Burden of vitamin D deficiency outlined in International Osteoporosis Foundation position paper

17 Jun 2024 --- The International Osteoporosis Foundation (IOF) Vitamin D Working Group commissioned a new position paper that underscores the burden of vitamin D deficiency and public health approaches to its prevention.

The paper addresses important issues such as global variations in vitamin D concentrations and the challenges of scientific testing methods, guidelines, screening, supplementation and food fortification.

“Vitamin D levels at the population level differ markedly around the world and are dependent on a range of factors such as diet, skin pigmentation, covering, latitude, effective sun exposure and supplement use,” says Dawson Hughes, senior scientist, endocrine division at Tufts Medical Center and senior author of the paper.

Diet and lifestyle measures
The paper, published in PubMed and Osteoporosis International, builds on recently published work by the European Society for Clinical and Economic Aspects of Osteoporosis, Osteoarthritis and Musculoskeletal Diseases. Its main finding is that the maintenance of vitamin D status at the population levels can be achieved through diet and lifestyle measures. 

Daily vitamin D supplementation is one approach to meet consumption requirements and the alternative root of food fortification practiced by some countries to optimize vitamin D status is another. The paper’s researchers note that any intervention should account for individual population characteristics such as habitual calcium intake. 

“We know that vitamin D is important for overall health and that severe vitamin D deficiency in some individuals may lead to serious health issues such as rickets or osteomalacia,” says Hughes.The paper's researchers recommend standardized dosage measures.

“In these patients, prompt vitamin D repletion is needed. However, at the level of public health, the role of vitamin D supplementation presents a different set of considerations. Here, the goal is to keep vitamin D levels high enough, on average, to reduce the risk of health problems overall.”

Variation in methodologies
The researchers note that methodological matters, including assay variability and a lack of standardization in reporting, result in gaps in documentation of vitamin D deficiency worldwide.

“This position paper, bringing together international experts from many different regions of the world, clarifies the approach to optimizing vitamin D status in populations. It was very evident that one size does not fit all, and that population- and context-specific variables such as overall calcium intake, should also be considered,” says Nicholas Harvey, president of IOF and first author of the paper.

“Approaches might include guidelines around diet, food fortification or supplementation, particularly for those at high risk of vitamin D deficiency and complications. Conversely, severe vitamin D deficiency associated with signs and symptoms of disease should be assessed and treated appropriately by a healthcare professional.”

To strengthen future studies on vitamin D epidemiology and guidelines, the researchers recommend that standardized measures of 25 hydroxy vitamin D, as outlined by the Vitamin D Standardization Program, should be reported in all studies and publications. 

Further, a major influence on the vitamin domain these days is the consumer shift to proactive health management, with the leading health benefits being healthy aging, women’s health and beauty. Nutrition Insight caught up with experts from Blue California, dsm-firmenich, SternVitamin and ADM, who share industry perspectives on what’s shaping the vitamin landscape.

Vitamin D screening
Based on the currently available evidence, there is not enough justification for vitamin D screening for deficiency in the general population. Screening or routine supplementation applies to high-risk populations such as seniors in residential care or people with pigmented skin who live in northern latitudes. 

Vitamin D testing is likely indicated in combination with a robust approach to vitamin D repletion where symptoms show deficiency at an individual level. The researchers caution against bolus doses where there is a risk of falls and fractures unless there is a need for rapid correction. 

Meanwhile, researchers from Queen Mary University of London, UK, and Harvard T.H. Chan School of Public Health, US, dispelled the longstanding myth that vitamin D supplements prevent fractures or improve bone strength in deficient children. The comprehensive study contradicts previous research findings that exaggerate the vitamin’s benefits on bone health.

By Inga de Jong