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New vitamin D recommendations for older men and women
The International Osteoporosis Foundation released a position statement with revised vitamin D recommendations for elderly men and women aged 60 years and older.
"Global vitamin D status shows widespread insufficiency and deficiency," Bess Dawson-Hughes, MD, senior scientist and director at the Tufts University Bone Metabolism Laboratory, said in a press release. "This high prevalence of suboptimal levels raises the possibility that many falls and fractures can be prevented with vitamin D supplementation. This is a relatively easy public health measure that could have significant positive effects on the incidence of osteoporotic fractures."
The position statement makes important recommendations for vitamin D nutrition from an evidence-based perspective.
The statement was published in Osteoporosis International.
Key recommendations
For older adults, the guidelines now recommend an average 800 IU to 1,000 IU of vitamin D per day to reach a serum 25OHD level of 30 ng/mL.
"Considerably higher doses would be needed to ensure that almost all older adults reached 30 ng/mL. Efficacy of doses higher than 800 IU per day for fractures and 1,000 IU per day for falls, however, have not been evaluated in randomized controlled trials. It is therefore premature to recommend higher intakes for all older adults at this time," according to the statement.
Daily vitamin D intake may be lowered to less than 800 IU per day in patients with regular sun exposure, but may need to be increased to as much as 2,000 IU per day in high-risk individuals who are obese, have osteoporosis, limited sun exposure (ie, housebound or institutionalized) and malabsorption or are of non-European heritage, such as Middle Eastern or South Asian.
In high-risk individuals, the recommendation is to measure the serum 25OHD level; the required dose to reach 30 ng/mL can be estimated from the measured 25OHD level, according to the statement.
The serum 25OHD level will increase by about 1 ng/mL for each 100 IU of added vitamin D. It is recommended that high-risk individuals have their serum 25OHD levels retested after about three months of supplementation to confirm that the target 25OHD level has been reached because of the variability in individual 25OHD responses to supplemental vitamin D. - by Matthew Brannon
The drums have been beating for sometime in anticipation of new recommendations for vitamin D supplementation. This position statement, generated by the IOF and reflecting the results of randomized, controlled clinical trials with fall and fracture endpoints, is accordingly directed to men and women aged older than 60 to 65 years. These experts estimate that 800 IU to 1,000 IU per day of vitamin D will enable older adults to reach a serum 25OHD level of at least 30 ng/ml. These recommendations are identical to the National Osteoporosis Foundation recommended doses, which the North American Menopause Society (NAMS) endorsed in our recent Osteoporosis Position Statement (Menopause. 2010;17:22-54). Both the IOF and NAMS express a preference for vitamin D3. Given the prevalence of vitamin D deficiency, having a low threshold for measuring 25OHD levels makes sense, particularly in persons with low bone density and other risks for vitamin D deficiency. The Institute of Medicine is expected to weigh in on suggested dosing by September 2010. Stay tuned as clinical trials establish whether vitamin D, possibly at doses of approximately twice those currently recommended, contributes to prevention of type 2 diabetes, cardiovascular disease, selected cancers, autoimmune diseases and mortality.
Cynthia A. Stuenkel, MD
President, North American Menopause Society,
Clinical Professor of Medicine, Endocrinology and Metabolism, University of California, San Diego
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