Vitamin D: deficiency, sufficiency and toxicity

Fahad Alshahrani, Naji Aljohani, Fahad Alshahrani, Naji Aljohani

Abstract

The plethora of vitamin D studies over the recent years highlight the pleomorphic effects of vitamin D outside its conventional role in calcium and bone homeostasis. Vitamin D deficiency, though common and known, still faces several challenges among the medical community in terms of proper diagnosis and correction. In this review, the different levels of vitamin D and its clinical implications are highlighted. Recommendations and consensuses for the appropriate dose and duration for each vitamin D status are also emphasized.

References

    1. DeLuca H. Overview of General physiological tenures and function of vitamin D. Am. J.Clin. Nutr. 2004;80:16895–16965.
    1. Mawer E.B., Hayes M.E., Heys S.E., Davies M., White A., Stewart M.F., Smith G.N. Constitutive synthesis of 1,25 dihydroxy vitamin D3 by a human small cell lung cancer cell line. J. Clin. Endocrinol. Metab. 1994;79:554–560. doi: 10.1210/jc.79.2.554.
    1. Schwartz G.G., Whitlutch L.W., Chen T.C., Lokeshwar B.L., Holick M.F. Human prostate cells synthesize 1,25 dihydroxyvitamin D3. Cancer Epidemiol. Biomark. Prev. 1998;7:391–395.
    1. Holick M.F. Sunlight, vitamin D and health: A D-lightful story. Nor. Acad. Sci. Lett. 2008;2008:147–166.
    1. Jones G., Strugnell S., DeLuca H.F. Current understanding of the molecular action of vitamin D. Physiol. Rev. 1998;78:1193–1231.
    1. Vieth R. Vitamin D supplementation, 25 hydroxy-vitamin D concentrations, and safety. Am. J. Clin. Nutr. 1999;69:842–856.
    1. Ahmed M.S., Shoker A. Vitamin D metabolites; protective versus toxic properties: Molecular and cellular perspectives. Nephrol.Rev. 2010;2:19–26.
    1. Holick M.F. High prevalence of vitamin D inadequacy and implications for health. Mayo Clin. Proc. 2006;81:353–373. doi: 10.4065/81.3.353.
    1. Holick M.F. Sunlight and vitamin D for bone health and prevention of autoimmune diseases, cancers and cardiovascular disease. Am. J. Clin. Nutr. 2004;80:1678S–1688S.
    1. Holick M.F. Vitamin D: the underappreciated D-lightful hormone that is important for skeletal and cellular health. Curr. Opin. Endocrinol. Diabetes. 2002;9:87–98. doi: 10.1097/00060793-200202000-00011.
    1. Heaney R.P., Dowell M.S., Hale C.A., Bendich A. Calcium absorption varies within the reference range for serum 25-hydroxyvitamin D. J. Am. Coll. Nutr. 2003;22:142–146. doi: 10.1080/07315724.2003.10719287.
    1. Bischoff-Ferrari H.A., Dietrich T., Orav E.J., Hu F.B., Zhang Y., Karlson E.W., Dawson-Hughes E.B. Higher 25 hydroxy-vitamin D concentration are associated with better lower-extremity function in both active and inactive persons aged > 60 yrs. Am. J. Clin. Nutr. 2004;80:752–758.
    1. Holick M.F. Vitamin D deficiency. N. Engl. J. Med. 2007;357:266–281. doi: 10.1056/NEJMra070553.
    1. Cannell J.J., Hollis B.W., Zasloff M., Heaney R.P. Diagnosis and treatment of vitamin D deficiency. Expert Opin. Pharmacother. 2008;9:107–118. doi: 10.1517/14656566.9.1.107.
    1. Lips P. Vitamin D deficiency of secondary hyperparathyroidism in the elderly: Consequences for bone loss and fractures and therapeutic implications. Endocr. Rev. 2001;22:477–501. doi: 10.1210/er.22.4.477.
    1. Chapuy M.C., Preziosi P., Maamer M., Arnaud S., Galan P., Hercberg S., Meunier P.J. Prevalence of vitamin D insufficiency in an adult normal population. Osteopros. Int. 1997;7:439–443. doi: 10.1007/s001980050030.
    1. Holick M.F., Siris E.S., Binkley N., Beard M.K., Khan A., Katzer J.T., Petruschke R.A., Chen E., de Papp A.E. Prevalence of vitamin D inadequacy among postmenopausal North American women receiving osteoporosis therapy. J. Clin. Endocrinol. Metab. 2005;90:3215–3224. doi: 10.1210/jc.2004-2364.
    1. Heaney P.R. Functional indices of vitamin D status and ramifications of vitamin D deficiency. Am. J. Clin. Nutr. 2004;80:1706S–1709S.
    1. Hanley D.A., Davison K.S. Vitamin D insufficiency in North America. J. Nutr. 2005;135:332–337.
    1. Hollis B.W., Wagner C.L. Assessment of dietary vitamin D requirements during pregnancy and lactation. Am. J. Clin. Nutr. 2004;79:717–726.
    1. Rajasree S., Rajpal K., Kartha C.C., Sarma P.S., Kutty V.R., Iyer C.S., Girija G. Serum 25-dihyroxyvitamin D3 levels are elevated in South Indian patients with ischemic heart disease. Eur. J. Epidemiol. 2001;17:567–571. doi: 10.1023/A:1014559600042.
    1. Wang T.J., Pencina M.J., Booth S.L., Jacques P.F., Ingelsson E., Lanier K., Benjamin E.J., DÁgostino R.B., Wolf M., Vasan R.S. Vitamin D deficiency and risk of cardiovascular disease. Circulation. 2008;117:503–511. doi: 10.1161/CIRCULATIONAHA.107.706127.
    1. Shepard M.R., Deluca H.F. Plasma concentrations of vitamin D3 and its metabolites in the rat as infused by vitamin D3 intake. Arch. Biochem. Biophys. 1980;202:43–53.
    1. Paulovitch H., Gurabedian M., Bulsan S. Calcium mobilizing effect of large doses of 25-dyroxycalciferol ion anephric rats. J. Clin. Investig. 1973;52:2656–2659. doi: 10.1172/JCI107458.
    1. Hughes M.R., Baylink D.J., Jones P.J., Haussler M.R. Radioligand receptor assay for 25-hydroxvitamin D2/D3 and 1 alpha,25-hydroxyvitamin. J. Clin. Investig. 1976;58:61–70. doi: 10.1172/JCI108459.
    1. Trang H.M., Cole D.E., Rubin L.A., Pierratos A., Siu S., Vieth R. Evidence that vitamin D3 increases serum 25-hydroxyvitamin D more efficiently than does vitamin D2. Am. J. Clin. Nutr. 1998;68:854–858.
    1. Armas L.A., Hollis B.W., Heaney R.P. Vitamin D2 is much less effective than vitamin D3 in humans. J. Clin. Endocrinol. Metab. 2004;89:5387–5391. doi: 10.1210/jc.2004-0360.
    1. Holick M.F., Biancuzzo R.M., Chen T.C., Klein E.K., Young A., Bibuld D., Reitz R., Salameh W., Ameri A., Tannenbaum A.D. Vitamin D2 is as effective as vitamin D3 in maintaining circulating concentrations of 25-hydroxyvitamin D. J. Clin. Endocrinol. Metab. 2008;93:677–681.
    1. Glendenning P., Chew G.T., Seymour M.J., Goldswain P.R., Inderjeeth C.A., Vasikaran S.D., Toronto M., Musk A.A., Fraser W.D. Serum 25 hydroxyvitamin D levels in vitamin D insufficient hip fracture patients after supplementation wit ergocalciferol and cholecalciferol. Bone. 2009;45:870–875. doi: 10.1016/j.bone.2009.07.015.
    1. Gordon C.M., Williams A.L., Feldman H.A., May J., Sinclair L., Vasquez A., Coz J.E. Treatment of hypovitaminosis D in infants and toddlers. J. Clin. Endocrinol. Metab. 2008;93:2716–2721. doi: 10.1210/jc.2007-2790.
    1. Biancuzzo R.M., Young A., Bibuld D., Cai M.H., Winter M.R., Klein E.K., Ameri A., Reitz R., Salameh W., Chen T.C., et al. Fortification of orange juice with vitamin D2 or vitamin D3 is as effective as an oral supplement in maintaining vitamin D status in an adult. Am. J. Clin. Nutr. 2010;91:162–166.
    1. Chan J. Vitamin D update for nutrition professionals. Veget. Nutr. 2009;18:1–2.
    1. Houghton A.L., Vieth R. The case against ergocalciferol (vitamin D2 as a vitamin supplement) Am. J. Clin. Nutr. 2006;84:694–697.
    1. Hollis B.W. Comparison of equilibrium and disequilibrium assay conditions of ergocalciferol and cholicalciferol and their metabolites. J. Steroid Biochem. 1989;21:81–86. doi: 10.1016/0022-4731(84)90063-3.
    1. Horst R.L., Reinhardt T.A., Ramberg C.F., Koszewski N.J., Napoli J.L. 24-Hydroxylation of 1,25-dihydroxyergocalciferol: An unambiguous deactivation process. J. Biol. Chem. 1986;261:9250–9256.
    1. Jones G. In: Analog Metabolism in Vitamin D. Feldman D., Glorieux F., Pike J.W., editors. Elsevier Academic Press; Melville, NY, USA: 1997. pp. 73–94.
    1. Institute of Medicine Standing Committee on the Scientific Evaluation of Dietary Reference Intakes. Dietary Reference Intakes for Calcium, Phosphorus, Magnesium, Vitamin D, and Fluoride. National Academy Press; Washington, DC, USA: 1997.
    1. Teresa K., Amy G., Jackie R., Jennie H., Sarina S. Vitamin D: An evidence based review. J. Am. Board. Fam. Med. 2009;22:698–706. doi: 10.3122/jabfm.2009.06.090037.
    1. Hanley D.A., Cranney A., Jones G., Whiting S.J., Leslie W.D. Guidelines Committee of the Scientific Advisory Council of Osteoporosis of Canada. Vitamin D in adult health and disease; a review and guideline statement from Osteoporosis Canada (summary) Can. Med. Assoc. J. 2010;182:1315–1319. doi: 10.1503/cmaj.091062.
    1. Dawson-Hughes B. Treatment of Vitamin D Deficient States. Wolters Kluwer Health Website. 2010. [(accessed on 11 September 2013)]. Available online: .
    1. Vieth R. Critique of the consideration for establishing the tolerable upper intake level for vitamin D: Critical need for revision upwards. J. Nutr. 2006;136:1117–1122.
    1. Dawson-Hughes B., Heaney R.P., Holick M.F., Lips P., Meunier P.J., Vieth R. Estimates of optimal vitamin D status. Osteoporos. Int. 2005;16:713–716.
    1. De Torrente de la Jara G., Pecoud A., Favrat B. Female asylum seekers with musculoskeletal pain; the importance of diagnosis and treatment of hypovitaminosis D. BMC Fam. Pract. 2006;7:4. doi: 10.1186/1471-2296-7-4.
    1. Institute of Medicine (US) Standing Committee on the Scientific Evaluation of Dietary Reference Intakes. Dietary Reference Intakes for Calcium, Phosphorus, Magnesium, Vitamin D, and Fluoride. National Academies Press; Washington, DC, USA: 1997.
    1. Holick M.F. Vitamin D deficiency: What a pain it is. Mayo Clin. Proc. 2003;78:1457–1459. doi: 10.4065/78.12.1457.
    1. Schwalfenberg G. Not enough vitamin D: health consequences for Canadians. Can. Fam. Phys. 2007;53:841–854.
    1. Jones G. Pharmacokinetics of vitamin D toxicity. Am. J. Clin. Nutr. 2008;88:5825–5865.
    1. Mawer E.B., Hann J.T., Berr J.L., Davies M. Vitamin D metabolism in patients intoxicated with ergocalciferol. Clin. Sci. (Lond.) 1985;68:135–141.
    1. Haddock L., Corcino J., Vazquez M.D. 25 OHD serum level in the normal Puerto Rican population and in subject with tropical sprue and parathyroid disease. Puerto Rico Health Sci. J. 1982;1:85–91.
    1. Krause R., Buhring M., Hopfenmuller W., Holick M.F., Sharma A.M. Ultraviolet B and blood pressure. Lancet. 1998;352:709–710.
    1. Mason R.S., Lissner D., Grunstein H.S., Posen S. A simplified assay for dihydroxylated vitamin D metabolites in human serum: Application to hyper- and hypovitaminosis D. Clin. Chem. 1980;26:444–450.
    1. Gertner J.M., Domenech M. 25-Hydroxyvitamin D levels in patients treated with high-dosage ergo- and cholecalciferol. Clin. Pathol. 1977;30:144–150. doi: 10.1136/jcp.30.2.144.
    1. Counts S.J., Baylink D.J., Shen F.H., Sherrard D.J., Hickman R.O. Vitamin D intoxication in an anephric child. Ann. Intern. Med. 1975;82:196–200. doi: 10.7326/0003-4819-82-2-196.
    1. Streck W.F., Waterhouse C., Haddad J.G. Glucocorticoid effects in vitamin D intoxication. Arch. Intern. Med. 1979;139:974–977. doi: 10.1001/archinte.1979.03630460018009.
    1. Davies M., Adams P.H. The continuing risk of vitamin-D intoxication. Lancet. 1978;2:621–623. doi: 10.1016/S0140-6736(78)92838-6.
    1. Allen S.H., Shah J.H. Calcinosis and metastatic calcification due to vitamin D intoxication. A case report and review. Horm. Res. 1992;37:68–77. doi: 10.1159/000182285.
    1. Rizzoli R., Stoermann C., Ammann P., Bonjour J.P. Hypercalcemia and hyperosteolysis in vitamin D intoxication: Effects of clodronate therapy. Bone. 1994;15:193–198. doi: 10.1016/8756-3282(94)90707-2.
    1. Pettifor J.M., Bikle D.D., Cavaleros M., Zachen D., Kamdar M.C., Ross F.P. Serum levels of free 1,25-dihydroxyvitamin D in vitamin D toxicity. Ann. Intern. Med. 1995;122:511–513. doi: 10.7326/0003-4819-122-7-199504010-00006.
    1. Jacobus C.H., Holick M.F., Shao Q., Chen T.C., Holm I.A., Kolodny J.M., Fuleihan G.E., Seely E.W. Hypervitaminosis D associated with drinking milk. N. Engl. J. Med. 1992;326:1173–1177. doi: 10.1056/NEJM199204303261801.

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