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Do Desirable Vitamin D Levels Vary Globally?

  • Ghada El-Hajj FuleihanEmail author
  • Maya Rahme
  • Darina Bassil
Chapter

Abstract

Vitamin D insufficiency is a common problem worldwide, with a varying prevalence depending on the population of interest and cutoff used to define insufficiency. The medical literature has witnessed an explosion in the number of vitamin D publications over the last three decades, most convincingly supporting a beneficial effect of vitamin D on musculoskeletal parameters. This led the Institute of Medicine (IOM) to issue an update in 2011 with an increase in the recommended vitamin D intake across all age groups and to set the desirable level at 50 nmol/L. This compares modestly to the desirable level recommended by the Endocrine Society (ES) of 75 nmol/L, which is similar to that recommended by the International Osteoporosis Foundation for older individuals. While the IOM Committee focused on the population needs in North America, the Endocrine Society tried to target high-risk populations. Some of the lowest vitamin D levels are recorded in black subjects and in non-western populations, populations in whom data on fractures and falls are scarce. Information using surrogate markers for the beneficial effect of vitamin D action on musculoskeletal health has many limitations, even in Caucasian subjects where it is the most available. The calcium–vitamin D economy in blacks seems different, and the desirable vitamin D level to optimize musculoskeletal health may be lower than that of Caucasians. Furthermore, some evidence from association studies suggests an increase in the risk of fractures in blacks, and possibly Asians, at 25(OH)D levels exceeding the desirable level for Caucasians. In view of this apparent divergence, the lack of solid outcome data in other ethnic and racial groups, and the multitude of modulators that affect vitamin D metabolism and action, the notion of a global desirable vitamin D level to date is not tenable.

Keywords

25(OH)D Desirable Falls Fractures Surrogate markers Ethnicity PTH Inflection point Plateau Pleiotropic effect of 25(OH)D 

Abbreviations

1.25(OH)2 D

1,25-Dihydroxyvitamin D

25(OH)D

Hydroxyvitamin D

AIDS

Acquired immune deficiency syndrome

BMI

Body mass index

CI

Confidence interval

ER

Estrogen receptor

ES

Endocrine Society

HIV

Human Immunodeficiency virus

HR

Hazard risk

IOF

International Osteoporosis ­Foundation

IOM

Institute of Medicine

LASA

Longitudinal Aging Study Amsterdam

NHANES

National Health and Nutrition Examination

OC

Osteocalcin

OR

Odds ratio

PM

Postmenopausal

PTH

Parathyroid hormone

RIA

Radioimmunoassay

RR

Relative risk or risk ratio

SNP

Single-nucleotide polymorphism

T1DM

Type 1 diabetes mellitus

T2DM

Type 2 diabetes mellitus

TB

Tuberculosis

USA

United States of America

VDR

Vitamin D receptor

WHI

Women’s Health ­Initiative

Notes

Acknowledgements

The authors would like to thank Dr. Heike Bischoff-Ferrari for providing information on her debate presentation entitled “Optimal 25(OH)D level for Bone and Muscle” at the 8th Nutritional Aspects of Osteoporosis Symposium in Lausanne; Ms. Aida Farha, Medical Information Specialist, Saab Medical Library, American University of Beirut, for her advice and assistance in designing comprehensive and complex searches of the various medical literature resources and for the provision of select articles; Ms. Maha Hoteit and Mr. Ali Hammoudi for their retrieval of relevant literature; and Mr. Ali Hammoudi for the art work.

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Copyright information

© Springer-Verlag London 2013

Authors and Affiliations

  • Ghada El-Hajj Fuleihan
    • 1
    Email author
  • Maya Rahme
    • 1
  • Darina Bassil
    • 1
  1. 1.Department of Internal MedicineAmerican University of Beirut Medical CenterBeirutLebanon

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