They may have a family member with osteoporosis, or perhaps they have had bone thinning themselves. Vitamin D is critical for healthy bones. But when we check that blood level, how to act on the result is the subject of great controversy in medical-research land.
So, what is the current cutoff value at which people are considered "low," and thus at risk for developing bone thinning and having fractures? We are talking about the blood level of hydroxy-vitamin D, which is usually measured in nanograms per milliliter.
This is where there is a lot of argument. In , the venerable Institute of Medicine IOM issued a report based on lengthy examination of data by a group of experts. In my practice, and in most, it is not uncommon to see a vitamin D level less than When that happens, we tell the patient that they are deficient and recommend fairly aggressive replenishment, as well as ongoing supplementation.
But in , the respected Endocrine Society issued a report urging a much, much higher minimum blood level of vitamin D. In this piece, several of the leading epidemiologists and endocrinologists who were on the original IOM committee argue for a lowering of the currently accepted cutoff level of 20, stating that the level they estimated as acceptable was never intended to be used to define vitamin D deficiency. They feel that we are over-screening for vitamin D deficiency, and unnecessarily treating individuals who are perfectly fine.
One study found that young people in Hawaii were low, even with considerable sun exposure. Remember, there are a number of factors in our ability to metabolize vitamin D including skin pigmentation and genetic makeup.
Vitamin D levels affect a number of aspects of our health. Age factors and body mass index, race, skin color, geo-local factors, all influence the vitamin D levels. If a doctor orders the serum dihydroxy vitamin D, you could end up being told that you have normal values when in reality you are severely deficient. You may think that the doctors know best. In my experience, unless a doctor is an expert in a particular discipline, they may not know the best practices.
Numerous times I have spoken up when doctors were making decisions based on labs that were inappropriate. For instance, in the bloodless medicine field, doctors will often use the serum iron levels. Although the serum iron can be high, the TIBC can be normal or low. Most considered the most potent form of vitamin D. It stimulates calcium absorption our the small intestine and bones along with PTH and increases reabsorption of calcium by the kidneys.
The level of serum 1,dihydroxy-vitamin D is not typically used to know vitamin D status. It has a short half-life of only 15 hours. It is regulated by parathyroid hormone, calcium, and phosphate. It means that your result is normal within the testing population, but if you are at the lower end of the range it may not be sufficient for optimal vitamin D status. Whatever your number and health status, work with your provider to achieve the optimal level for you, through supplementation, nutrition, or getting more sun exposure.
Your choice! When in doubt, give our ZRT Clinical Consultants a call and they can help walk you through the ever-evolving and sometimes conflicting data regarding ideal vitamin D levels. Call us at Twitter Facebook LinkedIn Instagram. Reference Range The reference range, a term often used in conjunction with laboratory testing, is a set of values that include the upper and lower limits of a lab test based on a group of otherwise healthy individuals.
Categories: Vitamin D. Please enable JavaScript to view the comments powered by Disqus. Alison McAllister Dr. Allison Smith Dr. Beth Baldwin Dr. David Zava Dr.
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