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type=\u0022text\/css\u0022 rel=\u0022stylesheet\u0022 href=\u0022\/\/d282kpwvnogo5m.cloudfront.net\/sites\/default\/files\/advagg_css\/css__ce2QY63WIanKyr8eSq7eavr1XQRRmFD6ZSmwpyJi8lM__zXwFqpqmxrZOXXcd_TpBQpjuELbmIP9wBR5UuTDWAO4__YJWWMMdfCJuAFm5cUEp88OsodhO3ZA-2lzRfoBsSlk4.css\u0022 media=\u0022all\u0022 \/\u003E\n\u003Clink rel=\u0027stylesheet\u0027 type=\u0027text\/css\u0027 href=\u0027\/sites\/all\/modules\/contrib\/panels\/plugins\/layouts\/onecol\/onecol.css\u0027 \/\u003E\u003C\/head\u003E\u003Cbody\u003E\u003Cdiv class=\u0022panels-ajax-tab-panel panels-ajax-tab-panel-sageoa-tab-art\u0022\u003E\u003Cdiv class=\u0022panel-display panel-1col clearfix\u0022 \u003E\n  \u003Cdiv class=\u0022panel-panel panel-col\u0022\u003E\n    \u003Cdiv\u003E\u003Cdiv class=\u0022panel-pane pane-highwire-markup\u0022 \u003E\n  \n      \n  \n  \u003Cdiv class=\u0022pane-content\u0022\u003E\n    \u003Cdiv class=\u0022highwire-markup\u0022\u003E\u003Cdiv xmlns=\u0022http:\/\/www.w3.org\/1999\/xhtml\u0022 id=\u0022content-block-markup\u0022 xmlns:xhtml=\u0022http:\/\/www.w3.org\/1999\/xhtml\u0022\u003E\u003Cdiv class=\u0022article fulltext-view \u0022\u003E\u003Cspan class=\u0022highwire-journal-article-marker-start\u0022\u003E\u003C\/span\u003E\u003Cdiv class=\u0022section abstract\u0022 id=\u0022abstract-1\u0022\u003E\u003Ch2\u003ESummary\u003C\/h2\u003E\n            \u003Cp id=\u0022p-1\u0022\u003EAn Endocrine Society Task Force released findings on updated guidelines for the evaluation, treatment, and prevention of vitamin D deficiency.\u003C\/p\u003E\n         \u003C\/div\u003E\u003Cul class=\u0022kwd-group\u0022\u003E\u003Cli class=\u0022kwd\u0022\u003EDeficiency Disorders\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003EPrevention \u0026amp; Screening\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003EDiabetes \u0026amp; Endocrinology Guidelines\u003C\/li\u003E\u003C\/ul\u003E\u003Cp id=\u0022p-2\u0022\u003EMichael F. Holick, PhD, MD, Boston University School of Medicine, Boston, Massachusetts, USA, released findings from an Endocrine Society Task Force on updated guidelines for the evaluation, treatment, and prevention of vitamin D deficiency. Few foods naturally contain vitamins D\u003Csub\u003E2\u003C\/sub\u003E or D\u003Csub\u003E3\u003C\/sub\u003E, and deficiency is common throughout the world across all age groups [Holick MF et al. \u003Cem\u003EJ Clin Endrinol Metab\u003C\/em\u003E 2011].\u003C\/p\u003E\u003Cp id=\u0022p-3\u0022\u003EThe updated clinical practice guidelines are based on a systematic review of the literature and represent the latest evidence-based findings [Holick MF et al. \u003Cem\u003EJ Clin Endrinol Metab\u003C\/em\u003E 2011].\u003C\/p\u003E\u003Cdiv class=\u0022section\u0022 id=\u0022sec-1\u0022\u003E\n         \u003Ch2 class=\u0022\u0022\u003EDiagnostic Procedure\u003C\/h2\u003E\n         \u003Cp id=\u0022p-4\u0022\u003EThe Task Force recommends screening for vitamin D deficiency using the serum circulating 25-hydroxyvitamin D [25(OH)D] level, measured by a reliable assay in individuals who are at risk for vitamin D deficiency. Population screening for individuals who are not at risk is not recommended. Vitamin D deficiency is defined as a 25(OH)D level below 20 ng\/ml (50 nmol\/L). Vitamin D insufficiency is defined as a 25(OH)D level of 21\u201325 ng\/ml (\u0026gt;5 nmol\/L). The Task Force recommended against using the serum 1,25(OH)\u003Csub\u003E2\u003C\/sub\u003ED assay to screen for deficiency. Rather, it should only be used to monitor certain conditions, such as acquired and inherited vitamin D and phosphate metabolism disorders.\u003C\/p\u003E\n      \u003C\/div\u003E\u003Cdiv class=\u0022section\u0022 id=\u0022sec-2\u0022\u003E\n         \u003Ch2 class=\u0022\u0022\u003ERecommended Dietary Intakes for Patients at Risk for Vitamin D Deficiency\u003C\/h2\u003E\n         \u003Cdiv id=\u0022sec-3\u0022 class=\u0022subsection\u0022\u003E\n            \u003Ch3\u003E\u003Cspan class=\u0022underline\u0022\u003EInfants and Children\u003C\/span\u003E\u003C\/h3\u003E\n            \u003Cp id=\u0022p-5\u0022\u003EInfants and children aged 0 to 1 year require at least 400 IU\/day (IU=25 ng\/ml) of vitamin D; those aged 1 year and older require at least 600 IU\/day to maximize bone health. It remains unknown whether these doses are enough to optimize all potential nonskeletal health benefits that are associated with vitamin D. The ability to consistently raise the blood level of 25(OH)D above 30 ng\/ml (75 nmol\/L) may require at least 1000 IU\/day of vitamin D.\u003C\/p\u003E\n            \u003Cul class=\u0022list-unord \u0022 id=\u0022list-1\u0022\u003E\u003Cli id=\u0022list-item-1\u0022\u003E\n                  \u003Cp id=\u0022p-6\u0022\u003E\n                     \u003Cspan class=\u0022underline\u0022\u003EAdults Aged 19 to 50 Years\u003C\/span\u003E\n                  \u003C\/p\u003E\n                  \u003Cp id=\u0022p-7\u0022\u003EAdults aged 19 to 50 years require at least 600 IU\/day of vitamin D to maximize bone health and muscle function; however, at least 1500 to 2000 IU\/day of vitamin D may be required to consistently raise the blood level of 25(OH)D above 30 ng\/ml\u003C\/p\u003E\n               \u003C\/li\u003E\u003Cli id=\u0022list-item-2\u0022\u003E\n                  \u003Cp id=\u0022p-8\u0022\u003E\n                     \u003Cspan class=\u0022underline\u0022\u003EAdults Aged 50 to 70 Years\u003C\/span\u003E\n                  \u003C\/p\u003E\n                  \u003Cp id=\u0022p-9\u0022\u003EAll adults aged 50 to 70 years and 70+ years require at least 600 IU\/day and 800 IU\/day, respectively, of vitamin D to maximize bone health and muscle function; however, to consistently raise the blood level of 25(OH)D above 30 ng\/ml may require at least 1500\u20132000 IU\/day of supplemental vitamin D\u003C\/p\u003E\n               \u003C\/li\u003E\u003Cli id=\u0022list-item-3\u0022\u003E\n                  \u003Cp id=\u0022p-10\u0022\u003E\n                     \u003Cspan class=\u0022underline\u0022\u003EPregnant and Lactating Women\u003C\/span\u003E\n                  \u003C\/p\u003E\n                  \u003Cp id=\u0022p-11\u0022\u003EPregnant and lactating women require at least 600 IU\/d of vitamin D; however, at least 1500\u20132000 IU\/day of vitamin D may be needed to maintain a blood level of 25(OH)D above 30 ng\/ml\u003C\/p\u003E\n               \u003C\/li\u003E\u003Cli id=\u0022list-item-4\u0022\u003E\n                  \u003Cp id=\u0022p-12\u0022\u003E\n                     \u003Cspan class=\u0022underline\u0022\u003EObesity, Anticonvulsants, Glucocorticoids, Antifungals, \u0026amp; AIDS Medications\u003C\/span\u003E\n                  \u003C\/p\u003E\n                  \u003Cp id=\u0022p-13\u0022\u003EObese children and adults, and patients who are taking anticonvulsant medications, glucocorticoids, antifungals (such as ketoconazole), and medications for AIDS should take at least 2 to 3 times more vitamin D than others in their age group to satisfy their bodies\u0027 vitamin D requirements.\u003C\/p\u003E\n               \u003C\/li\u003E\u003C\/ul\u003E\n         \u003C\/div\u003E\n      \u003C\/div\u003E\u003Cdiv class=\u0022section\u0022 id=\u0022sec-4\u0022\u003E\n         \u003Ch2 class=\u0022\u0022\u003EMaintenance Tolerable Upper Limits\u003C\/h2\u003E\n         \u003Cp id=\u0022p-14\u0022\u003EMaintenance tolerable upper limits (UL) of vitamin D are not to be exceeded without medical supervision. These should be 1000 IU\/day for infants aged up to 6 months; 1500 IU\/day for infants aged from 6 months to 1 year; at least 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 aged \u0026gt;8 years. Higher levels of 2000 IU\/day for children aged 0 to 1 year, 4000 IU\/day for children aged 1 to 18 years, and 10,000 IU\/day for children and adults aged \u226519 years might be needed to correct vitamin D deficiency.\u003C\/p\u003E\n      \u003C\/div\u003E\u003Cdiv class=\u0022section\u0022 id=\u0022sec-5\u0022\u003E\n         \u003Ch2 class=\u0022\u0022\u003ETreatment and Prevention Strategies for Those Who Are Vitamin D-Deficient\u003C\/h2\u003E\n         \u003Cp id=\u0022p-15\u0022\u003EEither vitamin D\u003Csub\u003E2\u003C\/sub\u003E or vitamin D\u003Csub\u003E3\u003C\/sub\u003E should be used for the treatment and prevention of vitamin D deficiency.\u003C\/p\u003E\n         \u003Cul class=\u0022list-unord \u0022 id=\u0022list-2\u0022\u003E\u003Cli id=\u0022list-item-5\u0022\u003E\n               \u003Cp id=\u0022p-16\u0022\u003E\n                  \u003Cstrong\u003EInfants and toddlers (0 to 1 year)\u003C\/strong\u003E who are vitamin D-deficient should be treated with 2000 IU\/day of vitamin D\u003Csub\u003E2\u003C\/sub\u003E or vitamin D\u003Csub\u003E3\u003C\/sub\u003E or with 50,000 IU of vitamin D\u003Csub\u003E2\u003C\/sub\u003E or vitamin D\u003Csub\u003E3\u003C\/sub\u003E once weekly for 6 weeks to achieve a blood level of 25(OH)D above 30 ng\/ml; maintenance therapy should be 400\u20131000 IU\/day\u003C\/p\u003E\n            \u003C\/li\u003E\u003Cli id=\u0022list-item-6\u0022\u003E\n               \u003Cp id=\u0022p-17\u0022\u003E\n                  \u003Cstrong\u003EChildren aged 1 to 18 years\u003C\/strong\u003E who are vitamin D-deficient should be treated with 2000 IU\/day of vitamin D\u003Csub\u003E2\u003C\/sub\u003E or vitamin D\u003Csub\u003E3\u003C\/sub\u003E for at least 6 weeks or with 50,000 IU of vitamin D\u003Csub\u003E2\u003C\/sub\u003E once a week for at least 6 weeks to achieve a blood level of 25(OH)D above 30 ng\/ml, followed by maintenance therapy of 600 to 1000 IU\/day\u003C\/p\u003E\n            \u003C\/li\u003E\u003Cli id=\u0022list-item-7\u0022\u003E\n               \u003Cp id=\u0022p-18\u0022\u003E\n                  \u003Cstrong\u003EAll adults\u003C\/strong\u003E who are vitamin D-deficient should be treated with 50,000 IU of vitamin D\u003Csub\u003E2\u003C\/sub\u003E or vitamin D\u003Csub\u003E3\u003C\/sub\u003E once a week for 8 weeks or the equivalent of 6000 IU of vitamin D\u003Csub\u003E2\u003C\/sub\u003E or vitamin D\u003Csub\u003E3\u003C\/sub\u003E daily to achieve a blood level of 25(OH)D above 30 ng\/ml, followed by maintenance therapy of 1500\u20132000 IU\/day\u003C\/p\u003E\n            \u003C\/li\u003E\u003Cli id=\u0022list-item-8\u0022\u003E\n               \u003Cp id=\u0022p-19\u0022\u003E\n                  \u003Cstrong\u003EPatients who are obese, have malabsorption syndromes, and those on medications affecting vitamin D metabolism\u003C\/strong\u003E should receive a higher dose (2 to 3 times higher; ie, at least 6000 to 10,000 IU\/day) of vitamin D\u003Csub\u003E2\u003C\/sub\u003E or vitamin D\u003Csub\u003E3\u003C\/sub\u003E to treat deficiency and maintain a 25(OH)D level above 30 ng\/ml; maintenance therapy should be 3000 to 6000 IU\/day\u003C\/p\u003E\n            \u003C\/li\u003E\u003Cli id=\u0022list-item-9\u0022\u003E\n               \u003Cp id=\u0022p-20\u0022\u003E\n                  \u003Cstrong\u003EPatients with extrarenal production of 1,25(OH)2D\u003C\/strong\u003E should receive serial monitoring of 25(OH)D levels and serum calcium levels during treatment with vitamin D to prevent hypercalcemia\u003C\/p\u003E\n            \u003C\/li\u003E\u003Cli id=\u0022list-item-10\u0022\u003E\n               \u003Cp id=\u0022p-21\u0022\u003E\n                  \u003Cstrong\u003EPatients with primary hyperparathyroidism\u003C\/strong\u003E and vitamin D deficiency should receive treatment with vitamin D as needed; serum calcium levels should be monitored\u003C\/p\u003E\n            \u003C\/li\u003E\u003C\/ul\u003E\n      \u003C\/div\u003E\u003Cdiv class=\u0022section\u0022 id=\u0022sec-6\u0022\u003E\n         \u003Ch2 class=\u0022\u0022\u003ENoncalcemic Benefits of Vitamin D\u003C\/h2\u003E\n         \u003Cp id=\u0022p-22\u0022\u003EThe Task Force recommended prescribing vitamin D supplementation for fall prevention. It did not recommend vitamin D supplementation beyond recommended daily needs for the purpose of preventing cardiovascular disease or death or improving quality-of-life (\u003Ca id=\u0022xref-table-wrap-1-1\u0022 class=\u0022xref-table\u0022 href=\u0022#T1\u0022\u003ETable 1\u003C\/a\u003E).\u003C\/p\u003E\n         \u003Cdiv id=\u0022T1\u0022 class=\u0022table pos-float\u0022\u003E\u003Cdiv class=\u0022table-inline\u0022\u003E\u003Cdiv class=\u0022callout\u0022\u003E\u003Cspan\u003EView this table:\u003C\/span\u003E\u003Cul class=\u0022callout-links\u0022\u003E\u003Cli class=\u00220 first\u0022\u003E\u003Ca href=\u0022\/\u0022 class=\u0022table-expand-inline\u0022 data-table-url=\u0022\/highwire\/markup\/12284\/expansion?postprocessors=highwire_figures%2Chighwire_math%2Chighwire_inline_linked_media%2Chighwire_embed\u0026amp;table-expand-inline=1\u0022 html=\u00221\u0022 fragment=\u0022#\u0022 external=\u00221\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EView inline\u003C\/a\u003E\u003C\/li\u003E\u003Cli class=\u00221\u0022\u003E\u003Ca href=\u0022\/highwire\/markup\/12284\/expansion?width=1000\u0026amp;height=500\u0026amp;iframe=true\u0026amp;postprocessors=highwire_figures%2Chighwire_math%2Chighwire_inline_linked_media\u0022 class=\u0022colorbox colorbox-load table-expand-popup\u0022 rel=\u0022gallery-fragment-tables\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EView popup\u003C\/a\u003E\u003C\/li\u003E\u003Cli class=\u00222 last\u0022\u003E\u003Ca href=\u0022\/highwire\/powerpoint\/12284\u0022 class=\u0022highwire-figure-link highwire-figure-link-ppt\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EDownload powerpoint\u003C\/a\u003E\u003C\/li\u003E\u003C\/ul\u003E\u003C\/div\u003E\u003C\/div\u003E\u003Cdiv class=\u0022table-caption\u0022\u003E\u003Cspan class=\u0022table-label\u0022\u003ETable 1.\u003C\/span\u003E \n               \u003Cp id=\u0022p-23\u0022 class=\u0022first-child\u0022\u003EIndications for 25(OH)D Measurement (Candidates for Screening).\u003C\/p\u003E\n            \u003Cdiv class=\u0022sb-div caption-clear\u0022\u003E\u003C\/div\u003E\u003C\/div\u003E\u003C\/div\u003E\n         \u003Cp id=\u0022p-24\u0022\u003EThe major source of vitamin D for adults and children is unprotected sun exposure; without it, it is difficult, if not impossible, to obtain an adequate amount of vitamin D from dietary sources without supplementation. Concerns about melanoma and other types of skin cancer make it necessary to avoid excessive exposure to midday sun. Such worries strengthen the case for supplementation, especially among those who live at about 33\u00b0 latitude [Grant WB et al. \u003Cem\u003EProg Biophys Mol Biol\u003C\/em\u003E 2009].\u003C\/p\u003E\n      \u003C\/div\u003E\u003Cul class=\u0022copyright-statement\u0022\u003E\u003Cli class=\u0022fn\u0022 id=\u0022copyright-statement-1\u0022\u003E\u00a9 2011 MD Conference Express\u003C\/li\u003E\u003C\/ul\u003E\u003Cspan class=\u0022highwire-journal-article-marker-end\u0022\u003E\u003C\/span\u003E\u003C\/div\u003E\u003Cspan id=\u0022related-urls\u0022\u003E\u003C\/span\u003E\u003C\/div\u003E\u003Ca href=\u0022http:\/\/mdc.sagepub.com\/content\/11\/5\/18.abstract\u0022 class=\u0022hw-link hw-link-article-abstract\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EView Summary\u003C\/a\u003E\u003C\/div\u003E  \u003C\/div\u003E\n\n  \n  \u003C\/div\u003E\n\u003C\/div\u003E\n  \u003C\/div\u003E\n\u003C\/div\u003E\n\u003C\/div\u003E\u003Cscript type=\u0022text\/javascript\u0022 src=\u0022http:\/\/mdc.sagepub.com\/sites\/all\/modules\/highwire\/highwire\/plugins\/highwire_markup_process\/js\/highwire_openurl.js?nzn28q\u0022\u003E\u003C\/script\u003E\n\u003Cscript type=\u0022text\/javascript\u0022 src=\u0022http:\/\/mdc.sagepub.com\/sites\/all\/modules\/highwire\/highwire\/plugins\/highwire_markup_process\/js\/highwire_tables.js?nzn28q\u0022\u003E\u003C\/script\u003E\n\u003C\/body\u003E\u003C\/html\u003E"}