Causes LOW VITAMIN D
Inadequate exposure to sunlight (sunscreen or dark skin)
Fat malabsorption syndrome (e.g., celiac disease)
Nephrotic syndrome (vitamin D bound to albumin)
Drug catabolism (HIV medications and anticonvulsants)
Granuloma-forming disorders, lymphomas, and primary hyperparathyroidism
The American Association of Clinical Endocrinologists (AACE) recommends for postmenopausal women to maintain vitamin D intake, and take supplement vitamin D if needed, to maintain serum levels of 25-hydroxyvitamin D [25(OH)D] in the 30 to 60 ng/mL range (Grade A; BEL 1).
Treatment for Fracture Risk Reduction
The USPSTF acknowledged the recommendations of WHO and IOM for the daily intake of calcium and vitamin D for overall health, but not for fracture prevention.
Rather, they summarized the evidence for treatment as follows: “Except for postmenopausal women, there is inadequate evidence to estimate the benefits of vitamin D or calcium supplementation to prevent fractures in noninstitutionalized adults. Due to the lack of effect on fracture incidence and the increased incidence of nephrolithiasis in the intervention group of the WHI [Women’s Health Initiative] trial, the USPSTF concludes with moderate certainty that daily supplementation with 400 IU of vitamin D3 and 1,000 mg of calcium has no net benefit for the primary prevention of fractures in noninstitutionalized, postmenopausal women.”
The USPSTF actually recommends against vitamin D and calcium supplementation for fracture prevention in one of the most common outpatient candidates: noninstitutionalized postmenopausal women!
Harms of supplementation in the WHI trial show the absolute risk of nephrolithiasis in individuals having supplementation with calcium and vitamin D at 2.5% in the intervention group and 2.1% in the placebo group. The number needed to harm was 273.
In a 2010 study by Sanders et al., a double-blind, randomized controlled trial with over 2,000 women in Australia, ages 70 and older, showed that with an annual dose of 500,000 vitamin D there was a 10% absolute risk increase in this already high-risk group, which went as high as 72.7% to 83.4% when they had supplementation.
David Newman, MD, at NNT.com states that by review of the evidence, the number needed to harm (NNH) with regard to nephrolithiasis or kidney injury from vitamin D supplementation was 36.
The World Congress on Osteoporosis, Osteoarthritis and Musculoskeletal Disease found that supplementation of vitamin D had to reach >800 IU daily to differ from placebo.
The Vitamin D Council has a great approach to finding the optimal dose of vitamin D supplementation. The group recommends a dose of 5,000 IU/day and gives the following reasons for it:
Is easy to obtain at most pharmacies
Will get at least 97% of people above 30 ng/ml
Will get most people above 40 ng/ml, and close to around 50 ng/ml
Will not cause anyone to get toxic levels