1. VITAMIN D DEFICIENCY Review article
New England Journal of Medicine, July 19, 2007
Michael F. Holick, M.D.Ph.D.
Prepared by Cendrella Hojeily, MD.

2. What is Vitamin D?
A compound required in tiny amounts for metabolic reactions in an organism
Fat soluble
Maintains normal blood levels of calcium and phosphorus

3. What are the sources of Vitamin D?

7. DEFINITION AND PREVALENCE OF VITAMIN D
Vit D deficiency: 25(OH)D<20ng/ml
Vit D intoxication: 25(OH)D>150ng/ml
Journal
Percentage
Category
Place
Vit(OH)D
Mayo Clin Proc, 2006
40-100%
Elderly men & women
US & Europe
25(OH)D<20ng/ml
J Clin Endocrinol Metab, 2005
>50%
Post- menopausal
25(OH)D<30ng/ml
Arch Pediatr Adolesc Med, 2004
52%
Hispanic & African American adolescents
Boston
J Am Diet Assoc, 2005
48%
Caucasian pre-adolescent girls
Maine
Am J Med, 2002
32%
Healthy students, physicians, residents
Boston Hospital
Am J Clin Nutr, 2005
30-50%
General population
Saudi Arabia, UAE, Australia, Turkey, India, Lebanon
N Eng J Med, 2006
78-80%
Pregnant women & their children
Philadelphia

10. OSTEOPOROSIS AND FRACTURE
33% of women y/o have OP
66% of women > 80 y/o have OP
47% of women > 50 y/o will have one osteoporotic fracture
22% of men > 50 y/o will have one osteoporotic fracture

11. Osteoporosis and fracture
Journal
Intake: Ca/Vit D vs placebo
Risk of fracture
N Engl J Med, 1992
1200mg Ca +
800 IU Vit D daily for 3 years
Hip fx: 43%
Non vert fx: %
Metaanalysis
400 IU Vit D daily
No benefit
Women’s Health
400 IU Vit D+1000mg Ca daily
Am J Clin Nutr, 2006
IU Vit D
Hip fx: 26%
Non vert fx: 23%
Record Trial, 2005
800 IU Vit D daily
(no exclusion criteria)
25(OH)D: 15-24
No benefit?

12. Proximal weakness
800 IU Vit D/day  reduces the risk of fall by 35% (OR0.65/CI 0.4-1).Am J clin Nutr, 2006
400 IU Vit D/day  no benefit. Am J Clin Nutr, 2006
800 IU Vit D + Ca/day  reduces the risk of fall by 72% (OR: 0.28/ CI ). J Amgeriatr soc, 2007

13. Cancer and Vit D
People living at higher latitudes are at increased risk for cancer J of Steriod Biochem Mol Bio, 2005
Journal
Condition
Incidence of cancer
J Natl Cancer Inst, 2006
Vit D deficiency: 25(OH)D < 20
30-50% increase (colon, prostate, breast)
J Steroid Biochem Mol Bio, 2005
Intake: 6-94 IU vs. IU
Decrease in colorectal cancer
p < 0.05
J Natl Cancer Inst, 2005
Sunlight exposure
40% decrease in NHL,
Decrease in melanoma mortality

14. Diseases and Vit D
Living at higher altitudes increases the risk of DMI, MS, and Crohn’s Toxicology, 2002
African-Americans are at higher risk of developing TB Science, 2006
Journal
Intake (per day)
Risk
Neurology, 2004
400 IU
MS + OA + RA %
Lancet, 2001
2000 IU
DMI % (children)
Diabetes Care, 2006
1200 Ca IU vs.
< 600 Ca IU
DMII %

15. Cardiovascular and Vit D
Living at higher altitudes increases risk of HTN/CAD. Prog Biophys Mol Bio, 2006
Vit D deficiency a/w CHF + inflammatory factors (CRP). Annal Cardiology, 2003
Patients with HTN exposed to UVB 3x/week for 3 months  25(OH)D increases and BP becomes normal (reduced by 6 mmHg: both systolic and diastolic). Lancet, 1998

16. Vit D deficiency and Psychiatric Disorders
Vit D deficiency has been linked to increase incidence of schizophrenia and depression. Schizophr Res, 2002
Maintaining sufficient Vit D in utero and in early life may be important for brain dev as well as for maintenance of mental function later in life. J Chem Neuroanat, 2005

17. Vit D deficiency and Lung Function
Men and women with 25(OH)D>35ng/ml have 176 ml increase in the forced expiratory volume in 1 second. Chest, 2005
Children of women who had Vit D deficiency during pregnancy are at increased risk for wheezing illnesses. Am J Clin Nutr, 2007

20. Vit D Intoxication 25(OH)D > 150ng/ml
Caused by ingestion of > 50,000 IU/day
Caution: people predisposed to hypercalcemia (granulomatous diseases)

21. CONCLUSION
Serum 25-hydroxyVitamin D is not only a predictor of bone health, but is also an independent risk predictor for cancer and other chronic diseases
1,25(OH)D should never be used for detecting Vit D deficiency

22. DISCUSSION Should we use 25(OH)D as a screening test?
25(OH)D assay is costly and may not be always available so screening is not recommended!
Adequate Vit D intake is recommended
800 IU Vit D/day guarantees Vit D sufficiency unless there are other conditions

24. “You’ve got a rare condition called ‘good health
“You’ve got a rare condition called ‘good health.’ Frankly, we’re not sure how to treat it.”