Serum 25-Hydroxyvitamin D Levels

Variability, Knowledge Gaps, and the Concept of a Desirable Range

Ghada El-Hajj Fuleihan, Roger Bouillon, Bart Clarke, Marlene Chakhtoura, Cyrus Cooper, Michael McClung, Ravinder Jit Singh

Research output: Contribution to journalArticle

85 Citations (Scopus)

Abstract

Hypovitaminosis D is prevalent worldwide but proportions vary widely between regions, depending on genetic and lifestyle factors, the threshold to define deficiency, and accuracy of 25-hydroxyvitamin D (25OHD) assays used. Latitude, pollution, concealing clothing, sun exposure, gender, dietary habits, and lack of government regulation account for up to 50% in variations in serum 25OHD levels, whereas genetic polymorphisms in the vitamin D pathway account for less than 5%. Organizations/societies have developed guidelines for recommended desirable 25OHD levels and vitamin D doses to reach them, but their applicability across age groups and populations are still debated. This article and the accompanying online Supporting Information highlight sources of variations in circulating 25OHD levels, uncertainties and knowledge gaps, and analytical problems facing 25OHD assays, while keeping efficacy and safety data as the dominant factors when defining a desirable range for 25OHD levels. We propose a desirable range of 20 to 40ng/mL (50 to 100nmol/L), provided precise and accurate assays are used. Although slightly lower levels, 15 to 20ng/mL, may be sufficient for some infants and adults, higher levels, 40 to 60ng/mL, may still be safe. This desirable range allows physicians to tailor treatment while taking season, lifestyle, vitamin D intake, and other sources of variation into account. We reserve 25OHD measurements for at-risk patients, defined by disease or lifestyle, and the use of 25OHD assays calibrated against the recommended international standards. Most target groups reach desirable target levels by a daily intake of 400 to 600IU for children and 800IU for adults. A total daily allowance of vitamin D of up to 1000IU in the pediatric age groups, and up to 2000IU in adults, tailored to an individual patient risk profile, is probably safe over long durations. Additional data are needed to validate the proposed range and vitamin D doses, especially in children, pregnant women, and non-white populations.

Original languageEnglish (US)
Pages (from-to)1119-1133
Number of pages15
JournalJournal of Bone and Mineral Research
Volume30
Issue number7
DOIs
StatePublished - Jul 1 2015

Fingerprint

Vitamin D
Life Style
Serum
Age Groups
Government Regulation
Clothing
Feeding Behavior
Solar System
Genetic Polymorphisms
Population
Uncertainty
Pregnant Women
25-hydroxyvitamin D
Organizations
Guidelines
Pediatrics
Physicians
Safety
Therapeutics

Keywords

  • DESIRABLE RANGE
  • EFFICACY
  • ETHNICITIES
  • KNOWLEDGE GAPS
  • SAFETY
  • VARIATIONS
  • VITAMIN D

ASJC Scopus subject areas

  • Orthopedics and Sports Medicine
  • Endocrinology, Diabetes and Metabolism

Cite this

Serum 25-Hydroxyvitamin D Levels : Variability, Knowledge Gaps, and the Concept of a Desirable Range. / El-Hajj Fuleihan, Ghada; Bouillon, Roger; Clarke, Bart; Chakhtoura, Marlene; Cooper, Cyrus; McClung, Michael; Singh, Ravinder Jit.

In: Journal of Bone and Mineral Research, Vol. 30, No. 7, 01.07.2015, p. 1119-1133.

Research output: Contribution to journalArticle

El-Hajj Fuleihan, Ghada ; Bouillon, Roger ; Clarke, Bart ; Chakhtoura, Marlene ; Cooper, Cyrus ; McClung, Michael ; Singh, Ravinder Jit. / Serum 25-Hydroxyvitamin D Levels : Variability, Knowledge Gaps, and the Concept of a Desirable Range. In: Journal of Bone and Mineral Research. 2015 ; Vol. 30, No. 7. pp. 1119-1133.
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