The new guidelines recommend limiting vitamin D supplements to the recommended daily intake.
Thanks to new guidelines published by the Endocrine Society, clinical laboratories may finally begin ordering fewer vitamin D tests from doctors. The new clinical practice guidelines advise against “unnecessary testing of vitamin D levels.” They also strongly encourage healthy people and those under age 75 to avoid taking more than the recommended daily intake of the vitamin, according to a news release.
The Association holds an annual general meeting and Journal of Clinical Endocrinology and Metabolism The paper is titled “Vitamin D for Disease Prevention: An Endocrine Society Clinical Practice Guideline.”
Although the Endocrine Society recommends vitamin D supplements for certain groups, it advises individuals against routine testing because there seems to be uncertainty among ordering clinicians about what to do with their patients based on vitamin D test results.
“When clinicians measure vitamin D, they’re forced to make a decision about how to proceed, and that’s where questions about levels arise. And that’s a big issue. So what this committee is saying is, ‘Don’t test,'” said Clifford Rosen, MD, director of clinical and translational research and senior scientist at the University of Maine Maine Medical Center Research Institute. Medscape Medical News.
“There is no data that testing improves quality of life, so testing is probably not worth it at any age,” he added.
“The guidelines are aimed at otherwise healthy people who have no clear indication for vitamin D, such as those who already have advanced osteoporosis. This guideline is not relevant to them,” Anastasios G. Pittas, MD (above), author of the Endocrine Society guidelines and professor of medicine at Tufts University School of Medicine in Boston, told Medscape Medical News. The new guidelines may reduce the number of times doctors ask labs to test for vitamin D. (Photo credit: Tufts University)
Vitamin D testing is not recommended for certain groups
A new clinical guideline from the Endocrine Society advises healthy adults under 75 years of age to avoid taking vitamin D supplements beyond those recommended by the Institute of Medicine (now the National Academy of Medicine (NAM)).
In addition, the updated guidelines are as follows:
- Vitamin D supplements above the NAM recommended levels are recommended to reduce the risks faced by children under 18 years of age, adults over 75 years of age, pregnant women, and people with prediabetes.
- For people over 50 years of age who “have an indication for vitamin D supplementation or treatment,” it is recommended that they take a low dose of vitamin D daily (rather than a higher dose of the vitamin daily).
- Advised against routine testing for 25-hydroxyvitamin D [aka, calcifediol] “There is no need to implement ’25-hydroxyvitamin D screening’ in all of the above groups, as no result-specific benefits based on these levels have been identified. This includes 25-hydroxyvitamin D screening for darker-skinned and obese individuals.”
An exception to the guidelines applies to people who already have osteoporosis, according to guideline author Anastasios G. Pittas, M.D., an endocrinologist who is chief of the Department of Endocrinology, Diabetes and Metabolism, co-director of the Tufts University Diabetes and Lipid Center, and a professor at Tufts University School of Medicine in Boston.
Researching the relationship between vitamin D and disease
During a panel discussion at the Endocrine Society’s annual meeting, members acknowledged that a growing body of research has shown a link between serum levels of 25-hydroxyvitamin D (25(OH)D) and physical diseases, including musculoskeletal, metabolic and cardiovascular diseases, but they questioned the link between vitamin D supplementation, testing and disease prevention.
“There is a lack of data on optimal levels and optimal intakes of vitamin D to prevent specific diseases. … What we really need are large clinical trials and biomarkers that can predict outcomes before disease occurs,” said Marie DeMay, an endocrinologist at Massachusetts General Hospital and professor of medicine at Harvard Medical School in Boston. Medscape Medical News report.
On the other hand, their Journal of Clinical Endocrinology and Metabolism In the paper, the researchers noted that according to the National Health and Nutrition Examination Surveys (NHANES) conducted by the National Center for Health Statistics (NCHS) of the Centers for Disease Control and Prevention (CDC) in 1999-2000 and 2013-2014, the use of dietary supplements (≥1,000 IU per day) increased from 0.3% to 18.2%.
“The use of 25(OH)D testing in clinical practice is also increasing; however, the cost-effectiveness of widespread testing has been questioned, especially given the uncertainty about the optimal levels of 25(OH)D needed to prevent disease,” the authors wrote.
“Therefore, the Study Committee suggests against routine 25(OH)D testing in all populations considered,” the researchers said at the Endocrine Society annual meeting.
Other groups support vitamin D testing
Pathologists and clinical laboratory leaders may remember the explosion in vitamin D testing that began nearly two decades ago. According to data cited in an analysis by the American Academy of Family Physicians (AAFP), vitamin D testing covered by Medicare Part B “increased 83-fold” between 2000 and 2010.
“Testing for vitamin D deficiency leads to hundreds of millions of dollars of wasted testing costs each year,” the AAFP said in an editorial on its website, “Vitamin D Testing and Supplementation in Primary Care: Time to Curb the Enthusiasm.”
And the United States Preventive Services Task Force (USPSTF) said in a statement that there was insufficient information to “recommend for or against” testing for vitamin D deficiency.
“No organization recommends population-based screening for vitamin D deficiency, and the American Society of Clinical Pathology does not recommend it,” the USPSTF noted.
Clinical laboratories can disseminate information
The debate about vitamin D has been going on for a while, and the Endocrine Society’s latest guidance may discourage doctors and patients from ordering vitamin D testing as part of annual physicals and routine screenings.
Medical laboratories can provide value by ensuring physicians and patients have up-to-date information regarding vitamin D test orders, reports, and interpretations.
—Donna Marie Pocius
Related information:
The Endocrine Society recommends that healthy adults get the recommended daily intake of vitamin D.
Vitamin D for Disease Prevention: Endocrine Society Clinical Practice Guideline
Don’t Test for Vitamin D: New Endocrine Society Guidelines
Institute of Medicine Vitamin D Recommendations
Vitamin D screening and supplementation in primary care: time to curb enthusiasm
Vitamin D Deficiency Screening Recommendations from the U.S. Preventive Services Task Force
