Vitamin D blood levels, unnecessary prescriptions, and retest in naïve patients

  • Giulio FormosoEmail author
  • Massimiliano Marino
  • Pietro Ragni
  • Roberto Giuseppe Grilli
  • Emilio Maestri
Letter to the Editor

Several studies in the last decade suggested a worldwide problem of vitamin D deficiency [1]. Scientific societies generally support a blood concentration of 30 ng/ml as threshold for “insufficiency,” [2] despite 2011 recommendations by the Institute of Medicine stating that concentrations > 20 ng/ml provide no benefits on calcium absorption [3]. Regarding clinical benefits, available evidence shows that vitamin D supplementation benefits specific subgroups of patients who are likely to be deficient, although most of them would not need testing (e.g., institutionalized people, patients with chronic kidney disease, pregnant women) [1, 3]. However, supplementation does not prevent cancer or cardiovascular disease [4, 5] or osteoporotic fractures in community-dwelling populations [6].

Nonetheless, widespread supplementation has gained popularity. In Italy, 10.5 defined daily doses (DDD) of vitamin D per 1000 inhabitants per day have been prescribed in 2017, with a 26% increase compared to...


Authors’ contributions

Conceived of or designed study: G. Formoso, M. Marino, P. Ragni, R. Grilli, E. Maestri

Performed research: G. Formoso, M. Marino

Analyzed data: M. Marino, G. Formoso

Wrote the paper: G. Formoso

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.


  1. 1.
    Manson JE, Brannon PM, Rosen CJ, Taylor CL (2016) Vitamin D deficiency — is there really a pandemic? N Engl J Med 375:1817–1820CrossRefGoogle Scholar
  2. 2.
    Holick MF, Binkley NC, Bischoff-Ferrari HA, Gordon CM, Hanley DA, Heaney RP, Murad MH, Weaver CM (2011) Evaluation, treatment, and prevention of vitamin D deficiency: an Endocrine Society clinical practice guideline. J Clin Endocrinol Metab 96:1911–1930CrossRefGoogle Scholar
  3. 3.
    Ross AC, Manson JE, Abrams SA, Aloia JF, Brannon PM, Clinton SK, Durazo-Arvizu RA, Gallagher JC, Gallo RL, Jones G, Kovacs CS, Mayne ST, Rosen CJ, Shapses SA (2011) The 2011 report on dietary reference intakes for calcium and vitamin D from the Institute of Medicine: what clinicians need to know. J Clin Endocrinol Metab 96:53–58CrossRefGoogle Scholar
  4. 4.
    Manson JE, Cook NR, Lee IM, Christen W, Bassuk SS, Mora S, Gibson H, Gordon D, Copeland T, D’Agostino D, Friedenberg G, Ridge C, for the VITAL Research Group et al (2019) Vitamin D supplements and prevention of cancer and cardiovascular disease. N Engl J Med 380:33–44CrossRefGoogle Scholar
  5. 5.
    Barbarawi M, Kheiri B, Zayed Y, Barbarawi O, Dhillon H, Swaid B, Yelangi A, Sundus S, Bachuwa G, Alkotob ML, Manson JE (2019) Vitamin D supplementation and cardiovascular disease risks in more than 83,000 individuals in 21 randomized clinical trials. A meta-analysis. JAMA Cardiol. [Epub ahead of print]
  6. 6.
    Kahwati LC, Palmieri Weber R, Pan H, Gourlay M, LeBlanc E, Coker-Schwimmer M, Viswanathan M (2018) Vitamin D, calcium, or combined supplementation for the primary prevention of fractures in community-dwelling adults. Evidence report and systematic review for the US Preventive Services Task Force. JAMA 319:1600–1612CrossRefGoogle Scholar
  7. 7.
    L’uso dei farmaci in Italia. Rapporto OsMed 2017. AIFA, July 2018 (available at

Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Clinical Governance UnitLocal Health Authority - IRCCS of Reggio EmiliaReggio EmiliaItaly
  2. 2.PiacenzaItaly

Personalised recommendations