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Nutrients 2018, 10(5), 546; https://doi.org/10.3390/nu10050546

Italian Association of Clinical Endocrinologists (AME) and Italian Chapter of the American Association of Clinical Endocrinologists (AACE) Position Statement: Clinical Management of Vitamin D Deficiency in Adults

1
Department of Internal Medicine, “S. M. Goretti” Hospital, 04100 Latina, Italy
2
Endocrinology Service, Galeazzi Institute IRCCS, 20161 Milan, Italy
3
Ospedale Classificato Villa Salus, 30174 Venezia Mestre, Italy
4
General Medicine and Endocrinology, University Hospital, 37126 Verona, Italy
5
Unit for Bone Metabolism Diseases and Diabetes & Lab of Endocrine and Metabolic Research, IRCCS Istituto Auxologico Italiano, 20149 Milan, Italy
6
Department of Clinical Sciences and Community Health, University of Milan, 20149 Milan, Italy
7
Centro Hercolani and Villa Alba (GVM), 40123 Bologna and EndOsMet, Villa Donatello Private Hospital, 50132 Florence, Italy
8
Department of Endocrinology and Metabolic Diseases, Regina Apostolorum Hospital, Albano Laziale, 00041 Rome, Italy
9
Department of Endocrinology and Diabetes, San Giovanni Addolorata Hospital, 00184 Rome, Italy
10
Endocrinology Unit, Department of Medical Science, Ospedale Casa Sollievo della Sofferenza IRCCS, 71013 San Giovanni Rotondo (FG), Italy
11
Endocrinology, Department of Clinical and Molecular Medicine, Sant‘Andrea Hospital, Sapienza University of Rome, 00189 Roma, Italy
12
Interdisciplinary Department of Medicine, Endocrinology and Metabolic Diseases, University of Bari “Aldo Moro”, 70124 Bari, Italy
13
Department of Endocrinology and Diabetes, Santa Maria della Misericordia Hospital, 33010 Udine, Italy
14
Endocrinology Unit, Arcispedale S. Maria Nuova IRCCS, 42123 Reggio Emilia, Italy
Associazione Medici Endocrinologi. In international contexts, it is translated as Italian Association of Clinical Endocrinologists.
*
Author to whom correspondence should be addressed.
Received: 16 January 2018 / Revised: 9 April 2018 / Accepted: 23 April 2018 / Published: 27 April 2018
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Abstract

Vitamin D deficiency is very common and prescriptions of both assay and supplementation are increasing more and more. Health expenditure is exponentially increasing, thus it is timely and appropriate to establish rules. The Italian Association of Clinical Endocrinologists appointed a task force to review literature about vitamin D deficiency in adults. Four topics were identified as worthy for the practicing clinicians. For each topic recommendations based on scientific evidence and clinical practice were issued according to the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) System. (1) What cut-off defines vitamin D deficiency: even though 20 ng/mL (50 nmol/L) can be considered appropriate in the general population, we recommend to maintain levels above 30 ng/mL (75 nmol/L) in categories at risk. (2) Whom, when, and how to perform screening for vitamin D deficiency: categories at risk (patients with bone, liver, kidney diseases, obesity, malabsorption, during pregnancy and lactation, some elderly) but not healthy people should be screened by the 25-hydroxy-vitamin D assay. (3) Whom and how to treat vitamin D deficiency: beyond healthy lifestyle (mostly sun exposure), we recommend oral vitamin D (vitamin D2 or vitamin D3) supplementation in patients treated with bone active drugs and in those with demonstrated deficiency. Dosages, molecules and modalities of administration can be profitably individually tailored. (4) How to monitor the efficacy of treatment with vitamin D: no routine monitoring is suggested during vitamin D treatment due to its large therapeutic index. In particular conditions, 25-hydroxy-vitamin D can be assayed after at least a 6-month treatment. We are confident that this document will help practicing clinicians in their daily clinical practice. View Full-Text
Keywords: Vitamin D; cholecalciferol; ergocalciferol; calcifediol; calcitriol; bone Vitamin D; cholecalciferol; ergocalciferol; calcifediol; calcitriol; bone
This is an open access article distributed under the Creative Commons Attribution License which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. (CC BY 4.0).

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Cesareo, R.; Attanasio, R.; Caputo, M.; Castello, R.; Chiodini, I.; Falchetti, A.; Guglielmi, R.; Papini, E.; Santonati, A.; Scillitani, A.; Toscano, V.; Triggiani, V.; Vescini, F.; Zini, M.; on behalf of AME and Italian AACE Chapter. Italian Association of Clinical Endocrinologists (AME) and Italian Chapter of the American Association of Clinical Endocrinologists (AACE) Position Statement: Clinical Management of Vitamin D Deficiency in Adults. Nutrients 2018, 10, 546.

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