day^[117]
- neither 800 IU vit D QD nor 50,000 IU twice monthly increases bone mineral density or reduces falls in elderly with serum 25-OH vitamin D of 14-27 ng/mL^[82]
- high-dose vitamin D3 (60,000 IU monthly or 24,000 IU + 300 ug of calcifediol) does not improve functional ability in community living elderly & actually increases fall risk^[83]
- vitamin D 1000-4000 IU/day might increase risk of fall with fracture^[123]
- vitamin D supplementation does not reduce risk of fractures in healthy elderly^[148]
  - may increase rosl of hip fractures in healthy elderly women^[146]
unlikely to reduce risk of type 2 diabetes^[76]
- does not prevent progression of prediabetes to diabetes^[88]^[106]
- combining results of 3 randomized trials that found no benefit, vitamin D supplementation conferred a 3% absolute risk reduction for progression of prediabetes to diabetes over 3 years^[139]
supplementation of little if any benefit for pregnant women
- marginal if any benefit as prenatal supplement in preventing childhood asthma^[84]
- high-dose supplementation (2400 IU)/day) does improve neurodevelopmental outcomes in offsprimng^[118]
supplementation does not reduce risk for depression in the elderly^[113]
vitamin D (2000 IU/day) does not prevent cognitive impairment in healthy adults > 70 years of age^[116]
- vitamin D supplementation has no benefit or harm for cognitive function in elderly > 60 years^[142]
vitamin D3 of no benefit for hospitalized patients with COVID-19^[119]
vitamin D (2000 IU/day) &/or fish oil (840 mg of omega-3 fatty acids EPA/DHA) of no benefit in preventing atrial fibrillation^[121]
60,000 IU of vit D3 oral monthly for 5 years of no benefit for mortalilty in adults^[124]
of no benefit in preventing statin myopathy^[132]
vitamin D therapy does not reduce the risk of all-cause death in people with chronic kidney disease^[144].

Benefit/risk

community-dwelling elderly^[80]
- no benefit in preventing fractures
- vitamin D3 2000 IU daily did not reduce risk of falls^[115]
institutionalized elderly^[81]
- number needed to treat (NNT)
  - 36 patients for an undisclosed period of time to prevent 1 hip fracture
number need to harm
- 36 patients for an undisclosed period of time to induce 1 case of kidney disease, kidney stone or other^[81]

Dosage

recommended daily allowance
- infants: 400 IU/day adequate^[61]
- children & adults <= 70 years of age: 600 IU/day^[40]^[68]
- elderly > 70 years of age: 800 IU/day
- higher levels not associated with increased bone density
- 1800 IU/day associated with increased risk of hypercalcemia*
hypocalcemia:
- requires weeks to achieve full effect
- 50,000 IU (1250 ug) PO QD (initially)
- 50,000-100,000 (1250-2500 ug) IU PO QD (maintenance)
- dose may be increased at 4-6 week intervals
osteoporosis, fracture & fall prevention:
- 800 IU (20 ug) QD^[2]^[3]^[4]
- 2000 IU (50 ug) QD for prevention of hospital re-admission after hip fracture in women with vitamin D deficiency^[41]
- 500,000 IU (12.5 mg) PO given to women annually paradoxically increases risk of fracture^[33]
vitamin D deficiency:
- 50,000 IU (1.25 mg) weekly for 6-12 weeks^[36]
toxic erythema of chemotherapy: 50,000-200,000 single dose^[136]

* ~ 1/5 of adults take >= 1000 IU/day, 3% take >= 4000 IU/day^[94]

* increases in total serum 25-OH vitamin D with vitamin D supplementation is lower at higher in persons with higher BMI^[138]

Adverse effects

toxicity
- risk begins at doses above 4000 IU/day
- doses > 10,000 IU (250 ug)/day associated with kidney damage^[40]
- may occur at doses of 50,000 (1.25 mg) IU/day for several months in adults^[36]
- bone mineral density loss at the radius at doses > 4000 IU/day^[108]
hypercalcemia & hypocalciuria^[33]
- hypercalciuria at higher doses
- may take over 2 months to resolve
- symptomatic hypercalcemia due to vitamin D should be treated with prednisone
serum PTH is suppressed^[33]
corneal opacification

Drug interactions

inducers of CYP3A4
- carbamazepine
statins, except rosuvastatin

drug interaction(s) of statins with vitamin D

Laboratory

serum 25-OH vitamin D provides best indicator of total body vitamin D status
- 30-100 ng/mL is target^[50]
- not necessary prior to initiation of vitamin D supplementation in elderly without regular sun exposure^[68]*
- neither 800 IU vit D QD nor 50,000 IU twice monthly increases bone mineral density or reduces falls in elderly with serum 25-OH vitamin D of 14-27 ng/mL^[82]

* GRS11 recommmends repeat DEXA scan every 5 years in women starting at age 65 years rather than initiation of vitamin D supplementation or measuring serum 25-OH vitamin D (seems that vitamin D supplementation is correct according to accompanying explanation)^[68]

Mechanism of action

precursor to calcitriol, thus role in absorption of Ca+2 & phosphate from the intestines (primary role)^[33]
- supplemental vitamin D enhances Ca+2 absorption very little in women with mild vitamin D insufficiency^[55]
- only 6% difference in Ca+2 absorption in women with serum 25-OH vitamin D levels of 60 ng/mL vs 20 ng/mL (58% vs 52%)^[55]
reduces production of renin^[6]
stimulates production of insulin^[6]
vitamin D2 & vitamin D3 equally effective in raising serum levels of 25-OH vitamin D^[16]
- vitamin D3 more effective than vitamin D2^[66]
- vitamin D2 decreases plasma 25-hydroxyvitamin D3^[66]
upregulates genes to induce Toll-like receptor-2 (TLR-2) on keratinocytes & increases expression of antimicrobial peptides such as cathelicidin; effects may be mediated through activation of SRC3^[27]
high-dose vitamin D 50,000-200,000 single dose has a dose-dependent anti-inflammatory response, reducing redness & swelling within 24-48 hours without significant increase in serum vitamin D or serum calcium^[136]

Notes

vitamin D production from exposure to sunlight varies by age, Fitzpatrick skin type, geographic location, season & time of day^[35]
- fair-skin persons produce more vitamin D than dark-skin persons
- exposure to 1 hour of bright sunlight can generate production of 20,000 IU (500 ug) of vitamin D in a fair-skin person at southern lattitudes &/or summer months
- north of the sun-belt, it is difficult to obtain sufficient sunlight exposure during the winter to produce the RDA of vitamin D^[35]
vitamin D should be obtained through foods, beverages, & supplements, not through unprotected exposure to sunlight^[18]
- plant-based milk (almond milk, soy milk) & goat's milk may contain inadequate amounts of vitamin D for children in Canada^[77]
most Americans get enough vitamin D^[40]
medications that adversely affect vitamin D status include phenobarbital, phenytoin, carbamazepine, rifampicin, & antiretroviral
activated macrophages in granulomatous diseases in the setting of renal failure can cause extrarenal metabolism of vitamin D, resulting in hypercalcemia
higher serum 25-hydroxyvitamin D levels associated with better cognitive function in adults
- this does not seem to be apparent in adolescents^[47]
- low serum 25-hydroxyvitamin D is associated with cognitive decline^[37]
- low serum 25-hydroxyvitamin D is associated increased risk of Parkinson's disease^[48]
higher brain 25-OH vit D3 associated with better cognitive function prior to death, but not associated with any neuropathology or biomarker outcome^[135]
no causal association between vitamin D status & health^[65]
response of serum 25-hydroxyvitamin D levels to vitamin D supplementation is 30% lower in obese persons (on average) but individual responses vary widely^[69]

More general terms

More specific terms

Additional terms

Component of

References

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↑ Prescriber's Letter 15(11): 2008 New Guidelines for Vitamin D Intake in Infants and Children Detail-Document#: http://prescribersletter.com/(5bhgn1a4ni4cyp2tvybwfh55)/pl/ArticleDD.aspx?li=1&st=1&cs=&s=PRL&pt=3&fpt=25&dd=241112&pb=PRL (subscription needed) http://www.prescribersletter.com
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↑ Prescriber's Letter 16(5): 2009 Vitamin D Dosing Detail-Document#: http://prescribersletter.com/(5bhgn1a4ni4cyp2tvybwfh55)/pl/ArticleDD.aspx?li=1&st=1&cs=&s=PRL&pt=3&fpt=25&dd=250508&pb=PRL (subscription needed) http://www.prescribersletter.com
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↑ Prescriber's Letter 17(1): 2010 Vitamin D in the Pediatric Population COMMENTARY: Vitamin D in the Pediatric Population GUIDELINES: AAP Guidelines on Prevention of Rickets and Vitamin D Deficiency GUIDELINES: CPS Guidelines for Vitamin D Supplementation: Recommendations for Canadian Mothers and Infants Detail-Document#: http://prescribersletter.com/(5bhgn1a4ni4cyp2tvybwfh55)/pl/ArticleDD.aspx?li=1&st=1&cs=&s=PRL&pt=3&fpt=25&dd=260110&pb=PRL (subscription needed) http://www.prescribersletter.com
↑ ^33.0 ^33.1 ^33.2 ^33.3 ^33.4 Medical Knowledge Self Assessment Program (MKSAP) 15, 16, 18, 19. American College of Physicians, Philadelphia 2009, 2012, 2018, 2023.
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Prescriber's Letter 18(1): 2011 COMMENTARY: Calcium and Vitamin D Supplementation: Who Needs It? COMMENTARY: Vitamin D Dosing: An Update PATIENT HANDOUT: Calcium and Vitamin D GUIDELINES: Dietary Reference Intakes for Calcium and Vitamin D Detail-Document#: http://prescribersletter.com/(5bhgn1a4ni4cyp2tvybwfh55)/pl/ArticleDD.aspx?li=1&st=1&cs=&s=PRL&pt=3&fpt=25&dd=270102&pb=PRL (subscription needed) http://www.prescribersletter.com
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↑ Prescriber's Letter 19(9): 2012 COMMENTARY: Vitamin D Dosing Detail-Document#: http://prescribersletter.com/(5bhgn1a4ni4cyp2tvybwfh55)/pl/ArticleDD.aspx?li=1&st=1&cs=&s=PRL&pt=3&fpt=25&dd=280921&pb=PRL (subscription needed) http://www.prescribersletter.com
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↑ Prescriber's Letter 20(4): 2013 COMMENTARY: Calcium and Cardiovascular Risk PATIENT EDUCATION HANDOUT: Calcium and Vitamin D Detail-Document#: http://prescribersletter.com/(5bhgn1a4ni4cyp2tvybwfh55)/pl/ArticleDD.aspx?li=1&st=1&cs=&s=PRL&pt=3&fpt=25&dd=290409&pb=PRL (subscription needed) http://www.prescribersletter.com
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↑ Malmberg HR, Hanel A, Taipale M Vitamin D Treatment Sequence Is Critical for Transcriptome Modulation of Immune Challenged Primary Human Cells. Front. Immunol. 2021. Dec 10
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Patient information

vitamin D patient information

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[ref3-3] 3.0 ^3.1 Prescriber's Letter 11(7):32 2004 Detail-Document#: http://prescribersletter.com/(5bhgn1a4ni4cyp2tvybwfh55)/pl/ArticleDD.aspx?li=1&st=1&cs=&s=PRL&pt=3&fpt=25&dd=200604&pb=PRL (subscription needed) http://www.prescribersletter.com

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[ref6-6] 6.0 ^6.1 ^6.2 Netscape News cites: (12/24/05) Michael F. Holick, PhD, MD, Vitamin D, Skin, and Bone Research Laboratory, Boston University School of Medicine.

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[ref8-8] 8.0 ^8.1 Hartman TJ, Albert PS, Snyder K, Slattery ML, Caan B, Paskett E, Iber F, Kikendall JW, Marshall J, Shike M, Weissfeld J, Brewer B, Schatzkin A, Lanza E; Polyp Prevention Study Group. The association of calcium and vitamin D with risk of colorectal adenomas. J Nutr. 2005 Feb;135(2):252-9. PMID: https://www.ncbi.nlm.nih.gov/pubmed/15671222
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[ref10-10] 10.0 ^10.1 Forman JP, Bischoff-Ferrari HA, Willett WC, Stampfer MJ, Curhan GC. Vitamin D intake and risk of incident hypertension: results from three large prospective cohort studies. Hypertension. 2005 Oct;46(4):676-82. Epub 2005 Sep 6. PMID: https://www.ncbi.nlm.nih.gov/pubmed/16144983

[ref11-11] 11.0 ^11.1 Internal Medicine World Report Dec 2005 cites Willet W, Chairman, Department of Nutrition, Harvard School of Public Health, at the annual meeting of the American Society of Nephrology

[ref12-12] Gorham ED, Garland CF, Garland FC, Grant WB, Mohr SB, Lipkin M, Newmark HL, Giovannucci E, Wei M, Holick MF. Vitamin D and prevention of colorectal cancer. J Steroid Biochem Mol Biol. 2005 Oct;97(1-2):179-94. Epub 2005 Oct 19. PMID: https://www.ncbi.nlm.nih.gov/pubmed/16236494
Giovannucci E. The epidemiology of vitamin D and colorectal cancer: recent findings. Curr Opin Gastroenterol. 2006 Jan;22(1):24-9. Review. PMID: https://www.ncbi.nlm.nih.gov/pubmed/16319673

[ref13-13] Prescriber's Letter 14(3): 2007 Calcium and Vitamin D Supplementation: Who Needs It? Detail-Document#: http://prescribersletter.com/(5bhgn1a4ni4cyp2tvybwfh55)/pl/ArticleDD.aspx?li=1&st=1&cs=&s=PRL&pt=3&fpt=25&dd=230304&pb=PRL (subscription needed) http://www.prescribersletter.com

[ref14-14] 14.0 ^14.1 Wicherts IS et al, Vitamin D status predicts physical performance and its decline in older persons. J Clin Endocrinol Metabol 2007, 92:2058 PMID: https://www.ncbi.nlm.nih.gov/pubmed/17341569

[ref15-15] 15.0 ^15.1 Prescriber's Letter 14(7): 2007 Vitamin D and Calcium: Not Just for Bones Anymore Detail-Document#: http://prescribersletter.com/(5bhgn1a4ni4cyp2tvybwfh55)/pl/ArticleDD.aspx?li=1&st=1&cs=&s=PRL&pt=3&fpt=25&dd=230708&pb=PRL (subscription needed) http://www.prescribersletter.com
Martins D, Wolf M, Pan D, Zadshir A, Tareen N, Thadhani R, Felsenfeld A, Levine B, Mehrotra R, Norris K. Prevalence of cardiovascular risk factors and the serum levels of 25-hydroxyvitamin D in the United States: data from the Third National Health and Nutrition Examination Survey. Arch Intern Med. 2007 Jun 11;167(11):1159-65. PMID: https://www.ncbi.nlm.nih.gov/pubmed/17563024
Lappe JM, Travers-Gustafson D, Davies KM, Recker RR, Heaney RP. Vitamin D and calcium supplementation reduces cancer risk: results of a randomized trial. Am J Clin Nutr. 2007 Jun;85(6):1586-91. PMID: https://www.ncbi.nlm.nih.gov/pubmed/17556697

[ref16-16] 16.0 ^16.1 Holick MF et al, Vitamin D2 is as effective as vitamin D3 in maintaining circulating concentrations of 25-hydroxyvitamin D. J Clin Endocrinol Metab 2008, 93:667 PMID: https://www.ncbi.nlm.nih.gov/pubmed/18089691

[ref17-17] Prescriber's Letter 15(11): 2008 New Guidelines for Vitamin D Intake in Infants and Children Detail-Document#: http://prescribersletter.com/(5bhgn1a4ni4cyp2tvybwfh55)/pl/ArticleDD.aspx?li=1&st=1&cs=&s=PRL&pt=3&fpt=25&dd=241112&pb=PRL (subscription needed) http://www.prescribersletter.com
Wagner CL et al, Prevention of rickets and vitamin d deficiency in infants, children, and adolescents. Pediatrics. 2008 Nov;122(5):1142-52. PMID: https://www.ncbi.nlm.nih.gov/pubmed/18977996

[ref18-18] 18.0 ^18.1 Ward KA et al Vitamin D status and muscle function in post-menarchal adolescent girls. J Clin Endocrinol Metab 2009 Feb; 94:559. PMID: https://www.ncbi.nlm.nih.gov/pubmed/19033372

[ref19-19] American Academy of Dermatology Position statement on vitamin D, 11/01/2008 http://www.aad.org/Forms/Policies/Uploads/PS/PS-Vitamin%20D.pdf

[ref20-20] Prescriber's Letter 16(5): 2009 Vitamin D Dosing Detail-Document#: http://prescribersletter.com/(5bhgn1a4ni4cyp2tvybwfh55)/pl/ArticleDD.aspx?li=1&st=1&cs=&s=PRL&pt=3&fpt=25&dd=250508&pb=PRL (subscription needed) http://www.prescribersletter.com

[ref21-21] Orwoll E et al. Vitamin D deficiency in older men. J Clin Endocrinol Metab 2009 Apr; 94:1214. PMID: https://www.ncbi.nlm.nih.gov/pubmed/19174492

[ref22-22] Jacobs ET et al. Vitamin D insufficiency in southern Arizona. Am J Clin Nutr 2008 Mar; 87:608. PMID: https://www.ncbi.nlm.nih.gov/pubmed/18326598

[ref23-23] 23.0 ^23.1 ^23.2 Dobnig H et al. Independent association of low serum 25-hydroxyvitamin D and 1,25-dihydroxyvitamin D levels with all-cause and cardiovascular mortality. Arch Intern Med 2008 Jun 23; 168:1340. PMID: https://www.ncbi.nlm.nih.gov/pubmed/18574092

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[ref25-25] 25.0 ^25.1 Blackmore KM et al. Vitamin D from dietary intake and sunlight exposure and the risk of hormone-receptor-defined breast cancer. Am J Epidemiol 2008 Oct 15; 168:915. PMID: https://www.ncbi.nlm.nih.gov/pubmed/18756015

[ref26-26] 26.0 ^26.1 Hicks GE et al Associations between vitamin D status and pain in older adults: The Invecchiare in Chianti Study. J Am Geriatr Soc 2008 May; 56:785 PMID: https://www.ncbi.nlm.nih.gov/pubmed/18331
Warner AE and Arnspiger SA. Diffuse musculoskeletal pain is not associated with low vitamin D levels or improved by treatment with vitamin D. J Clin Rheumatol 2008 Feb; 14:12. PMID: https://www.ncbi.nlm.nih.gov/pubmed/18431091

[ref27-27] 27.0 ^27.1 Schauber J et al. Histone acetylation in keratinocytes enables control of the expression of cathelicidin and CD14 by 1,25-dihydroxyvitamin D3. J Invest Dermatol 2008 Apr; 128:816 PMID: https://www.ncbi.nlm.nih.gov/pubmed/17943182
Segaert S. Vitamin D regulation of cathelicidin in the skin: Toward a renaissance of vitamin D in dermatology? J Invest Dermatol 2008 Apr; 128:773. PMID: https://www.ncbi.nlm.nih.gov/pubmed/18337709

[ref28-28] 28.0 ^28.1 Wang TJ et al Vitamin D deficiency and risk of cardiovascular disease. Circulation. 2008 Jan 29;117(4):503-11. Epub 2008 Jan 7. <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/18180395 <Internet> http://circ.ahajournals.org/cgi/reprint/CIRCULATIONAHA.107.706127v1
Wang L et al. Systematic review: Vitamin D and calcium supplementation in prevention of cardiovascular events. Ann Intern Med 2010 Mar 2; 152:315. PMID: https://www.ncbi.nlm.nih.gov/pubmed/20194238
Guallar E et al. Vitamin D supplementation in the age of lost innocence. Ann Intern Med 2010 Mar 2; 152:327 PMID: https://www.ncbi.nlm.nih.gov/pubmed/20194240

[ref29-29] Ginde AA et al Demographic differences and trends of vitamin D insufficiency in the US population, 1988-2004. Arch Intern Med 2009 Mar 23; 169:626. PMID: https://www.ncbi.nlm.nih.gov/pubmed/19307527

[ref30-30] 30.0 ^30.1 AHRQ: Agency for Healthcare Research and Quality Vitamin D and Calcium: Systematic Review of Health Outcomes http://www.ahrq.gov/clinic/tp/vitadcaltp.htm

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[ref32-32] Prescriber's Letter 17(1): 2010 Vitamin D in the Pediatric Population COMMENTARY: Vitamin D in the Pediatric Population GUIDELINES: AAP Guidelines on Prevention of Rickets and Vitamin D Deficiency GUIDELINES: CPS Guidelines for Vitamin D Supplementation: Recommendations for Canadian Mothers and Infants Detail-Document#: http://prescribersletter.com/(5bhgn1a4ni4cyp2tvybwfh55)/pl/ArticleDD.aspx?li=1&st=1&cs=&s=PRL&pt=3&fpt=25&dd=260110&pb=PRL (subscription needed) http://www.prescribersletter.com

[ref33-33] 33.0 ^33.1 ^33.2 ^33.3 ^33.4 Medical Knowledge Self Assessment Program (MKSAP) 15, 16, 18, 19. American College of Physicians, Philadelphia 2009, 2012, 2018, 2023.

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[ref35-35] 35.0 ^35.1 ^35.2 Terushkin V et al. Estimated equivalency of vitamin D production from natural sun exposure versus oral vitamin D supplementation across seasons at two US latitudes. J Am Acad Dermatol 2010 Jun; 62:929.e1. PMID: https://www.ncbi.nlm.nih.gov/pubmed/20363523
Tsiaras WG and Weinstock MA. Ultraviolet irradiation and oral ingestion as sources of optimal vitamin D. J Am Acad Dermatol 2010 Jun; 62:935. PMID: https://www.ncbi.nlm.nih.gov/pubmed/20363525

[ref36-36] 36.0 ^36.1 ^36.2 Prescriber's Letter 17(7): 2010 Vitamin D Dosing: An Update Detail-Document#: http://prescribersletter.com/(5bhgn1a4ni4cyp2tvybwfh55)/pl/ArticleDD.aspx?li=1&st=1&cs=&s=PRL&pt=3&fpt=25&dd=260707&pb=PRL (subscription needed) http://www.prescribersletter.com

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Grey A et al. A place in the sun? Arch Intern Med 2010 Jul 12; 170:1099. PMID: https://www.ncbi.nlm.nih.gov/pubmed/20625012

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[ref39-39] Cawthon PM et al. Serum 25-hydroxyvitamin D, parathyroid hormone, and mortality in older men. J Clin Endocrinol Metab 2010 Oct; 95:4625 PMID: https://www.ncbi.nlm.nih.gov/pubmed/20631024

[ref40-40] 40.0 ^40.1 ^40.2 ^40.3 ^40.4 ^40.5 ^40.6 Institute of Medicine, 11/30/2010 Dietary Reference Intakes for Calcium and Vitamin D http://www.iom.edu/Reports/2010/Dietary-Reference-Intakes-for-Calcium-and-Vitamin-D/Report-Brief.aspx
Prescriber's Letter 18(1): 2011 COMMENTARY: Calcium and Vitamin D Supplementation: Who Needs It? COMMENTARY: Vitamin D Dosing: An Update PATIENT HANDOUT: Calcium and Vitamin D GUIDELINES: Dietary Reference Intakes for Calcium and Vitamin D Detail-Document#: http://prescribersletter.com/(5bhgn1a4ni4cyp2tvybwfh55)/pl/ArticleDD.aspx?li=1&st=1&cs=&s=PRL&pt=3&fpt=25&dd=270102&pb=PRL (subscription needed) http://www.prescribersletter.com

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[ref44-44] 44.0 ^44.1 ^44.2 ^44.3 Chung M et al Vitamin D With or Without Calcium Supplementation for Prevention of Cancer and Fractures: An Updated Meta-analysis for the U.S. Preventive Services Task Force Annals of Internal Medicine, Dec 20, 2011 155(12)827-838 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/22184690 <Internet> http://www.annals.org/content/155/12/827.abstract
McGreevy C and Williams D New Insights About Vitamin D and Cardiovascular Disease A Narrative Review Annals of Internal Medicine, Dec 20, 2011 155(12)820-826 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/22184689 <Internet> http://www.annals.org/content/155/12/820.abstract

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[ref50-50] 50.0 ^50.1 ^50.2 Bischoff-Ferrari HA, Willett WC, Orav EJ et al A Pooled Analysis of Vitamin D Dose Requirements for Fracture Prevention N Engl J Med 2012; 367:40-49 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/22762317 <Internet> http://www.nejm.org/doi/full/10.1056/NEJMoa1109617
Heaney RP Vitamin D - Baseline Status and Effective Dose N Engl J Med 2012; 367:77-78 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/22762324 <Internet> http://www.nejm.org/doi/full/10.1056/NEJMe1206858

[ref51-51] Prescriber's Letter 19(9): 2012 COMMENTARY: Vitamin D Dosing Detail-Document#: http://prescribersletter.com/(5bhgn1a4ni4cyp2tvybwfh55)/pl/ArticleDD.aspx?li=1&st=1&cs=&s=PRL&pt=3&fpt=25&dd=280921&pb=PRL (subscription needed) http://www.prescribersletter.com

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Linder JA Vitamin D and the Cure for the Common Cold JAMA. 2012;308(13):1375-1376 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/23032554 <Internet> http://jama.jamanetwork.com/article.aspx?articleid=1367448

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Martineau AR. Bolus-dose vitamin D and prevention of childhood pneumonia. Lancet 2012 Apr 14; 379:1373. PMID: https://www.ncbi.nlm.nih.gov/pubmed/22494825

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Annweiler C, Muir SW, Nabeel S et al Higher serum vitamin d concentration is associated with better balance in older adults with supra-optimal vitamin d status. J Am Geriatr Soc. 2013 Jan;61(1):163-5. doi:http://dx.doi.org/ 10.1111/jgs.12053. PMID: https://www.ncbi.nlm.nih.gov/pubmed/23311560

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[ref60-60] Prescriber's Letter 20(4): 2013 COMMENTARY: Calcium and Cardiovascular Risk PATIENT EDUCATION HANDOUT: Calcium and Vitamin D Detail-Document#: http://prescribersletter.com/(5bhgn1a4ni4cyp2tvybwfh55)/pl/ArticleDD.aspx?li=1&st=1&cs=&s=PRL&pt=3&fpt=25&dd=290409&pb=PRL (subscription needed) http://www.prescribersletter.com

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Abrams SA Targeting Dietary Vitamin D Intakes and Plasma 25-Hydroxyvitamin D in Healthy Infants. JAMA. 2013;309(17):1830-1831 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/23632728 <Internet> http://jama.jamanetwork.com/article.aspx?articleid=1682920

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Kanasuo E et al Regular use of vitamin D supplement is associated with fewer melanoma cases compared to non-use: a cross-sectional study in 498 adult subjects at risk of skin cancers. Melanoma Research 2022. December 28. PMID: https://www.ncbi.nlm.nih.gov/pubmed/36580363 https://journals.lww.com/melanomaresearch/Abstract/9900/Regular_use_of_vitamin_D_supplement_is_associated.51.aspx

[ref138-138] 138.0 ^138.1 Tobias DK, Luttmann-Gibson H, Mora S et al Association of Body Weight With Response to Vitamin D Supplementation and Metabolism. JAMA Netw Open. 2023;6(1):e2250681. PMID: https://www.ncbi.nlm.nih.gov/pubmed/36648947 PMCID: PMC9856931 Free PMC article https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2800490

[ref139-139] 139.0 ^139.1 Monaco K Can High-Dose Vitamin D Prevent Diabetes? While three trials found no net benefit, combining them yielded significant risk reduction. MedPage Today February 6, 2023 https://www.medpagetoday.com/endocrinology/diabetes/102980
Pittas AG, Kawahara T, Jorde R. Vitamin D and Risk for Type 2 Diabetes in People With Prediabetes. A Systematic Review and Meta-analysis of Individual Participant Data From 3 Randomized Clinical Trials. Annals of Internal Medcine. 2023. Feb 7. PMID: https://www.ncbi.nlm.nih.gov/pubmed/36745886 https://www.acpjournals.org/doi/10.7326/M22-3018

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vitamin D

Contents

Introduction

Indications

Contraindications

Benefit/risk

Dosage

Adverse effects

Drug interactions

Laboratory

Mechanism of action

Notes

More general terms

More specific terms

Additional terms

Component of

References

Patient information

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vitamin D

Introduction

Indications

Contraindications

Benefit/risk

Dosage

Adverse effects

Drug interactions

Laboratory

Mechanism of action

Notes

More general terms

More specific terms

Additional terms

Component of

References

Patient information

Navigation menu

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