This American Family Physician review, published on 1 October, brings together the randomised trial evidence on vitamin D for community-dwelling adults.
Its conclusion is direct: there is no evidence to support screening or supplementing the general population, regardless of baseline 25-hydroxyvitamin D level. Trials in the general population, including people with low levels, show no reduction in all-cause mortality or cardiovascular disease, and no consistent benefit for falls, fractures, cancer, dementia, respiratory infection, depression, fatigue, hair loss or chronic pain, nor in pregnancy or menopause. The one possible exception is selected people with prediabetes, in whom three or more years of higher-dose supplementation may reduce progression to diabetes.
The recommended intake — 600 IU daily up to age 70 and 800 IU over 70, from food, sunlight, supplements or a mix — keeps almost everyone above the deficiency threshold of 12 ng/mL.
Vitamin D testing is among the most common investigations in Indian private practice, and low results are frequent and often treated with high-dose regimens. This evidence supports testing only where there is a clinical reason, such as malabsorption, metabolic bone disease or certain medications.
- Avoid ordering vitamin D levels in well adults without a specific clinical indication.
- Do not prescribe vitamin D to treat fatigue, hair loss, chronic pain or low mood on the basis of a low level alone.
- Advise the recommended daily intake (600 IU to age 70, 800 IU after) through diet, sunlight or a modest supplement.
- Keep testing for clear indications such as malabsorption, osteomalacia, chronic kidney disease or anticonvulsant use.
- Explain to patients asking for a test why it is unlikely to change what helps them.
Why it matters
It challenges one of the most common tests in primary care, and the treatments that follow a low result.
Don't overread it
This applies to community-dwelling adults; it does not cover people with malabsorption, bone disease or other specific indications.
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