The question, whether for routine screening for vitamin D deficiency or recommend vitamin D supplementation in high doses to patients, continues to be one of the themes of the più disconcerting in clinical practice, and many physicians are looking for guidance on these issues.
there Seems to be a disconnect growing between the observational studies and the randomized clinical trials of vitamin D.
For example, observational studies show a relationship fairly consistent between low blood levels of vitamin D and an increased risk of heart disease, cancer, diabetes, and many other chronic diseases.
However, the randomized clinical trials of vitamin D supplementation, to date, have been generally disappointing. This means that when we administer the Vitamin D, these diseases are the same way.
There are recent studies, including an analysis of the più studies regarding the supplementation of vitamin D, which show the minimum, perhaps, benefit in terms of reduction of the blood pressure.
another study on the supplementation of vitamin D in high doses that does not detect any obvious benefit for the muscle strength, densityà bone mineral, or even the risk of falls.
A more recent study, published in the New England Journal of Medicine, on vitamin D supplementation with and without calcium, which does not detect any obvious benefit in reducing the risk of adenoma, colorectal.
The Institute of Medicine (IOM) and the Preventive Services Task Force, us do not approve of the universal screening routine for the deficiency of vitamin D. It also recommended the recruitment of quantityà più light.
For example, the IOM recommends 600 to 800 IU per day for adults and is also recommended to avoid daily doses above 4000 IU, as the level of intake the maximum tolerable.
However, it is important to keep in mind that these are the guidelines for a population is generally healthy, and in no way exclude a personal assessment of the doctor to a patient who may have health conditions or risk factors that would indicate a benefit from the screening targeted to vitamin D deficiency, supplementation with high dosage.
For example, some patients may have required the più high in vitamin D. This può to include patients with health problems of the bones ” (osteoporosis, osteomalacia), or poor diets, those who spend insufficient time outdoors, those with syndromes, malabsorption, or those who take drugs that may interfere with vitamin D metabolism (glucocorticoids, anticonvulsant drugs and anti-tb drugs ), women who, for religious reasons, or costume to keep the skin covered.
So, overall, there is a role for a decision-making process adjusted to the individual, in terms of assessment for vitamin D deficiency in patients who have bone problems or health risk factors, details, and also treatment with doses of the più high levels of vitamin D, which can go above 4000 IU per day in patients who have higher requirements.
In the next few years, will be completed large-scale studies on vitamin D supplementation, even at high doses, and these results will be published. They will help to inform the decision-making process in the clinical setting.
No advantage with the administration of high doses of vitamin D in postmenopausal women
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12 novembre 2015