IOM committee members respond to Endocrine Society vitamin D guideline

Abstract

In early 2011, a committee convened by the Institute of Medicine issued a report on the Dietary Reference Intakes for calcium and vitamin D. The Endocrine Society Task Force in July 2011 published a guideline for the evaluation, treatment, and prevention of vitamin D deficiency. Although these reports are intended for different purposes, the disagreements concerning the nature of the available data and the resulting conclusions have caused confusion for clinicians, researchers, and the public. In this commentary, members of the Institute of Medicine committee respond to aspects of The Endocrine Society guideline that are not well supported and in need of reconsideration. These concerns focus on target serum 25-hydroxyvitamin D levels, the definition of vitamin D deficiency, and the question of who constitutes a population at risk vs. the general population.

Fig. 1.

IOM committee integration of optimal bone health outcomes (y-axis) and achieved serum 250HD levels (x-axis) revealing congruence of benefit between 16 and 20 ng/ml. BMD, Bone mineral density. [Reproduced from IOM (Institute of Medicine): Dietary reference intakes for calcium and vitamin D, p 293. Washington DC: The National Academies Press 2011 (2), with permission.]

Fig. 2.

Levels of serum 250HD at which serum PTH plateaus and/or is maximally suppressed, as demonstrated by 59 studies reviewed by Sai et al. (4). Not included are eight studies in which serum PTH continually decreased with increasing serum 25OHD and three studies that found no relationship between serum 250HD and serum PTH. [Reproduced from A. Sai et al.: Relationship between vitamin D, parathyroid hormone, and bone health. J Clin Endocrinol Metab 96:E436–E446, 2011 (4), with permission. ©The Endocrine Society.]

Fig. 3.

Relative risk of falls and mean achieved serum 25OHD concentrations. The IOM committee reanalysis of 2009 metaregression data on falls (8) demonstrates correct metaregressions with continuous predictors showing nonsignificance. [Reproduced from IOM (Institute of Medicine) Dietary reference intakes for calcium and vitamin D, p 161. Washington DC: The National Academies Press (2), with permission.]