From the Guidelines
Vitamin D levels should be checked in patients at high risk for deficiency, including those with limited sun exposure, dark skin, obesity, malabsorption disorders, liver or kidney disease, and those taking medications that affect vitamin D metabolism (like anticonvulsants, glucocorticoids, and HIV medications) 1.
Key Patient Groups for Screening
- Older adults
- Pregnant or breastfeeding women
- Individuals with osteoporosis, osteopenia, or history of fractures
- People with certain medical conditions such as hyperparathyroidism, autoimmune diseases, and chronic inflammatory conditions
- Patients with symptoms of deficiency like bone pain, muscle weakness, or frequent infections
Screening and Monitoring Recommendations
- The 25-hydroxyvitamin D blood test is the standard measurement, with levels below 20 ng/mL indicating deficiency 1
- Regular monitoring is recommended for those on vitamin D supplements or with persistent risk factors, typically every 3-6 months until levels normalize, then annually 1
Importance of Vitamin D
- Vitamin D is crucial for calcium absorption, bone health, immune function, and may play a role in preventing various chronic diseases 1
From the Research
Patients Requiring Vitamin D Checks
The following groups of patients are considered to be at risk for vitamin D deficiency and may require checks:
- Older adults, as production and metabolism of vitamin D change with aging due to factors such as reduced sun exposure and reduced production capacity of the skin 2
- Patients with chronic kidney disease (CKD), particularly those with proteinuria, due to loss of 25-hydroxyvitamin D and its binding protein 3
- Individuals with inadequate sun exposure, limited oral intake, and impaired intestinal absorption 4
- Community-dwelling, nonpregnant adults who have signs or symptoms of vitamin D deficiency or conditions for which vitamin D treatment is recommended 5
Risk Factors for Vitamin D Deficiency
Some common risk factors for vitamin D deficiency include:
- Inadequate sun exposure
- Limited oral intake
- Impaired intestinal absorption
- Aging
- Chronic kidney disease (CKD)
- Proteinuria
Screening for Vitamin D Deficiency
The US Preventive Services Task Force (USPSTF) concludes that the current evidence is insufficient to assess the balance of benefits and harms of screening for vitamin D deficiency in asymptomatic adults 5. However, patients at risk for vitamin D deficiency, such as those with CKD or older adults, may benefit from screening and supplementation 3, 2.