Re: Endocrine Society Issues Practice Guideline on Vitamin D

June 7, 2011

I just posted this on my blog...I was surprised that Vit D2 and Vit D3 were

considered " equal " . I usually encourage the Vit D3 and discourage the

50,000 IU Vit D2 that MDs usually prescribe. Any insight or thoughts on

this???

On Tue, Jun 7, 2011 at 8:17 PM, ne <

fivestar@...> wrote:

> Medscape Medical News from:

>

> ENDO 2011: The Endocrine Society 93rd Annual Meeting

>

> This coverage is not sanctioned by, nor a part of, The Endocrine Society.

>

> From Medscape Medical News

>

> Endocrine Society Issues Practice Guideline on Vitamin D

>

> Authors and Disclosures

>

> June 7, 2011 (Boston, Massachusetts) — The Endocrine Society today

> unveiled a Clinical Practice Guideline on the evaluation, treatment, and

> prevention of vitamin D deficiency, with an emphasis on the care of

> patients who are at risk for vitamin D deficiency.

>

> F. Holick, MD, PhD, from Boston University Medical Center,

> Massachusetts, who chaired the 8-member task force that developed the

> guideline, summarized the recommendations at a press briefing here at

> ENDO 2011: The Endocrine Society 93rd Annual Meeting.

>

> The guideline also was published online June 6 in the Journal of

> Clinical Endocrinology and Metabolism.

>

> " Based on all the evidence, at a minimum, we recommend vitamin D levels

> of 30 ng/mL, and because of the vagaries of some of the assays, to

> guarantee sufficiency, we recommend between 40 and 60 ng/mL for both

> children and adults, " Dr. Holick said.

>

> The society's clinical practice guideline was developed by " experts in

> the field who carefully reviewed the current literature and features the

> latest and most comprehensive recommendations available on the

> prevention and treatment of vitamin D deficiency, " he said.

>

> The guideline recommends that clinicians screen for vitamin D deficiency

> in people at risk for deficiency, including obese individuals, blacks,

> pregnant and lactating women, and patients with malabsorption syndromes.

>

> " We do not recommend population screening for vitamin D deficiency in

> individuals who are not at risk, " Dr. Holick said, but added that

> " vitamin D deficiency is very common in all age groups — essentially

> everyone is at risk. "

>

> Screening should be performed using a " reliable assay " for

> 25-hydroxy-vitamin D (25[OH]D), not 1,25-dihydroxy-vitamin D

> (1,25[OH]2D), " which tells you nothing about vitamin D status, " Dr.

> Holick said. Vitamin D deficiency is defined as 25[OH]D levels below 20

> ng/mL.

>

> " Considering that vitamin D deficiency is very common in all age groups

> and that few foods contain vitamin D, the Task Force recommended

> supplementation at suggested daily intake and tolerable upper limit

> levels, depending on age and clinical circumstances, " the guideline states.

>

> For bone health, infants and children up to 1 year of age require at

> least 400 IU/day vitamin D, and children 1 year and older need at least

> 600 IU/day, the guideline states. However, at least 1000 IU/day of

> vitamin D may be needed to raise the blood level of 25(OH)D consistently

> above 30 ng/mL, it notes.

>

> Adults aged 19 to 70 years require at least 600 IU/day of vitamin D to

> maximize bone health and muscle function. However, getting 25(OH)D

> levels consistently above 30 ng/mL may require at least 1500 to 2000

> IU/day of vitamin D.

>

> Adults 70 years and older require at least 800 IU/day of vitamin D for

> bone health and fall prevention; at least 1500 to 2000 IU/day of

> supplemental vitamin D may be needed to keep 25(OH)D levels above 30 ng/mL.

>

> Pregnant and lactating women need a minimum of 600 IU/day of vitamin D;

> 1500 IU/day may be needed to maintain blood levels of 25(OH)D higher

> than 30 ng/mL.

>

> " Obese children and adults and children and adults on anticonvulsant

> medications, glucocorticoids, antifungals such as ketoconazole, and

> medications for AIDS need at least 2 to 3 times more vitamin D for their

> age group to satisfy their body's vitamin D requirement, " Dr. Holick

> reported.

>

> Tolerable upper limits of vitamin D, which " should not be exceeded

> without medical supervision, " include the following:

>

> 1000 IU/day for infants aged up to 6 months,

> 1500 IU/day for infants aged 6 months to 1 year old,

> 2500 IU/day for children aged 1 to 3 years,

> 3000 IU/day for children aged 4 to 8 years, and

> 4000 IU/day for everyone older than 8 years.

>

> However, the guideline states that for individuals who are vitamin D

> deficient, higher levels of vitamin D (2000 IU/day for children up to

> age 1 year; 4000 IU/day for children aged 1 - 18 years, and up to 10,000

> IU/day for adults aged 19 years and older) " may be necessary to correct,

> treat, and prevent vitamin D deficiency, " Dr. Holick said.

>

> " Both vitamin D2 and vitamin D3 is equally fine in treating and

> preventing vitamin D deficiency, " he added.

>

> For all age groups, it is unknown whether these age-specific levels of

> vitamin D are " enough to provide all of the potential nonskeletal health

> benefits associated with vitamin D, " Dr. Holick noted.

>

> He also said that at present, " there is not sufficient evidence to

> recommend prescribing vitamin D to attain the noncalcemic benefit for

> cardiovascular protection. " However, association studies have suggested

> that increasing vitamin D levels may help protect against some cancers,

> including colorectal cancer, as well as infectious disease, diabetes,

> and high blood pressure.

>

> The upper limits and the dietary intake levels in the Endocrine Society

> guideline for the most part mirror those of the 2010 Institute of

> Medicine consensus report, " Dietary Reference Intakes for Calcium and

> Vitamin D, " although the Endocrine Society gives more explicit

> recommendations for care.

>

> Dr. Holick commented that the Institute of Medicine report used a

> " population model, not a medical model, and was not intended to direct

> physicians on care of patients. It was up to professional associations

> to establish guidelines of care, which is why [the Endocrine Society]

> became involved. "

>

> Stencel, media relations officer of the National Academy of

> Sciences, said the committee that issued the 2010 report is no longer an

> entity and would not have a comment on the Endocrine Society guideline.

>

> " At some point down the road, there is the potential that [institute of

> Medicine] could convene a new committee to reexamine all the new

> information and look at changing the [dietary reference intakes], but at

> this point we wouldn't do any immediate re-look at this, " she said.

>

> Development of the clinical practice guideline was supported solely by

> the Endocrine Society. Dr. Holick has disclosed financial or

> business/organizational interests with Merck, Novartis, Nichols-Quest

> Diagnostics, Bayer, Aventis, Warner Chilcott, Amgen, the UV Foundation,

> DMI, and the Mushroom Council. A complete list of disclosures for the

> task force are listed with the original article.

>

> ENDO 2011: The Endocrine Society 93rd Annual Meeting. Presented June 6,

> 2011.

>

> J Clin Endocrinol Metabol. Published online June 6, 2011. Abstract

>

> http://www.medscape.com/viewarticle/744128?sssdmh=dm1.693427 & src=nldne

>

> ------------------------------------

>

June 8, 2011

The efficacy can be the same if the patient doesn't have renal impairment. It is

needed a higher dose of vitamin D2 though to have the same effect as vitamin D3

since it has transformed in the kidney. Since renal function declines with age

imo elderly patients should receive vitamin D3.

Catia Borges

>

> > Medscape Medical News from:

> >

> > ENDO 2011: The Endocrine Society 93rd Annual Meeting

> >

> > This coverage is not sanctioned by, nor a part of, The Endocrine Society.

> >

> > From Medscape Medical News

> >

> > Endocrine Society Issues Practice Guideline on Vitamin D

> >

> > Authors and Disclosures

> >

> > June 7, 2011 (Boston, Massachusetts) — The Endocrine Society today

> > unveiled a Clinical Practice Guideline on the evaluation, treatment, and

> > prevention of vitamin D deficiency, with an emphasis on the care of

> > patients who are at risk for vitamin D deficiency.

> >

> > F. Holick, MD, PhD, from Boston University Medical Center,

> > Massachusetts, who chaired the 8-member task force that developed the

> > guideline, summarized the recommendations at a press briefing here at

> > ENDO 2011: The Endocrine Society 93rd Annual Meeting.

> >

> > The guideline also was published online June 6 in the Journal of

> > Clinical Endocrinology and Metabolism.

> >

> > " Based on all the evidence, at a minimum, we recommend vitamin D levels

> > of 30 ng/mL, and because of the vagaries of some of the assays, to

> > guarantee sufficiency, we recommend between 40 and 60 ng/mL for both

> > children and adults, " Dr. Holick said.

> >

> > The society's clinical practice guideline was developed by " experts in

> > the field who carefully reviewed the current literature and features the

> > latest and most comprehensive recommendations available on the

> > prevention and treatment of vitamin D deficiency, " he said.

> >

> > The guideline recommends that clinicians screen for vitamin D deficiency

> > in people at risk for deficiency, including obese individuals, blacks,

> > pregnant and lactating women, and patients with malabsorption syndromes.

> >

> > " We do not recommend population screening for vitamin D deficiency in

> > individuals who are not at risk, " Dr. Holick said, but added that

> > " vitamin D deficiency is very common in all age groups — essentially

> > everyone is at risk. "

> >

> > Screening should be performed using a " reliable assay " for

> > 25-hydroxy-vitamin D (25[OH]D), not 1,25-dihydroxy-vitamin D

> > (1,25[OH]2D), " which tells you nothing about vitamin D status, " Dr.

> > Holick said. Vitamin D deficiency is defined as 25[OH]D levels below 20

> > ng/mL.

> >

> > " Considering that vitamin D deficiency is very common in all age groups

> > and that few foods contain vitamin D, the Task Force recommended

> > supplementation at suggested daily intake and tolerable upper limit

> > levels, depending on age and clinical circumstances, " the guideline states.

> >

> > For bone health, infants and children up to 1 year of age require at

> > least 400 IU/day vitamin D, and children 1 year and older need at least

> > 600 IU/day, the guideline states. However, at least 1000 IU/day of

> > vitamin D may be needed to raise the blood level of 25(OH)D consistently

> > above 30 ng/mL, it notes.

> >

> > Adults aged 19 to 70 years require at least 600 IU/day of vitamin D to

> > maximize bone health and muscle function. However, getting 25(OH)D

> > levels consistently above 30 ng/mL may require at least 1500 to 2000

> > IU/day of vitamin D.

> >

> > Adults 70 years and older require at least 800 IU/day of vitamin D for

> > bone health and fall prevention; at least 1500 to 2000 IU/day of

> > supplemental vitamin D may be needed to keep 25(OH)D levels above 30 ng/mL.

> >

> > Pregnant and lactating women need a minimum of 600 IU/day of vitamin D;

> > 1500 IU/day may be needed to maintain blood levels of 25(OH)D higher

> > than 30 ng/mL.

> >

> > " Obese children and adults and children and adults on anticonvulsant

> > medications, glucocorticoids, antifungals such as ketoconazole, and

> > medications for AIDS need at least 2 to 3 times more vitamin D for their

> > age group to satisfy their body's vitamin D requirement, " Dr. Holick

> > reported.

> >

> > Tolerable upper limits of vitamin D, which " should not be exceeded

> > without medical supervision, " include the following:

> >

> > 1000 IU/day for infants aged up to 6 months,

> > 1500 IU/day for infants aged 6 months to 1 year old,

> > 2500 IU/day for children aged 1 to 3 years,

> > 3000 IU/day for children aged 4 to 8 years, and

> > 4000 IU/day for everyone older than 8 years.

> >

> > However, the guideline states that for individuals who are vitamin D

> > deficient, higher levels of vitamin D (2000 IU/day for children up to

> > age 1 year; 4000 IU/day for children aged 1 - 18 years, and up to 10,000

> > IU/day for adults aged 19 years and older) " may be necessary to correct,

> > treat, and prevent vitamin D deficiency, " Dr. Holick said.

> >

> > " Both vitamin D2 and vitamin D3 is equally fine in treating and

> > preventing vitamin D deficiency, " he added.

> >

> > For all age groups, it is unknown whether these age-specific levels of

> > vitamin D are " enough to provide all of the potential nonskeletal health

> > benefits associated with vitamin D, " Dr. Holick noted.

> >

> > He also said that at present, " there is not sufficient evidence to

> > recommend prescribing vitamin D to attain the noncalcemic benefit for

> > cardiovascular protection. " However, association studies have suggested

> > that increasing vitamin D levels may help protect against some cancers,

> > including colorectal cancer, as well as infectious disease, diabetes,

> > and high blood pressure.

> >

> > The upper limits and the dietary intake levels in the Endocrine Society

> > guideline for the most part mirror those of the 2010 Institute of

> > Medicine consensus report, " Dietary Reference Intakes for Calcium and

> > Vitamin D, " although the Endocrine Society gives more explicit

> > recommendations for care.

> >

> > Dr. Holick commented that the Institute of Medicine report used a

> > " population model, not a medical model, and was not intended to direct

> > physicians on care of patients. It was up to professional associations

> > to establish guidelines of care, which is why [the Endocrine Society]

> > became involved. "

> >

> > Stencel, media relations officer of the National Academy of

> > Sciences, said the committee that issued the 2010 report is no longer an

> > entity and would not have a comment on the Endocrine Society guideline.

> >

> > " At some point down the road, there is the potential that [institute of

> > Medicine] could convene a new committee to reexamine all the new

> > information and look at changing the [dietary reference intakes], but at

> > this point we wouldn't do any immediate re-look at this, " she said.

> >

> > Development of the clinical practice guideline was supported solely by

> > the Endocrine Society. Dr. Holick has disclosed financial or

> > business/organizational interests with Merck, Novartis, Nichols-Quest

> > Diagnostics, Bayer, Aventis, Warner Chilcott, Amgen, the UV Foundation,

> > DMI, and the Mushroom Council. A complete list of disclosures for the

> > task force are listed with the original article.

> >

> > ENDO 2011: The Endocrine Society 93rd Annual Meeting. Presented June 6,

> > 2011.

> >

> > J Clin Endocrinol Metabol. Published online June 6, 2011. Abstract

> >

> > http://www.medscape.com/viewarticle/744128?sssdmh=dm1.693427 & src=nldne

> >

> > ------------------------------------

> >

June 8, 2011

The efficacy can be the same if the patient doesn't have renal impairment. It is

needed a higher dose of vitamin D2 though to have the same effect as vitamin D3

since it has transformed in the kidney. Since renal function declines with age

imo elderly patients should receive vitamin D3.

Catia Borges

>

> > Medscape Medical News from:

> >

> > ENDO 2011: The Endocrine Society 93rd Annual Meeting

> >

> > This coverage is not sanctioned by, nor a part of, The Endocrine Society.

> >

> > From Medscape Medical News

> >

> > Endocrine Society Issues Practice Guideline on Vitamin D

> >

> > Authors and Disclosures

> >

> > June 7, 2011 (Boston, Massachusetts) — The Endocrine Society today

> > unveiled a Clinical Practice Guideline on the evaluation, treatment, and

> > prevention of vitamin D deficiency, with an emphasis on the care of

> > patients who are at risk for vitamin D deficiency.

> >

> > F. Holick, MD, PhD, from Boston University Medical Center,

> > Massachusetts, who chaired the 8-member task force that developed the

> > guideline, summarized the recommendations at a press briefing here at

> > ENDO 2011: The Endocrine Society 93rd Annual Meeting.

> >

> > The guideline also was published online June 6 in the Journal of

> > Clinical Endocrinology and Metabolism.

> >

> > " Based on all the evidence, at a minimum, we recommend vitamin D levels

> > of 30 ng/mL, and because of the vagaries of some of the assays, to

> > guarantee sufficiency, we recommend between 40 and 60 ng/mL for both

> > children and adults, " Dr. Holick said.

> >

> > The society's clinical practice guideline was developed by " experts in

> > the field who carefully reviewed the current literature and features the

> > latest and most comprehensive recommendations available on the

> > prevention and treatment of vitamin D deficiency, " he said.

> >

> > The guideline recommends that clinicians screen for vitamin D deficiency

> > in people at risk for deficiency, including obese individuals, blacks,

> > pregnant and lactating women, and patients with malabsorption syndromes.

> >

> > " We do not recommend population screening for vitamin D deficiency in

> > individuals who are not at risk, " Dr. Holick said, but added that

> > " vitamin D deficiency is very common in all age groups — essentially

> > everyone is at risk. "

> >

> > Screening should be performed using a " reliable assay " for

> > 25-hydroxy-vitamin D (25[OH]D), not 1,25-dihydroxy-vitamin D

> > (1,25[OH]2D), " which tells you nothing about vitamin D status, " Dr.

> > Holick said. Vitamin D deficiency is defined as 25[OH]D levels below 20

> > ng/mL.

> >

> > " Considering that vitamin D deficiency is very common in all age groups

> > and that few foods contain vitamin D, the Task Force recommended

> > supplementation at suggested daily intake and tolerable upper limit

> > levels, depending on age and clinical circumstances, " the guideline states.

> >

> > For bone health, infants and children up to 1 year of age require at

> > least 400 IU/day vitamin D, and children 1 year and older need at least

> > 600 IU/day, the guideline states. However, at least 1000 IU/day of

> > vitamin D may be needed to raise the blood level of 25(OH)D consistently

> > above 30 ng/mL, it notes.

> >

> > Adults aged 19 to 70 years require at least 600 IU/day of vitamin D to

> > maximize bone health and muscle function. However, getting 25(OH)D

> > levels consistently above 30 ng/mL may require at least 1500 to 2000

> > IU/day of vitamin D.

> >

> > Adults 70 years and older require at least 800 IU/day of vitamin D for

> > bone health and fall prevention; at least 1500 to 2000 IU/day of

> > supplemental vitamin D may be needed to keep 25(OH)D levels above 30 ng/mL.

> >

> > Pregnant and lactating women need a minimum of 600 IU/day of vitamin D;

> > 1500 IU/day may be needed to maintain blood levels of 25(OH)D higher

> > than 30 ng/mL.

> >

> > " Obese children and adults and children and adults on anticonvulsant

> > medications, glucocorticoids, antifungals such as ketoconazole, and

> > medications for AIDS need at least 2 to 3 times more vitamin D for their

> > age group to satisfy their body's vitamin D requirement, " Dr. Holick

> > reported.

> >

> > Tolerable upper limits of vitamin D, which " should not be exceeded

> > without medical supervision, " include the following:

> >

> > 1000 IU/day for infants aged up to 6 months,

> > 1500 IU/day for infants aged 6 months to 1 year old,

> > 2500 IU/day for children aged 1 to 3 years,

> > 3000 IU/day for children aged 4 to 8 years, and

> > 4000 IU/day for everyone older than 8 years.

> >

> > However, the guideline states that for individuals who are vitamin D

> > deficient, higher levels of vitamin D (2000 IU/day for children up to

> > age 1 year; 4000 IU/day for children aged 1 - 18 years, and up to 10,000

> > IU/day for adults aged 19 years and older) " may be necessary to correct,

> > treat, and prevent vitamin D deficiency, " Dr. Holick said.

> >

> > " Both vitamin D2 and vitamin D3 is equally fine in treating and

> > preventing vitamin D deficiency, " he added.

> >

> > For all age groups, it is unknown whether these age-specific levels of

> > vitamin D are " enough to provide all of the potential nonskeletal health

> > benefits associated with vitamin D, " Dr. Holick noted.

> >

> > He also said that at present, " there is not sufficient evidence to

> > recommend prescribing vitamin D to attain the noncalcemic benefit for

> > cardiovascular protection. " However, association studies have suggested

> > that increasing vitamin D levels may help protect against some cancers,

> > including colorectal cancer, as well as infectious disease, diabetes,

> > and high blood pressure.

> >

> > The upper limits and the dietary intake levels in the Endocrine Society

> > guideline for the most part mirror those of the 2010 Institute of

> > Medicine consensus report, " Dietary Reference Intakes for Calcium and

> > Vitamin D, " although the Endocrine Society gives more explicit

> > recommendations for care.

> >

> > Dr. Holick commented that the Institute of Medicine report used a

> > " population model, not a medical model, and was not intended to direct

> > physicians on care of patients. It was up to professional associations

> > to establish guidelines of care, which is why [the Endocrine Society]

> > became involved. "

> >

> > Stencel, media relations officer of the National Academy of

> > Sciences, said the committee that issued the 2010 report is no longer an

> > entity and would not have a comment on the Endocrine Society guideline.

> >

> > " At some point down the road, there is the potential that [institute of

> > Medicine] could convene a new committee to reexamine all the new

> > information and look at changing the [dietary reference intakes], but at

> > this point we wouldn't do any immediate re-look at this, " she said.

> >

> > Development of the clinical practice guideline was supported solely by

> > the Endocrine Society. Dr. Holick has disclosed financial or

> > business/organizational interests with Merck, Novartis, Nichols-Quest

> > Diagnostics, Bayer, Aventis, Warner Chilcott, Amgen, the UV Foundation,

> > DMI, and the Mushroom Council. A complete list of disclosures for the

> > task force are listed with the original article.

> >

> > ENDO 2011: The Endocrine Society 93rd Annual Meeting. Presented June 6,

> > 2011.

> >

> > J Clin Endocrinol Metabol. Published online June 6, 2011. Abstract

> >

> > http://www.medscape.com/viewarticle/744128?sssdmh=dm1.693427 & src=nldne

> >

> > ------------------------------------

> >

June 8, 2011

The efficacy can be the same if the patient doesn't have renal impairment. It is

needed a higher dose of vitamin D2 though to have the same effect as vitamin D3

since it has transformed in the kidney. Since renal function declines with age

imo elderly patients should receive vitamin D3.

Catia Borges

>

> > Medscape Medical News from:

> >

> > ENDO 2011: The Endocrine Society 93rd Annual Meeting

> >

> > This coverage is not sanctioned by, nor a part of, The Endocrine Society.

> >

> > From Medscape Medical News

> >

> > Endocrine Society Issues Practice Guideline on Vitamin D

> >

> > Authors and Disclosures

> >

> > June 7, 2011 (Boston, Massachusetts) — The Endocrine Society today

> > unveiled a Clinical Practice Guideline on the evaluation, treatment, and

> > prevention of vitamin D deficiency, with an emphasis on the care of

> > patients who are at risk for vitamin D deficiency.

> >

> > F. Holick, MD, PhD, from Boston University Medical Center,

> > Massachusetts, who chaired the 8-member task force that developed the

> > guideline, summarized the recommendations at a press briefing here at

> > ENDO 2011: The Endocrine Society 93rd Annual Meeting.

> >

> > The guideline also was published online June 6 in the Journal of

> > Clinical Endocrinology and Metabolism.

> >

> > " Based on all the evidence, at a minimum, we recommend vitamin D levels

> > of 30 ng/mL, and because of the vagaries of some of the assays, to

> > guarantee sufficiency, we recommend between 40 and 60 ng/mL for both

> > children and adults, " Dr. Holick said.

> >

> > The society's clinical practice guideline was developed by " experts in

> > the field who carefully reviewed the current literature and features the

> > latest and most comprehensive recommendations available on the

> > prevention and treatment of vitamin D deficiency, " he said.

> >

> > The guideline recommends that clinicians screen for vitamin D deficiency

> > in people at risk for deficiency, including obese individuals, blacks,

> > pregnant and lactating women, and patients with malabsorption syndromes.

> >

> > " We do not recommend population screening for vitamin D deficiency in

> > individuals who are not at risk, " Dr. Holick said, but added that

> > " vitamin D deficiency is very common in all age groups — essentially

> > everyone is at risk. "

> >

> > Screening should be performed using a " reliable assay " for

> > 25-hydroxy-vitamin D (25[OH]D), not 1,25-dihydroxy-vitamin D

> > (1,25[OH]2D), " which tells you nothing about vitamin D status, " Dr.

> > Holick said. Vitamin D deficiency is defined as 25[OH]D levels below 20

> > ng/mL.

> >

> > " Considering that vitamin D deficiency is very common in all age groups

> > and that few foods contain vitamin D, the Task Force recommended

> > supplementation at suggested daily intake and tolerable upper limit

> > levels, depending on age and clinical circumstances, " the guideline states.

> >

> > For bone health, infants and children up to 1 year of age require at

> > least 400 IU/day vitamin D, and children 1 year and older need at least

> > 600 IU/day, the guideline states. However, at least 1000 IU/day of

> > vitamin D may be needed to raise the blood level of 25(OH)D consistently

> > above 30 ng/mL, it notes.

> >

> > Adults aged 19 to 70 years require at least 600 IU/day of vitamin D to

> > maximize bone health and muscle function. However, getting 25(OH)D

> > levels consistently above 30 ng/mL may require at least 1500 to 2000

> > IU/day of vitamin D.

> >

> > Adults 70 years and older require at least 800 IU/day of vitamin D for

> > bone health and fall prevention; at least 1500 to 2000 IU/day of

> > supplemental vitamin D may be needed to keep 25(OH)D levels above 30 ng/mL.

> >

> > Pregnant and lactating women need a minimum of 600 IU/day of vitamin D;

> > 1500 IU/day may be needed to maintain blood levels of 25(OH)D higher

> > than 30 ng/mL.

> >

> > " Obese children and adults and children and adults on anticonvulsant

> > medications, glucocorticoids, antifungals such as ketoconazole, and

> > medications for AIDS need at least 2 to 3 times more vitamin D for their

> > age group to satisfy their body's vitamin D requirement, " Dr. Holick

> > reported.

> >

> > Tolerable upper limits of vitamin D, which " should not be exceeded

> > without medical supervision, " include the following:

> >

> > 1000 IU/day for infants aged up to 6 months,

> > 1500 IU/day for infants aged 6 months to 1 year old,

> > 2500 IU/day for children aged 1 to 3 years,

> > 3000 IU/day for children aged 4 to 8 years, and

> > 4000 IU/day for everyone older than 8 years.

> >

> > However, the guideline states that for individuals who are vitamin D

> > deficient, higher levels of vitamin D (2000 IU/day for children up to

> > age 1 year; 4000 IU/day for children aged 1 - 18 years, and up to 10,000

> > IU/day for adults aged 19 years and older) " may be necessary to correct,

> > treat, and prevent vitamin D deficiency, " Dr. Holick said.

> >

> > " Both vitamin D2 and vitamin D3 is equally fine in treating and

> > preventing vitamin D deficiency, " he added.

> >

> > For all age groups, it is unknown whether these age-specific levels of

> > vitamin D are " enough to provide all of the potential nonskeletal health

> > benefits associated with vitamin D, " Dr. Holick noted.

> >

> > He also said that at present, " there is not sufficient evidence to

> > recommend prescribing vitamin D to attain the noncalcemic benefit for

> > cardiovascular protection. " However, association studies have suggested

> > that increasing vitamin D levels may help protect against some cancers,

> > including colorectal cancer, as well as infectious disease, diabetes,

> > and high blood pressure.

> >

> > The upper limits and the dietary intake levels in the Endocrine Society

> > guideline for the most part mirror those of the 2010 Institute of

> > Medicine consensus report, " Dietary Reference Intakes for Calcium and

> > Vitamin D, " although the Endocrine Society gives more explicit

> > recommendations for care.

> >

> > Dr. Holick commented that the Institute of Medicine report used a

> > " population model, not a medical model, and was not intended to direct

> > physicians on care of patients. It was up to professional associations

> > to establish guidelines of care, which is why [the Endocrine Society]

> > became involved. "

> >

> > Stencel, media relations officer of the National Academy of

> > Sciences, said the committee that issued the 2010 report is no longer an

> > entity and would not have a comment on the Endocrine Society guideline.

> >

> > " At some point down the road, there is the potential that [institute of

> > Medicine] could convene a new committee to reexamine all the new

> > information and look at changing the [dietary reference intakes], but at

> > this point we wouldn't do any immediate re-look at this, " she said.

> >

> > Development of the clinical practice guideline was supported solely by

> > the Endocrine Society. Dr. Holick has disclosed financial or

> > business/organizational interests with Merck, Novartis, Nichols-Quest

> > Diagnostics, Bayer, Aventis, Warner Chilcott, Amgen, the UV Foundation,

> > DMI, and the Mushroom Council. A complete list of disclosures for the

> > task force are listed with the original article.

> >

> > ENDO 2011: The Endocrine Society 93rd Annual Meeting. Presented June 6,

> > 2011.

> >

> > J Clin Endocrinol Metabol. Published online June 6, 2011. Abstract

> >

> > http://www.medscape.com/viewarticle/744128?sssdmh=dm1.693427 & src=nldne

> >

> > ------------------------------------

> >

June 8, 2011

Catia,

I have a home health client with advanced osteoporosis - has lost 8 inches

in height in the last few years and has suffered atleast 3 compression

fractures of spine. She has difficulty eating enough calories and continues

to lose weight - a total of 15 lbs since first fx 2 years ago. She is

prescribed amonth her multiple meds Vitamin D 3500 IU She will not take it

bc per client her extensive research and sources indicate that Vit D in

large doses is toxic. She has argued this with her MD, with me, the

pharmacist. She is educated (mental health field) and has access to current

literature. I have not been able to convince her that her deterioration will

continue unless she takes the supplements prescribed and she will continue

to lose bone. This in turn increases her pain, gastric distress and risk of

fractures.

I need additional sources that contradict her conviction and that are not as

" controversial " or " iffy " as what she is reading. Her torso has folded

forward and I have grave concern for her at this time. She is scared to

death and I don't blame her.

From: rd-usa [mailto:rd-usa ] On Behalf Of

catianutr

Sent: Wednesday, June 08, 2011 2:51 AM

To: rd-usa

Subject: Re: Endocrine Society Issues Practice Guideline on Vitamin

D

The efficacy can be the same if the patient doesn't have renal impairment.

It is needed a higher dose of vitamin D2 though to have the same effect as

vitamin D3 since it has transformed in the kidney. Since renal function

declines with age imo elderly patients should receive vitamin D3.

Catia Borges

>

> > Medscape Medical News from:

> >

> > ENDO 2011: The Endocrine Society 93rd Annual Meeting

> >

> > This coverage is not sanctioned by, nor a part of, The Endocrine

Society.

> >

> > From Medscape Medical News

> >

> > Endocrine Society Issues Practice Guideline on Vitamin D

> >

> > Authors and Disclosures

> >

> > June 7, 2011 (Boston, Massachusetts) - The Endocrine Society today

> > unveiled a Clinical Practice Guideline on the evaluation, treatment, and

> > prevention of vitamin D deficiency, with an emphasis on the care of

> > patients who are at risk for vitamin D deficiency.

> >

> > F. Holick, MD, PhD, from Boston University Medical Center,

> > Massachusetts, who chaired the 8-member task force that developed the

> > guideline, summarized the recommendations at a press briefing here at

> > ENDO 2011: The Endocrine Society 93rd Annual Meeting.

> >

> > The guideline also was published online June 6 in the Journal of

> > Clinical Endocrinology and Metabolism.

> >

> > " Based on all the evidence, at a minimum, we recommend vitamin D levels

> > of 30 ng/mL, and because of the vagaries of some of the assays, to

> > guarantee sufficiency, we recommend between 40 and 60 ng/mL for both

> > children and adults, " Dr. Holick said.

> >

> > The society's clinical practice guideline was developed by " experts in

> > the field who carefully reviewed the current literature and features the

> > latest and most comprehensive recommendations available on the

> > prevention and treatment of vitamin D deficiency, " he said.

> >

> > The guideline recommends that clinicians screen for vitamin D deficiency

> > in people at risk for deficiency, including obese individuals, blacks,

> > pregnant and lactating women, and patients with malabsorption syndromes.

> >

> > " We do not recommend population screening for vitamin D deficiency in

> > individuals who are not at risk, " Dr. Holick said, but added that

> > " vitamin D deficiency is very common in all age groups - essentially

> > everyone is at risk. "

> >

> > Screening should be performed using a " reliable assay " for

> > 25-hydroxy-vitamin D (25[OH]D), not 1,25-dihydroxy-vitamin D

> > (1,25[OH]2D), " which tells you nothing about vitamin D status, " Dr.

> > Holick said. Vitamin D deficiency is defined as 25[OH]D levels below 20

> > ng/mL.

> >

> > " Considering that vitamin D deficiency is very common in all age groups

> > and that few foods contain vitamin D, the Task Force recommended

> > supplementation at suggested daily intake and tolerable upper limit

> > levels, depending on age and clinical circumstances, " the guideline

states.

> >

> > For bone health, infants and children up to 1 year of age require at

> > least 400 IU/day vitamin D, and children 1 year and older need at least

> > 600 IU/day, the guideline states. However, at least 1000 IU/day of

> > vitamin D may be needed to raise the blood level of 25(OH)D consistently

> > above 30 ng/mL, it notes.

> >

> > Adults aged 19 to 70 years require at least 600 IU/day of vitamin D to

> > maximize bone health and muscle function. However, getting 25(OH)D

> > levels consistently above 30 ng/mL may require at least 1500 to 2000

> > IU/day of vitamin D.

> >

> > Adults 70 years and older require at least 800 IU/day of vitamin D for

> > bone health and fall prevention; at least 1500 to 2000 IU/day of

> > supplemental vitamin D may be needed to keep 25(OH)D levels above 30

ng/mL.

> >

> > Pregnant and lactating women need a minimum of 600 IU/day of vitamin D;

> > 1500 IU/day may be needed to maintain blood levels of 25(OH)D higher

> > than 30 ng/mL.

> >

> > " Obese children and adults and children and adults on anticonvulsant

> > medications, glucocorticoids, antifungals such as ketoconazole, and

> > medications for AIDS need at least 2 to 3 times more vitamin D for their

> > age group to satisfy their body's vitamin D requirement, " Dr. Holick

> > reported.

> >

> > Tolerable upper limits of vitamin D, which " should not be exceeded

> > without medical supervision, " include the following:

> >

> > 1000 IU/day for infants aged up to 6 months,

> > 1500 IU/day for infants aged 6 months to 1 year old,

> > 2500 IU/day for children aged 1 to 3 years,

> > 3000 IU/day for children aged 4 to 8 years, and

> > 4000 IU/day for everyone older than 8 years.

> >

> > However, the guideline states that for individuals who are vitamin D

> > deficient, higher levels of vitamin D (2000 IU/day for children up to

> > age 1 year; 4000 IU/day for children aged 1 - 18 years, and up to 10,000

> > IU/day for adults aged 19 years and older) " may be necessary to correct,

> > treat, and prevent vitamin D deficiency, " Dr. Holick said.

> >

> > " Both vitamin D2 and vitamin D3 is equally fine in treating and

> > preventing vitamin D deficiency, " he added.

> >

> > For all age groups, it is unknown whether these age-specific levels of

> > vitamin D are " enough to provide all of the potential nonskeletal health

> > benefits associated with vitamin D, " Dr. Holick noted.

> >

> > He also said that at present, " there is not sufficient evidence to

> > recommend prescribing vitamin D to attain the noncalcemic benefit for

> > cardiovascular protection. " However, association studies have suggested

> > that increasing vitamin D levels may help protect against some cancers,

> > including colorectal cancer, as well as infectious disease, diabetes,

> > and high blood pressure.

> >

> > The upper limits and the dietary intake levels in the Endocrine Society

> > guideline for the most part mirror those of the 2010 Institute of

> > Medicine consensus report, " Dietary Reference Intakes for Calcium and

> > Vitamin D, " although the Endocrine Society gives more explicit

> > recommendations for care.

> >

> > Dr. Holick commented that the Institute of Medicine report used a

> > " population model, not a medical model, and was not intended to direct

> > physicians on care of patients. It was up to professional associations

> > to establish guidelines of care, which is why [the Endocrine Society]

> > became involved. "

> >

> > Stencel, media relations officer of the National Academy of

> > Sciences, said the committee that issued the 2010 report is no longer an

> > entity and would not have a comment on the Endocrine Society guideline.

> >

> > " At some point down the road, there is the potential that [institute of

> > Medicine] could convene a new committee to reexamine all the new

> > information and look at changing the [dietary reference intakes], but at

> > this point we wouldn't do any immediate re-look at this, " she said.

> >

> > Development of the clinical practice guideline was supported solely by

> > the Endocrine Society. Dr. Holick has disclosed financial or

> > business/organizational interests with Merck, Novartis, Nichols-Quest

> > Diagnostics, Bayer, Aventis, Warner Chilcott, Amgen, the UV Foundation,

> > DMI, and the Mushroom Council. A complete list of disclosures for the

> > task force are listed with the original article.

> >

> > ENDO 2011: The Endocrine Society 93rd Annual Meeting. Presented June 6,

> > 2011.

> >

> > J Clin Endocrinol Metabol. Published online June 6, 2011. Abstract

> >

> > http://www.medscape.com/viewarticle/744128?sssdmh=dm1.693427

<http://www.medscape.com/viewarticle/744128?sssdmh=dm1.693427 & src=nldne>

& src=nldne

> >

> > ------------------------------------

> >

June 9, 2011

http://www.ncbi.nlm.nih.gov/pubmed/20200964

Effect of Vitamin D3 and Calcium on Fracture Risk in 65- to 71-Year-Old Women:

American Society for Bone and Mineral Research) *** 800 IU vit D & 1000 mg Ca x

3 yr study in Finland

http://www.ajcn.org/content/91/1/82.

Bolland, Mark J., Bacon, J., Horne, Anne M, Mason, Barbar H, Ames,

Rth W., Wang, Tom KM, Grey, B., Gamble, Greg D,, and Reid, Ian R,

Vitamin D insufficiency and health outcomes over 5 Y in older women, (Am J Clin

Nutr January 2010 vol. 91 no. 1 82-89, 2010, American Society for Nutrition)

â€œWomen with a seasonally adjusted 25(OH)D concentration < 50 nmol/L were not

at

increased risk of adverse consequences for any musculoskeletal outcome,

including fracture, falls, bone density, or grip strength or any nonskeletal

outcomes, including death, myocardial infarction, cancer, hart failure,

diabetes, or adverse changes in blood pressure, weight body composition,

cholesterol, or glucose.â€

http://www.medscape.com/viewarticle/515957

Magnesium intake from food and supplements is associated with bone mineral

density in healthy older white subjects. (elderly health), M. Ryder,

I Shorr, J. Bush, Tamara , Stone and Frances A

Tylavsky. Journal of the American Geriatrics Society, 53.11 (Nove 2005):

p1875-1881. Academic One File. Web. 13 Dec. 2010, PMID: 16274367 [PubMed -

indexed for MEDLINE]

Vajda, R.D.

www.GingerJens.com

________________________________

To: rd-usa

Sent: Wed, June 8, 2011 10:37:58 AM

Subject: RE: Re: Endocrine Society Issues Practice Guideline on Vitamin