Vitamin D is one of the important factors in skeletal muscle and bone health, and has recently been associated to various metabolic and cardiovascular diseases. There have been studied of an association with vitamin D deficiency and various metabolic disease. However, results of the studies are not concluded. There are no unified recommendations on criteria, measurement, and preventive supplementation for vitamin D deficiency. Recently, the US Preventive Services Task Force in 2021 and the Endocrine Society in 2024 addressed including evaluation, treatment, and prevention for vitamin D deficiency. This review examines the screening and prevention of vitamin D deficiency according to recent guidelines.
비타민D는 칼슘 항상성 및 뼈 대사에 중요한 역할을 하며 골격계 및 외부의 다른 세포 조절 기능에도 영향을 미치는 지용성 비타민 중 하나이다[
대한골대사학회 진료지침에 따르면 비타민D의 혈중 상태를 나타내는 혈청 25 하이드록시 비타민D (25-hydroxyvitamin D, 25[OH]비타민D) 농도가 20 ng/mL 이하면 비타민D 결핍(deficiency), 20-30 ng/mL면 불충분(inadequacy)으로 정의한다[
비타민D의 대사는 대부분 조직에서 발현되는 비타민D 수용체에 의해 매개된다[
골무기질 대사와 관련된 질병 영역에서 비타민D가 부족하면 골무기질화 불충분으로 이어질 수 있으며 소아 구루병, 성인 골연화증을 유발할 수 있고 이차성 부갑상선기능항진증이 발생하며 골손실로 인한 골감소증 또는 골다공증을 발생시킬 수 있다고 알려져 있다[
혈청 총 25(OH)비타민D는 순환 25(OH)D2와 25(OH)D3의 농도의 합으로 계산되며 임상에서 비타민D 상태를 측정하는 가장 좋은 지표로 널리 인정받고 있다[
많은 연구에서 25(OH)비타민D의 혈청 농도와 근골격계, 대사질환, 심혈관질환, 암, 및 감염성 질환 등의 연관성에 대한 연구들이 발표되었으나 25[OH]비타민D 결핍과의 인과관계는 명확하게 밝혀지지 않았다[
가이드라인에서 제안한 당뇨병 전단계와 비만인에서 비타민D 보충에 관한 권고안을 살펴보면 당뇨병 전단계의 성인에게는 생활 습관 개선과 더불어 비타민D 보충제를 경험적을 사용할 것을 제안하였는데 이는 당뇨병 전단계에서 당뇨병으로 진행될 위험을 감소시킬 수 있기 때문이다[
최근 USPSTF에서는 비타민D 결핍 검사의 이점에 대한 전반적인 증거는 부족하고 따라서 무증상 성인의 비타민D 결핍 검사의 이득과 위해의 균형은 결정할 수 없다고 보고하였다. 또한 미국내분비학회 가이드라인에서 건강한 성인에 대해서 저칼슘혈증과 같은 특별한 적응증이 없는 건강한 사람의 경우 25(OH) 비타민D 검사를 일상적인 선별 검사 및 정기적 검사를 하지 않기를 권장한다. 더불어 1-18세, 75세 이상의 성인, 임산부, 당뇨병 전단계에서 경험적 비타민D 보충을 제안하였다. 추후 비타민D 결핍을 측정하는 적절한 지표가 25(OH)비타민D인지를 분석하고 결핍과 부족 등을 평가하는 적절한 수치, 비타민D 보충제의 용량 및 질병의 예방 등에 도움이 될 수 있는 최적의 25(OH)비타민D 수치 등에 대한 연구 등이 필요할 것으로 사료된다.
No potential conflict of interest relevant to this article was reported.
None.
M.H.S. drafted the manuscript, reviewed and revised the manuscript.
None.
Summary of USPSTF assessment: vitamin D deficiency in adults
| Category | Evaluation |
|---|---|
| Assessment and evaluation | Vitamin D requirements vary among individuals |
| No universal threshold for defining vitamin D deficiency using 25(OH)D levels | |
| Total 25(OH)D is considered the best indicator of vitamin D status but is challenging to measure accurately; however, levels are difficult to measure accurately | |
| Evidence suggests that results vary by testing method and between laboratories using the same testing methods | |
| Benefits of early detection, intervention, and treatment | No direct evidence on the benefits of screening for vitamin D deficiency |
| Adequate evidence that treatment of asymptomatic vitamin D deficiency has no benefit on mortality, risk for fractures in persons selected solely on the basis of low vitamin D levels (as opposed to clinical risks such as low bone density), or incidence of type 2 diabetes mellitus | |
| Inadequate evidence on the benefit of treatment of asymptomatic vitamin D deficiency on other outcomes, including falls, cancer, cardiovascular events, depression, infection, or physical functioning | |
| Despite adequate evidence to conclude no benefit for a few health outcomes, evidence on the benefits of treatment of asymptomatic vitamin D deficiency in adults for other health outcomes remains inadequate | |
| The overall evidence on the benefits of treatment of asymptomatic vitamin D deficiency in adults is inadequate | |
| Harms of early detection and treatment (supplementation) | No direct evidence on the harms of screening for vitamin D deficiency |
| Adequate evidence that the harms of treatment of vitamin D deficiency are small to none | |
| USPSTF assessment | The overall evidence on the benefits of screening for vitamin D deficiency is lacking |
| Therefore, the balance of benefits and harms of screening for vitamin D deficiency in asymptomatic adults cannot be determined |
USPSTF, United States Preventive Services Taskforce.
Modified from United States Preventive Services Taskforce el al. [
Summary of the 2024 Endocrine Society for vitamin D for the prevention of disease
| Group | Recommendation |
|---|---|
| Ages 1-18 years | Empiric vitamin D supplementation |
| To prevent nutritional rickets and because of the potential to lower the risk of respiratory tract infections | |
| Ages 19-49 years | No empiric vitamin D supplementation |
| Follow the Institute of Medicine recommended daily allowance | |
| Ages 50-74 years | No empiric vitamin D supplementation |
| Follow the Institute of Medicine recommended daily allowance | |
| Ages over 75 years | Empiric vitamin D supplementation |
| Because of the potential to lower the risk of mortality | |
| Pregnancy | Empiric vitamin D supplementation |
| Because of the potential to lower the risk of preeclampsia, intrauterine mortality, preterm birth, small-for-gestational-age birth, and neonatal mortality | |
| Prediabetes | Empiric vitamin D supplementation |
| Because of the potential to lower the risk of progression to diabetes | |
| The recommended DRI established by the United States Institute of Medicine (currently the National Academy of Medicine) | |
| The recommended daily allowance in the DRI | |
| Ages 1-70, 600 IU (15 µg) | |
| Ages 70 and older, 800 IU (20 µg) | |
| Pregnancy, 600 IU (15 µg) according to American College of Obstetricians and Gynecologists | |
| For people older than 50 years for whom vitamin D treatment is indicated, the panel suggests supplementation via daily administration of vitamin D, rather than intermittent high doses | |
| The panel suggests against routine 25-hydroxyvitamin D testing for generally healthy individuals who do not otherwise have established indications for 25-hydroxyvitamin D testing (e.g., hypocalcemia) | |
| The panel did not specifically address whether and how those who present with low levels of 25-hydroxyvitamin D should be evaluated and/or treated |
DRI, dietary reference intakes.
Modified from Demay et al. [