USA: The US Preventive Services Task Force has released an updated recommendation statement on screening for vitamin D deficiency in adults. The latest recommendations, published in the journal JAMA, are based on a systematic review on screening for vitamin D deficiency, including the benefits and harms of screening and early treatment.
Don't screen asymptomatic adults for vitamin D deficiency, according to the US Task Force.
"The current evidence is insufficient to assess the balance of benefits and harms of screening for vitamin D deficiency in asymptomatic adults," wrote the authors. "In the absence of screening recommendations, clinicians may be best advised to instead focus on diet and supplementation for those considered at risk."
This recommendation applies to community-dwelling, nonpregnant adults who have no signs or symptoms of vitamin D deficiency, such as bone pain or muscle weakness, or conditions for which vitamin D treatment is recommended. This recommendation focuses on screening (ie, testing for vitamin D deficiency in asymptomatic adults and treating those found to have a deficiency), which differs from USPSTF recommendation statements on supplementation.
Vitamin D is a fat-soluble vitamin that performs an important role in bone metabolism and calcium homeostasis and also affects many other cellular regulatory functions outside the skeletal system. Vitamin D requirements vary from individual to individual; thus, no one serum vitamin D level cutpoint defines deficiency, and no consensus exists regarding the precise serum levels of vitamin D that represent optimal health or sufficiency
The USPSTF concludes that 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.
"While gaps remain in the understanding of the value of free 25(OH)D vs total 25(OH)D, the medical and scientific communities should also be thoughtful regarding the balance between investigation and pragmatism," Sherri-Ann M. Burnett-Bowie and Anne R. Cappola wrote in an accompanying editorial.
To that end, future studies of treating vitamin D deficiency should assess the best vitamin D biomarker, have adequate racial and ethnic diversity, and target enrollment by degree of vitamin D deficiency and likelihood of benefit. Until the target populations who would benefit from treatment with vitamin D are established, it is premature to conduct studies evaluating the role of screening for vitamin D deficiency.