JAMA PATIENT PAGE Screening for Vitamin D Deficiency in Adults

The US Preventive Services Task Force (USPSTF) has recently published recommendations on screening for vitamin D deficiency in adults. What Is Vitamin D Deficiency? Screening for Vitamin D Deficiency in Adults Vitamin D is a fat-soluble vitamin that plays an important role in cal- cium regulation and bone health. Very few foods naturally contain Vitamin D is important for calcium regulation and bone health. vitamin D, although in the US many foods are fortified with vitamin However, it is not known whether screening for vitamin D deficiency leads to improved health outcomes. D (such as milk, formula, and cereals). Most of the vitamin D the hu- man body uses is made by the skin as a result of exposure to sun- light. After that, vitamin D is processed by the liver and kidney to Population be useful to the bones. Nonpregnant adults who do not have any signs or symptoms of vitamin D deficiency Vitamin D deficiency results when a person does not get enough vitamin D from the skin (via sun exposure) or food or their liver and/or kidney has problems processing it. Every person has a different level USPSTF recommendation of need for vitamin D, so an exact level of deficiency is difficult to The USPSTF concludes that the current evidence define. Significant vitamin D deficiency can result in bone prob- is insufficient to assess the balance of benefits Statement and harms of screening for vitamin D deficiency lems for both children (rickets, osteomalacia) and adults (osteoma- in asymptomatic adults. lacia, osteoporosis). Many studies have suggested links between vi- tamin D deficiency and a variety of health concerns including depression, falls, fractures, diabetes, heart disease, cancer, and in- fection; however, many of these links are inconclusive. vitaminDdeficiencybecauseofvariabilityincutoffvaluesandamong different tests. Another rare potential harm of screening is over- What Test Is Used to Screen for Vitamin D Deficiency? treatment with high-dose vitamin D supplements, which can lead Screening for vitamin D is done through a blood test. Measuring a to vitamin D toxicity. person’s level of total 25-hydroxyvitamin D is currently considered the best indicator of vitamin D status. How Strong Is the Recommendation to Screen for Vitamin D Deficiency? What Is the Population Under Consideration for Screening Given current evidence, the USPSTF concludes that overall for Vitamin D Deficiency? evidence on the benefits of screening for vitamin D deficiency This recommendation applies to nonpregnant adults who do not is lacking. Therefore, the balance of benefits and harms of screen- have any signs or symptoms of vitamin D deficiency. ing for vitamin D deficiency in asymptomatic adults cannot be determined. What Are the Potential Benefits and Harms of Screening for Vitamin D Deficiency? FOR MORE INFORMATION The goal of screening for vitamin D deficiency is to identify and treat US Preventive Services Task Force it before adverse clinical outcomes occur. However, there is cur- https://www.uspreventiveservicestaskforce.org/uspstf/topic_ rently not enough evidence to say whether screening for and treat- search_results?topic_status=P ing asymptomatic vitamin D deficiency improves any of the health

problems described above. To find this and other JAMA Patient Pages, go to the Patient Part of the challenge in interpreting studies is the variable defi- Information collection at jamanetworkpatientpages.com. nition of vitamin D deficiency.Screening may misclassify people with

Author: Jill Jin, MD, MPH The JAMA Patient Page is a public service of JAMA. The information and Author Affiliation: Associate Editor, JAMA. recommendations appearing on this page are appropriate in most instances, but they are not a substitute for medical diagnosis. For specific information concerning your Conflict of Interest Disclosures: None reported. personal medical condition, JAMA suggests that you consult your physician. This page may be photocopied noncommercially by physicians and other health care professionals to share with patients. To purchase bulk reprints, email reprints@ jamanetwork.com.

1480 JAMA April 13, 2021 Volume 325, Number 14 (Reprinted) jama.com

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