Children, and Adults Who Are Pregnant, Have Prediabetes, or Are Older Than 74 Years, May Benefit From Empiric Vitamin D

Should people without an established indication for vitamin D supplementation receive empiric treatment or undergo testing for vitamin D levels?

There is no need to obtain vitamin D levels. The working group did not find evidence that any specific cutoff is valuable for defining vitamin D deficiency and did not find research to support achieving a specific vitamin D level. There is no demographic group that must receive vitamin D. There are some groups that may benefit from a daily intake of vitamin D through fortified foods or vitamin D supplementation, including children and adolescents, and adults who are pregnant, have impaired glucose tolerance, or are older than 74 years. (Level of Evidence = 5)

The guideline aimed to give guidance regarding the effect of empiric vitamin D supplementation; that is, vitamin D supplementation in people without an identified deficiency and without first checking vitamin D levels to prevent adverse patient outcomes. The authors performed a systematic review, graded the evidence quality, and specified the strength of their recommendations. The working group included content experts, a patient representative, and a methodologist. The working group chairperson and most of the members did not have any conflict of interest. The guidelines do not apply to people with identified vitamin D disorders (eg, rickets) and are relevant to people in developed countries. The group answered 10 questions regarding populations and the role of empiric vitamin D. The important recommendations include:

• Children and adolescents should receive vitamin D from fortified food or daily vitamins to prevent rickets and lower the risk of respiratory infections (low-quality evidence).
• Vitamin D supplementation can be considered without testing during pregnancy to lower the risk of preeclampsia and poor outcomes (low-quality evidence).
• Adults 75 years and older can consider vitamin D supplementation without testing to lower mortality risk (moderate-quality evidence).
• Adults with impaired glucose tolerance but without diabetes (prediabetes) can consider vitamin D supplementation (moderate-quality evidence).
• Adults younger than 74 years who do not fit into other categories do not need vitamin D supplementation or vitamin D testing.

Study design: Practice guideline

Funding source: Self-funded or unfunded

Setting: Various (guideline)

Reference: Demay MB, Pittas AG, Bikle DD, et al. Vitamin D for the prevention of disease: an Endocrine Society clinical practice guideline. J Clin Endocrinol Metab. 2024;109(8):1907-1947.

Editor’s Note: Dr. Shaughnessy is an assistant medical editor for AFP