A review in American Family Physician (1 October) summarises the randomised evidence on vitamin D in community-dwelling adults. It finds no support for screening the general population or for supplementing, regardless of the baseline 25-hydroxyvitamin D level.
Trials, including in people with low levels, have not shown lower mortality or better cardiovascular health, and have not consistently reduced falls, fractures, cancer, dementia, respiratory infections or depression, or improved fatigue, hair loss or chronic pain. The recommended intake from the US National Academy of Medicine is 600 IU a day up to age 70 and 800 IU after, achievable through diet, supplements or both. The one possible exception is prediabetes, where at least three years of higher-dose supplementation may slow progression to diabetes.
Vitamin D tests are among the most commonly ordered and least useful in primary care. Stopping routine testing in well adults saves money and avoids treating a number.
- Do not screen asymptomatic adults for vitamin D deficiency
- Do not prescribe high-dose supplements for fatigue, pain, hair loss or low mood
- Advise recommended daily intake: 600 IU to age 70, 800 IU after
- Continue testing and treating where there is a clear indication, such as osteomalacia, malabsorption or bone disease under treatment
- Discuss supplementation in prediabetes as a possible, modest benefit
Why it matters
It removes a common test that changes outcomes for almost no one.
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