Management of endocrine disease: Therapeutics of Vitamin D

PR Ebeling, RA Adler, G Jones, UA Liberman, G Mazziotti, S Minisola, CF Munns, N Napoli, AG Pittas, A Giustina, JP Bilezikian, R Rizzoli

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Abstract

Objective: The central role of vitamin D in bone health is well recognized. However, controversies regarding its clinical application remain. We therefore aimed to review the definition of hypovitaminosis D, the skeletal and extra-skeletal effects of vitamin D and the available therapeutic modalities. Design: Narrative and systematic literature review. Methods: An international working group that reviewed the current evidence linking bone and extra-skeletal health and vitamin D therapy to identify knowledge gaps for future research. Results: Findings from observational studies and randomized controlled trials (RCTs) in vitamin D deficiency are discordant, with findings of RCTs being largely negative. This may be due to reverse causality with the illness itself contributing to low vitamin D levels. The results of many RCTs have also been inconsistent. However, overall evidence from RCTs shows vitamin D reduces fractures (when administered with calcium) in the institutionalized elderly. Although controversial, vitamin D reduces acute respiratory tract infections (if not given as bolus monthly or annual doses) and may reduce falls in those with the lowest serum 25-hydroxyvitamin D (25OHD) levels. However, despite large ongoing RCTs with 21 000-26 000 participants not recruiting based on baseline 25OHD levels, they will contain a large subset of participants with vitamin D deficiency and are adequately powered to meet their primary end-points. Conclusions: The effects of long-term vitamin D supplementation on non-skeletal outcomes, such as type 2 diabetes mellitus (T2DM), cancer and cardiovascular disease (CVD) and the optimal dose and serum 25OHD level that balances extra-skeletal benefits (T2DM) vs risks (e.g. CVD), may soon be determined by data from large RCTs. © 2018 European Society of Endocrinology.
Original languageEnglish
Pages (from-to)R239-R259
JournalEuropean Journal of Endocrinology
Volume179
Issue number5
DOIs
Publication statusPublished - 2018

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    Ebeling, PR., Adler, RA., Jones, G., Liberman, UA., Mazziotti, G., Minisola, S., Munns, CF., Napoli, N., Pittas, AG., Giustina, A., Bilezikian, JP., & Rizzoli, R. (2018). Management of endocrine disease: Therapeutics of Vitamin D. European Journal of Endocrinology, 179(5), R239-R259. https://doi.org/10.1530/EJE-18-0151