Vitamin D inadequacy in 2007: what it is and how to manage it

Purpose of review Recent evidence confirms the widespread occurrence of vitamin D deficiency and inadequacy in the general population, especially in patients with fractures and in populations at risk for osteoporotic fractures. Recent findings Limited exposure to sunlight and dietary sources, especially among the elderly, has contributed to the reemergence of musculoskeletal problems attributable to hypovitaminosis D. Overarching themes in the recent literature include the alarming evidence that recommendations for ensuring skeletal health are not being utilized, and the evidence indicating that daily intakes for vitamin D need to be higher than the current national recommendations. Summary Clinicians and healthcare advocacy organizations have called attention to the need for revision of the recommended daily intake of vitamin D on the basis of the amount required to achieve a serum 25-hydroxyvitamin D level of at least 32 ng/ml (80 nmol/l), the serum concentration that is needed to optimize absorption of dietary calcium, suppress excess secretion of parathyroid hormone, and reduce fracture risk. Evidence indicates that to sustain adequate serum levels of 25-hydroxyvitamin D, a daily oral dose of vitamin D3 should be in the order of 1000–2000 IU/day.