Evaluation, Treatment, and Prevention of Vitamin D Deficiency: An Endocrine Society Clinical Practice Guideline

The Endocrine Society published these guidelines on vitamin D deficiency in July 2011.  This summary of those guidelines will focus on the screening and treatment recommendations.

Screening for Vitamin D Deficiency
Population-wide screening for vitamin D deficiency is not warranted.  However, screening is warranted in individuals at risk for vitamin D deficiency.  This includes people with (list is not exhaustive):

The serum circulating 25-hydroxyvitamin D (25[OH]D)level, as measured by a reliable assay, is recommended to assess vitamin D status.  The guidelines recommend against serum 1,25(OH)2D assay.

The 25(OH)D level is the preferred screening level because it is the major circulating form of vitamin D; its half-life is 2 to 3 weeks.

In comparison, the circulating half-life of 1,25 (OH)2D is about 4 hours; serum 1,25(OH)2D also does not include vitamin D reserves.  For those 2 reasons, it is not a useful method for monitoring vitamin D status.

In using the 25(OH)D levels, the following definitions should be used:

Treatment of Vitamin D Deficiency
Either vitamin D2 or vitamin D3 should be used for treatment and prevention of vitamin D deficiency.  The following doses are recommended:

Commentary by Pauline M. Camacho MD, FACE

The threshold which defines vitamin D sufficiency continues to be a controversial topic. The Institute of Medicine recommended a level of 20 ng/ml.  This comprehensive guideline from the Endocrine Society recommends a 25(OH)D level of 30 ng/ml to definite sufficiency. Recommendations on screening and therapy for various clinical scenarios are clearly outlined in this clinical guideline.  You can access a full copy of the guidelines on the Endocrine Society website.