Italian Association of Clinical Endocrinologists (AME) and Italian Chapter of the American Association of Clinical Endocrinologists (AACE) Position Statement: Clinical Management of Vitamin D Deficiency in Adults

AME and Italian AACE Chapter

Research output: Contribution to journalReview article

Abstract

Vitamin D deficiency is very common and prescriptions of both assay and supplementation are increasing more and more. Health expenditure is exponentially increasing, thus it is timely and appropriate to establish rules. The Italian Association of Clinical Endocrinologists appointed a task force to review literature about vitamin D deficiency in adults. Four topics were identified as worthy for the practicing clinicians. For each topic recommendations based on scientific evidence and clinical practice were issued according to the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) System. (1) What cut-off defines vitamin D deficiency: even though 20 ng/mL (50 nmol/L) can be considered appropriate in the general population, we recommend to maintain levels above 30 ng/mL (75 nmol/L) in categories at risk. (2) Whom, when, and how to perform screening for vitamin D deficiency: categories at risk (patients with bone, liver, kidney diseases, obesity, malabsorption, during pregnancy and lactation, some elderly) but not healthy people should be screened by the 25-hydroxy-vitamin D assay. (3) Whom and how to treat vitamin D deficiency: beyond healthy lifestyle (mostly sun exposure), we recommend oral vitamin D (vitamin D2 or vitamin D3) supplementation in patients treated with bone active drugs and in those with demonstrated deficiency. Dosages, molecules and modalities of administration can be profitably individually tailored. (4) How to monitor the efficacy of treatment with vitamin D: no routine monitoring is suggested during vitamin D treatment due to its large therapeutic index. In particular conditions, 25-hydroxy-vitamin D can be assayed after at least a 6-month treatment. We are confident that this document will help practicing clinicians in their daily clinical practice.

Original languageEnglish
JournalNutrients
Volume10
Issue number5
DOIs
Publication statusPublished - Apr 27 2018

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vitamin D deficiency
Vitamin D Deficiency
vitamin D
Vitamin D
bones
ergocalciferol
health care costs
Ergocalciferols
Bone and Bones
malabsorption
cholecalciferol
monitoring
Cholecalciferol
Kidney Diseases
assays
Solar System
Advisory Committees
Health Expenditures
kidney diseases
Lactation

Keywords

  • Adult
  • Aged
  • Aged, 80 and over
  • Biomarkers/blood
  • Consensus
  • Dietary Supplements/adverse effects
  • Endocrinology/standards
  • Female
  • Humans
  • Italy/epidemiology
  • Male
  • Middle Aged
  • Predictive Value of Tests
  • Risk Factors
  • Time Factors
  • Treatment Outcome
  • Vitamin D/administration & dosage
  • Vitamin D Deficiency/diagnosis

Cite this

@article{d910f6dd891c4e7eb34158d973286434,
title = "Italian Association of Clinical Endocrinologists (AME) and Italian Chapter of the American Association of Clinical Endocrinologists (AACE) Position Statement: Clinical Management of Vitamin D Deficiency in Adults",
abstract = "Vitamin D deficiency is very common and prescriptions of both assay and supplementation are increasing more and more. Health expenditure is exponentially increasing, thus it is timely and appropriate to establish rules. The Italian Association of Clinical Endocrinologists appointed a task force to review literature about vitamin D deficiency in adults. Four topics were identified as worthy for the practicing clinicians. For each topic recommendations based on scientific evidence and clinical practice were issued according to the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) System. (1) What cut-off defines vitamin D deficiency: even though 20 ng/mL (50 nmol/L) can be considered appropriate in the general population, we recommend to maintain levels above 30 ng/mL (75 nmol/L) in categories at risk. (2) Whom, when, and how to perform screening for vitamin D deficiency: categories at risk (patients with bone, liver, kidney diseases, obesity, malabsorption, during pregnancy and lactation, some elderly) but not healthy people should be screened by the 25-hydroxy-vitamin D assay. (3) Whom and how to treat vitamin D deficiency: beyond healthy lifestyle (mostly sun exposure), we recommend oral vitamin D (vitamin D2 or vitamin D3) supplementation in patients treated with bone active drugs and in those with demonstrated deficiency. Dosages, molecules and modalities of administration can be profitably individually tailored. (4) How to monitor the efficacy of treatment with vitamin D: no routine monitoring is suggested during vitamin D treatment due to its large therapeutic index. In particular conditions, 25-hydroxy-vitamin D can be assayed after at least a 6-month treatment. We are confident that this document will help practicing clinicians in their daily clinical practice.",
keywords = "Adult, Aged, Aged, 80 and over, Biomarkers/blood, Consensus, Dietary Supplements/adverse effects, Endocrinology/standards, Female, Humans, Italy/epidemiology, Male, Middle Aged, Predictive Value of Tests, Risk Factors, Time Factors, Treatment Outcome, Vitamin D/administration & dosage, Vitamin D Deficiency/diagnosis",
author = "{AME and Italian AACE Chapter} and Roberto Cesareo and Roberto Attanasio and Marco Caputo and Roberto Castello and Iacopo Chiodini and Alberto Falchetti and Rinaldo Guglielmi and Enrico Papini and Assunta Santonati and Alfredo Scillitani and Vincenzo Toscano and Vincenzo Triggiani and Fabio Vescini and Michele Zini",
year = "2018",
month = "4",
day = "27",
doi = "10.3390/nu10050546",
language = "English",
volume = "10",
journal = "Nutrients",
issn = "2072-6643",
publisher = "NLM (Medline)",
number = "5",

}

TY - JOUR

T1 - Italian Association of Clinical Endocrinologists (AME) and Italian Chapter of the American Association of Clinical Endocrinologists (AACE) Position Statement

T2 - Clinical Management of Vitamin D Deficiency in Adults

AU - AME and Italian AACE Chapter

AU - Cesareo, Roberto

AU - Attanasio, Roberto

AU - Caputo, Marco

AU - Castello, Roberto

AU - Chiodini, Iacopo

AU - Falchetti, Alberto

AU - Guglielmi, Rinaldo

AU - Papini, Enrico

AU - Santonati, Assunta

AU - Scillitani, Alfredo

AU - Toscano, Vincenzo

AU - Triggiani, Vincenzo

AU - Vescini, Fabio

AU - Zini, Michele

PY - 2018/4/27

Y1 - 2018/4/27

N2 - Vitamin D deficiency is very common and prescriptions of both assay and supplementation are increasing more and more. Health expenditure is exponentially increasing, thus it is timely and appropriate to establish rules. The Italian Association of Clinical Endocrinologists appointed a task force to review literature about vitamin D deficiency in adults. Four topics were identified as worthy for the practicing clinicians. For each topic recommendations based on scientific evidence and clinical practice were issued according to the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) System. (1) What cut-off defines vitamin D deficiency: even though 20 ng/mL (50 nmol/L) can be considered appropriate in the general population, we recommend to maintain levels above 30 ng/mL (75 nmol/L) in categories at risk. (2) Whom, when, and how to perform screening for vitamin D deficiency: categories at risk (patients with bone, liver, kidney diseases, obesity, malabsorption, during pregnancy and lactation, some elderly) but not healthy people should be screened by the 25-hydroxy-vitamin D assay. (3) Whom and how to treat vitamin D deficiency: beyond healthy lifestyle (mostly sun exposure), we recommend oral vitamin D (vitamin D2 or vitamin D3) supplementation in patients treated with bone active drugs and in those with demonstrated deficiency. Dosages, molecules and modalities of administration can be profitably individually tailored. (4) How to monitor the efficacy of treatment with vitamin D: no routine monitoring is suggested during vitamin D treatment due to its large therapeutic index. In particular conditions, 25-hydroxy-vitamin D can be assayed after at least a 6-month treatment. We are confident that this document will help practicing clinicians in their daily clinical practice.

AB - Vitamin D deficiency is very common and prescriptions of both assay and supplementation are increasing more and more. Health expenditure is exponentially increasing, thus it is timely and appropriate to establish rules. The Italian Association of Clinical Endocrinologists appointed a task force to review literature about vitamin D deficiency in adults. Four topics were identified as worthy for the practicing clinicians. For each topic recommendations based on scientific evidence and clinical practice were issued according to the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) System. (1) What cut-off defines vitamin D deficiency: even though 20 ng/mL (50 nmol/L) can be considered appropriate in the general population, we recommend to maintain levels above 30 ng/mL (75 nmol/L) in categories at risk. (2) Whom, when, and how to perform screening for vitamin D deficiency: categories at risk (patients with bone, liver, kidney diseases, obesity, malabsorption, during pregnancy and lactation, some elderly) but not healthy people should be screened by the 25-hydroxy-vitamin D assay. (3) Whom and how to treat vitamin D deficiency: beyond healthy lifestyle (mostly sun exposure), we recommend oral vitamin D (vitamin D2 or vitamin D3) supplementation in patients treated with bone active drugs and in those with demonstrated deficiency. Dosages, molecules and modalities of administration can be profitably individually tailored. (4) How to monitor the efficacy of treatment with vitamin D: no routine monitoring is suggested during vitamin D treatment due to its large therapeutic index. In particular conditions, 25-hydroxy-vitamin D can be assayed after at least a 6-month treatment. We are confident that this document will help practicing clinicians in their daily clinical practice.

KW - Adult

KW - Aged

KW - Aged, 80 and over

KW - Biomarkers/blood

KW - Consensus

KW - Dietary Supplements/adverse effects

KW - Endocrinology/standards

KW - Female

KW - Humans

KW - Italy/epidemiology

KW - Male

KW - Middle Aged

KW - Predictive Value of Tests

KW - Risk Factors

KW - Time Factors

KW - Treatment Outcome

KW - Vitamin D/administration & dosage

KW - Vitamin D Deficiency/diagnosis

U2 - 10.3390/nu10050546

DO - 10.3390/nu10050546

M3 - Review article

C2 - 29702603

VL - 10

JO - Nutrients

JF - Nutrients

SN - 2072-6643

IS - 5

ER -