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[Review of the concept of vitamin D "sufficiency and insufficiency"].
Nefrologia. 2003; 23 Suppl 2:73-7.N

Abstract

There has been a poor consensus in defining normal levels of 25(OH) D. It has been traditionally recognized that 25(OH)D serum levels below 5-7 ng/ml induce osteomalacia, serum levels below 10-12 ng/ml induce secondary hyperparathyroidism and osteoporosis, and serum levels above 18-20 ng/ml are usually considered normal or adequate. Due to the results obtained in several studies, a more functional classification has recently been proposed defining serum 25(OH)D levels > 40 ng/ml or > 100 nmol/l as "desirable", serum levels between 20 and 40 ng/ml or 50 and 100 nmol/l as hypovitaminosis D, levels between 10 and 20 ng/ml or 25 and 50 mmol/l as vitamin D insufficiency and 25(OH)D levels below 10 ng/ml or 25 nmol/l as deficient. These new cut-off levels, suggest that, in the past, we had been using a wrong statistical approach for defining "normal serum 25(OH)D levels". In agreement with this new classification, in a recent study conducted in a random sample of our population, a high prevalence of low levels of 25(OH)D and secondary hyperparathyroidism was found. In our study, only in those people having "excellent" renal function, representing only 15% of the sample (serum creatinine < 1 mg/dl in men and < 0.8 in women, mean age of 68 years) hyperparathyroidism was not diagnosed despite observing 25(OH)D serum levels around 18-30 ng/ml or 45-75 nmol/l). In the remaining people (85% of the sample), who showed the expected serum creatinine increments according to their age, secondary hyperparathyroidism was avoided only if the serum 25(OH)D levels were higher than 30 ng/ml or 75 nmol/l. These remarkable findings demonstrate the importance of maintaining higher 25(OH)D levels--in addition to normal calcitriol levels--in order to avoid stimulation of the parathyroid gland. In 87 patients with a functioning renal transplantation only a 11.5% of they had levels of 25(OH)D higher than 30 ng/ml and it was correlated with PTH. These remarkable findings demonstrate the importance of maintaining higher 25(OH)D levels--in addition to normal calcitriol levels--in order to avoid stimulation of the parathyroid gland in aged people. Thus, the deficiency or even "subtle deficiency" of 25(OH)D, currently neglected in the daily management of patients with chronic renal failure, may play an important role in the maintenance of hormonal and mineral homeostasis.

Authors+Show Affiliations

Gómez Alonso C
Servicio de Metabolismo Oseo y Mineral, Instituto Reina Sofía de Investigación, Hospital Universitario Central de Asturias, Universidad de Oviedo, Oviedo. cgomez@hca.es
Naves Díaz M
No affiliation info available
Rodríguez García M
No affiliation info available
Fernández Martín JL
No affiliation info available
Cannata Andía JB
No affiliation info available

MeSH

AgedAged, 80 and overCalcifediolCalcitriolCreatinineFemaleHumansHyperparathyroidism, SecondaryMaleMiddle AgedNutritional RequirementsOsmolar ConcentrationOsteomalaciaOsteoporosisParathyroid HormonePrevalenceRandom AllocationReference ValuesSampling StudiesSpainVitamin DVitamin D Deficiency

Pub Type(s)

English Abstract
Journal Article
Research Support, Non-U.S. Gov't
Review

Language

spa

PubMed ID

12778859

Citation

Gómez Alonso, C, et al. "[Review of the Concept of Vitamin D "sufficiency and Insufficiency"]." Nefrologia : Publicacion Oficial De La Sociedad Espanola Nefrologia, vol. 23 Suppl 2, 2003, pp. 73-7.
Gómez Alonso C, Naves Díaz M, Rodríguez García M, et al. [Review of the concept of vitamin D "sufficiency and insufficiency"]. Nefrologia. 2003;23 Suppl 2:73-7.
Gómez Alonso, C., Naves Díaz, M., Rodríguez García, M., Fernández Martín, J. L., & Cannata Andía, J. B. (2003). [Review of the concept of vitamin D "sufficiency and insufficiency"]. Nefrologia : Publicacion Oficial De La Sociedad Espanola Nefrologia, 23 Suppl 2, 73-7.
Gómez Alonso C, et al. [Review of the Concept of Vitamin D "sufficiency and Insufficiency"]. Nefrologia. 2003;23 Suppl 2:73-7. PubMed PMID: 12778859.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - [Review of the concept of vitamin D "sufficiency and insufficiency"]. AU - Gómez Alonso,C, AU - Naves Díaz,M, AU - Rodríguez García,M, AU - Fernández Martín,J L, AU - Cannata Andía,J B, PY - 2003/6/5/pubmed PY - 2003/7/31/medline PY - 2003/6/5/entrez SP - 73 EP - 7 JF - Nefrologia : publicacion oficial de la Sociedad Espanola Nefrologia JO - Nefrologia VL - 23 Suppl 2 N2 - There has been a poor consensus in defining normal levels of 25(OH) D. It has been traditionally recognized that 25(OH)D serum levels below 5-7 ng/ml induce osteomalacia, serum levels below 10-12 ng/ml induce secondary hyperparathyroidism and osteoporosis, and serum levels above 18-20 ng/ml are usually considered normal or adequate. Due to the results obtained in several studies, a more functional classification has recently been proposed defining serum 25(OH)D levels > 40 ng/ml or > 100 nmol/l as "desirable", serum levels between 20 and 40 ng/ml or 50 and 100 nmol/l as hypovitaminosis D, levels between 10 and 20 ng/ml or 25 and 50 mmol/l as vitamin D insufficiency and 25(OH)D levels below 10 ng/ml or 25 nmol/l as deficient. These new cut-off levels, suggest that, in the past, we had been using a wrong statistical approach for defining "normal serum 25(OH)D levels". In agreement with this new classification, in a recent study conducted in a random sample of our population, a high prevalence of low levels of 25(OH)D and secondary hyperparathyroidism was found. In our study, only in those people having "excellent" renal function, representing only 15% of the sample (serum creatinine < 1 mg/dl in men and < 0.8 in women, mean age of 68 years) hyperparathyroidism was not diagnosed despite observing 25(OH)D serum levels around 18-30 ng/ml or 45-75 nmol/l). In the remaining people (85% of the sample), who showed the expected serum creatinine increments according to their age, secondary hyperparathyroidism was avoided only if the serum 25(OH)D levels were higher than 30 ng/ml or 75 nmol/l. These remarkable findings demonstrate the importance of maintaining higher 25(OH)D levels--in addition to normal calcitriol levels--in order to avoid stimulation of the parathyroid gland. In 87 patients with a functioning renal transplantation only a 11.5% of they had levels of 25(OH)D higher than 30 ng/ml and it was correlated with PTH. These remarkable findings demonstrate the importance of maintaining higher 25(OH)D levels--in addition to normal calcitriol levels--in order to avoid stimulation of the parathyroid gland in aged people. Thus, the deficiency or even "subtle deficiency" of 25(OH)D, currently neglected in the daily management of patients with chronic renal failure, may play an important role in the maintenance of hormonal and mineral homeostasis. SN - 0211-6995 UR - https://www.unboundmedicine.com/medline/citation/12778859/[Review_of_the_concept_of_vitamin_D_"sufficiency_and_insufficiency"]_ DB - PRIME DP - Unbound Medicine ER -