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Do Desirable Vitamin D Levels Vary Globally?

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Nutritional Influences on Bone Health

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.

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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

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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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  1. Department of Internal Medicine, American University of Beirut Medical Center, Cairo Street – Hamra, Beirut, 1107 2020, Lebanon

    Ghada El-Hajj Fuleihan MD, MPH, Maya Rahme MS & Darina Bassil MPH

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  1. Ghada El-Hajj Fuleihan MD, MPH
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  2. Maya Rahme MS
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  3. Darina Bassil MPH
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Correspondence to Ghada El-Hajj Fuleihan MD, MPH .

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  1. , Department of Internal Medicine, Hirslanden Clinic/Bois Cerf, Ave. d'Ouchy 31, Lausanne, 1006, Vaud, Switzerland

    Peter Burckhardt

  2. , Human Nutrition Research Center on Aging, Tufts University, 711 Washington Street, Boston, 02111, Massachusetts, USA

    Bess Dawson-Hughes

  3. , Nutrition and Science, Purdue University, W. State Street 700, West Lafayette, 47907-2059, Indiana, USA

    Connie M. Weaver

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Fuleihan, G.EH., Rahme, M., Bassil, D. (2013). Do Desirable Vitamin D Levels Vary Globally?. In: Burckhardt, P., Dawson-Hughes, B., Weaver, C. (eds) Nutritional Influences on Bone Health. Springer, London. https://doi.org/10.1007/978-1-4471-2769-7_27

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