Diagnosis and treatment of Vitamin D deficiency

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Mike Bartolatz
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Diagnosis and treatment of Vitamin D deficiency

Post by Mike Bartolatz » Fri Feb 29, 2008 9:50 pm

Pdf version, a full length article will be available through the Vitamin D council in April.

______________________________________________________________________________________________________a full article is availabe now online for $89 US

Expert Opinion on Pharmacotherapy
January 2008, Vol. 9, No. 1, Pages 107-118

Diagnosis and treatment of vitamin D deficiency
JJ Cannell‌1, BW Hollis‌2, M Zasloff‌3 & RP Heaney‌4
1Atascadero State Hospital, 10333 El Camino Real, Atascadero, California 93422, USA +1 805 468 2061; jcannell@ash.dmh.ca.gov
2Medical University of South Carolina, Departments of Biochemistry and Molecular Biology, Charleston, South Carolina, USA
3Georgetown University, Departments of Surgery and Pediatrics, Washington, District of Columbia, USA
4Creighton University Medical Center, Department of Medicine, Omaha, Nebraska, USA
† Author for correspondence

The recent discovery – in a randomised, controlled trial – that daily ingestion of 1100 IU of colecalciferol (vitamin D) over a 4-year period dramatically reduced the incidence of non-skin cancers makes it difficult to overstate the potential medical, social and economic implications of treating vitamin D deficiency. Not only are such deficiencies common, probably the rule, vitamin D deficiency stands implicated in a host of diseases other than cancer. The metabolic product of vitamin D is a potent, pleiotropic, repair and maintenance, secosteroid hormone that targets > 200 human genes in a wide variety of tissues, meaning it has as many mechanisms of action as genes it targets. A common misconception is that government agencies designed present intake recommendations to prevent or treat vitamin D deficiency. They did not. Instead, they are guidelines to prevent particular metabolic bone diseases. Official recommendations were never designed and are not effective in preventing or treating vitamin D deficiency and in no way limit the freedom of the physician – or responsibility – to do so. At this time, assessing serum 25-hydroxy-vitamin D is the only way to make the diagnosis and to assure that treatment is adequate and safe. The authors believe that treatment should be sufficient to maintain levels found in humans living naturally in a sun-rich environment, that is, > 40 ng/ml, year around. Three treatment modalities exist: sunlight, artificial ultraviolet B radiation or supplementation. All treatment modalities have their potential risks and benefits. Benefits of all treatment modalities outweigh potential risks and greatly outweigh the risk of no treatment. As a prolonged ‘vitamin D winter’, centred on the winter solstice, occurs at many temperate latitudes, ≤ 5000 IU (125 μg) of vitamin D/day may be required in obese, aged and/or dark-skinned patients to maintain adequate levels during the winter, a dose that makes many physicians uncomfortable.

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