USPSTF Final Recommendation
Evidence Lacking on Screening for Vitamin D Deficiency
April 22, 2021, 9:35 a.m. News Staff — On April 13, the U.S. Preventive Services Task Force posted a final recommendation statement, final evidence review and evidence summary on screening for vitamin D deficiency in adults.
Based on its review, the task force concluded that the current evidence is insufficient to assess the balance of benefits and harms of screening for vitamin D deficiency in asymptomatic adults. This is an “I” recommendation.
The recommendation applies to community-dwelling, non-pregnant adults who do not have signs or symptoms of vitamin D deficiency or conditions for which vitamin D treatment is recommended. It does not apply to people who are hospitalized or living in institutions such as nursing homes. People who are concerned about their vitamin D level are encouraged to consult with a clinician about their individual health needs.
“We know that vitamin D is an important nutrient for keeping bones healthy and may also have a role in other aspects of good health,” said task force member Michael Silverstein, M.D., M.P.H., in a press release. "However, we need more research on what level of vitamin D people need to stay healthy before we can make a recommendation for or against screening.”
While vitamin D is produced naturally in the body through exposure to sunlight, it can also be obtained through dietary supplements and some foods such as milk, salmon and egg yolks. Vitamin D plays an important role in bone health by promoting calcium absorption; consequently, a lack of vitamin D may contribute to bone diseases such as osteoporosis, osteomalacia or rickets.
Story Highlights
Update of Previous Recommendation
The final recommendation statement updates and is consistent with the task force’s November 2014 statement on the topic, which concluded at that time that there was insufficient evidence to assess the balance of benefits and harms of screening for vitamin D deficiency in asymptomatic adults. The AAFP supported the 2014 recommendation.
To update the recommendation, the task force commissioned a systematic review of the evidence on screening for vitamin D deficiency, including the benefits and harms of screening and early treatment. The review consisted of published studies, trial registries and other sources through March 12, 2020, with additional bibliographies from retrieved articles, outside experts and literature surveillance through Nov. 30, 2020. A total of 46 studies were included in the review, 13 of which were assessed as good quality.
While no studies directly evaluated the benefits of screening for vitamin D deficiency, 27 studies reported on the effectiveness of treatment of vitamin D deficiency for a variety of health outcomes. Among community-dwelling populations, treatment with vitamin D (either with or without calcium) was shown to have no effect on mortality or on the incidence of fractures, falls, cardiovascular disease, diabetes, cancer, depression or adverse events. Evidence for the impact of treatment with vitamin D on physical functioning was mixed, and evidence for the impact of treatment with vitamin D on infection was limited.
The task force also noted several research gaps. Specifically, it stated that more studies are needed to
- determine the cutoff level that defines vitamin D deficiency and whether it varies by clinical outcome or by patient subgroups as defined by race, ethnicity or sex;
- determine the benefits and harms of screening for vitamin D deficiency;
- clarify the impact of vitamin D on some health outcomes for which the current evidence is insufficient or where additional clarity is needed to determine optimal doses and regimens for benefits;
- clarify potential harms from intermittent high-dose regimens; and
- better differentiate the effects of treatment among patient subgroups.
Response to Public Comment
A draft recommendation statement was posted for public comment on the USPSTF website from Sept. 22, 2020 to Oct. 19, 2020.
In response to requests from some commenters that the task force evaluate the evidence on or make a recommendation regarding vitamin D supplementation, the USPSTF clarified that this recommendation focuses on screening for vitamin D deficiency.
The task force also noted that it has issued several recommendation statements that address supplementation with vitamin D for other conditions, including prevention of fractures in community-dwelling adults, prevention of cancer and cardiovascular disease and prevention of falls in older adults.
In response to other comments, the USPSTF clarified that this recommendation applies to asymptomatic, community-dwelling adults. It does not apply to those in institutional or hospital settings who may have underlying or intercurrent conditions that warrant vitamin D testing or treatment.
Finally, the USPSTF clarified that it did not review any of the emerging evidence regarding vitamin D and COVID-19.
Up Next
The AAFP’s Commission on Health of the Public and Science plans to review the task force’s final recommendation statement, final evidence review and evidence summary, and will then determine the Academy’s stance on the recommendation.