Consensus Statement on Vitamin D Status Assessment and Supplementation: Whys, Whens, and Hows

Andrea Giustina; John P Bilezikian; Robert A Adler; Giuseppe Banfi; Daniel D Bikle; Neil C Binkley; Jens Bollerslev; Roger Bouillon; Maria Luisa Brandi; Felipe F Casanueva; Luigi di Filippo; Lorenzo M Donini; Peter R Ebeling; Ghada El-Hajj Fuleihan; Angelo Fassio; Stefano Frara; Glenville Jones; Claudio Marcocci; Adrian R Martineau; Salvatore Minisola; Nicola Napoli; Massimo Procopio; René Rizzoli; Anne L Schafer; Christopher T Sempos; Fabio Massimo Ulivieri; Jyrki K Virtanen

doi:10.1210/endrev/bnae009

Consensus Statement on Vitamin D Status Assessment and Supplementation: Whys, Whens, and Hows

Endocr Rev. 2024 Apr 27:bnae009. doi: 10.1210/endrev/bnae009. Online ahead of print.

Authors

Andrea Giustina¹, John P Bilezikian², Robert A Adler³, Giuseppe Banfi^{4

5}, Daniel D Bikle^{6

7}, Neil C Binkley⁸, Jens Bollerslev⁹, Roger Bouillon¹⁰, Maria Luisa Brandi¹¹, Felipe F Casanueva¹², Luigi di Filippo¹, Lorenzo M Donini¹³, Peter R Ebeling¹⁴, Ghada El-Hajj Fuleihan¹⁵, Angelo Fassio¹⁶, Stefano Frara¹, Glenville Jones¹⁷, Claudio Marcocci¹⁸, Adrian R Martineau¹⁹, Salvatore Minisola²⁰, Nicola Napoli²¹, Massimo Procopio²², René Rizzoli²³, Anne L Schafer⁶, Christopher T Sempos²⁴, Fabio Massimo Ulivieri¹, Jyrki K Virtanen²⁵

Affiliations

¹ Institute of Endocrine and Metabolic Sciences, San Raffaele Vita-Salute University and IRCCS Hospital, Milan 20132, Italy.
² Department of Medicine, Vagelos College of Physicians and Surgeons, New York, NY 10032, USA.
³ Richmond Veterans Affairs Medical Center and Virginia Commonwealth University, Richmond, VA 23284, USA.
⁴ IRCCS Galeazzi Sant'Ambrogio Hospital, Milano 20161, Italy.
⁵ San Raffaele Vita-Salute University, Milan 20132, Italy.
⁶ Department of Medicine, University of California and San Francisco Veterans Affairs Health Center, San Francisco, CA 94121-1545, USA.
⁷ Department of Endocrinology, University of California and San Francisco Veterans Affairs Health Center, San Francisco, CA 94121-1545, USA.
⁸ School of Medicine and Public Health, University of Wisconsin-Madison, Madison, WI 53726, USA.
⁹ Faculty of Medicine, University of Oslo, Oslo 0313, Norway.
¹⁰ Laboratory of Clinical and Experimental Endocrinology, Department of Chronic Diseases, Metabolism and Ageing, KU Leuven, 3000 Leuven, Belgium.
¹¹ Italian Foundation for the Research on Bone Diseases (F.I.R.M.O.), Florence 50129, Italy.
¹² Department of Medicine, Instituto de Investigación Sanitaria (IDIS), Complejo Hospitalario Universitario and CIBER de Fisiopatologia de la Obesidad y Nutricion (CIBERobn), Santiago de Compostela University, Santiago de Compostela 15706, Spain.
¹³ Department of Experimental Medicine, Sapienza University, Rome 00161, Italy.
¹⁴ Department of Medicine, School of Clinical Sciences, Monash University, Clayton 3168, Australia.
¹⁵ Calcium Metabolism and Osteoporosis Program, WHO CC for Metabolic Bone Disorders, Division of Endocrinology, American University of Beirut, Beirut 1107 2020, Lebanon.
¹⁶ Rheumatology Unit, University of Verona, Verona 37129, Italy.
¹⁷ Department of Biomedical and Molecular Sciences, Queen's University, Kingston, Ontario, ON K7L 3N6, Canada.
¹⁸ Department of Clinical and Experimental Medicine, University of Pisa, Pisa 56126, Italy.
¹⁹ Faculty of Medicine and Dentistry, Queen Mary University of London, London E1 4NS, UK.
²⁰ Department of Clinical, Internal, Anesthesiologic and Cardiovascular Sciences, Sapienza University of Rome, Rome 00161, Italy.
²¹ Unit of Endocrinology and Diabetes Campus Bio-Medico, University of Rome, Rome 00128, Italy.
²² Division of Endocrinology, Diabetology and Metabolic Diseases, "Molinette" Hospital, University of Turin, Turin 10126, Italy.
²³ Geneva University Hospitals and Faculty of Medicine, Geneva 1205, Switzerland.
²⁴ Vitamin D Standardization Program (VDSP), Havre de Grace, MD 21078, USA.
²⁵ Institute of Public Health and Clinical Nutrition, University of Eastern Finland, Kuopio FI-70211, Finland.

PMID: 38676447
DOI: 10.1210/endrev/bnae009

Abstract

The 6th International Conference, "Controversies in Vitamin D," was convened to discuss controversial topics, such as vitamin D metabolism, assessment, actions, and supplementation. Novel insights into vitamin D mechanisms of action suggest links with conditions that do not depend only on reduced solar exposure or diet intake and that can be detected with distinctive noncanonical vitamin D metabolites. Optimal 25-hydroxyvitamin D (25(OH)D) levels remain debated. Varying recommendations from different societies arise from evaluating different clinical or public health approaches. The lack of assay standardization also poses challenges in interpreting data from available studies, hindering rational data pooling and meta-analyses. Beyond the well-known skeletal features, interest in vitamin D's extraskeletal effects has led to clinical trials on cancer, cardiovascular risk, respiratory effects, autoimmune diseases, diabetes, and mortality. The initial negative results are likely due to enrollment of vitamin D-replete individuals. Subsequent post hoc analyses have suggested, nevertheless, potential benefits in reducing cancer incidence, autoimmune diseases, cardiovascular events, and diabetes. Oral administration of vitamin D is the preferred route. Parenteral administration is reserved for specific clinical situations. Cholecalciferol is favored due to safety and minimal monitoring requirements. Calcifediol may be used in certain conditions, while calcitriol should be limited to specific disorders in which the active metabolite is not readily produced in vivo. Further studies are needed to investigate vitamin D effects in relation to the different recommended 25(OH)D levels and the efficacy of the different supplementary formulations in achieving biochemical and clinical outcomes within the multifaced skeletal and extraskeletal potential effects of vitamin D.

Keywords: Vitamin D Standardization Program (VDSP); calcifediol; calcitriol; cholecalciferol; vitamin D; vitamin D assay.

Grants and funding

Abiogen Pharma