Which patients require vitamin D level checks?

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, kidney or liver disease, and those taking medications that affect vitamin D metabolism (like anticonvulsants, glucocorticoids, and HIV medications) 1.

Patient Populations that Benefit from Screening

The following patient populations are at high risk for vitamin D deficiency and should be screened:

• Older adults
• Pregnant or breastfeeding women
• Individuals with osteoporosis, osteopenia, or history of fractures
• People with certain medical conditions such as hyperparathyroidism, inflammatory bowel disease, celiac disease
• Those with symptoms of deficiency like bone pain, muscle weakness, or frequent infections

Screening Method

The 25-hydroxyvitamin D blood test is the standard measurement, with levels below 20 ng/mL indicating deficiency 1.

Importance of Targeted Testing

Routine screening in the general population without risk factors is not recommended, as targeted testing is more cost-effective and clinically relevant 1.

Role of Vitamin D in Health

Vitamin D is crucial for calcium absorption, bone health, immune function, and may play a role in preventing various chronic diseases.

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:

• Adults with inadequate sun exposure, limited oral intake, and impaired intestinal absorption 2
• Patients with chronic kidney disease (CKD), particularly those with proteinuria 3
• 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 4
• Community-dwelling, nonpregnant adults who have signs or symptoms of vitamin D deficiency or conditions for which vitamin D treatment is recommended 5

Specific Conditions Requiring Vitamin D Checks

• Chronic kidney disease (CKD) 3, 6
• Osteoporosis 3
• Older population with reduced bone mineral density, osteomalacia, and fractures 4
• Patients at risk for falls, reduced muscle strength, diabetes, cancer, and cardiovascular disease 4

Screening Recommendations

• 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
• Only individuals at risk for vitamin D deficiency should be screened 2