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Controversies and consensus regarding vitamin D deficiency in 2015: whom to test and whom to treat?

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Controversy persists regarding who should be tested and who should be treated for vitamin D deficiency

Controversy continues to surround vitamin D testing, the diagnosis and clinical significance of vitamin D deficiency, and the benefits — or lack thereof — of vitamin D supplementation. Over 2000 peer-reviewed articles have been published on these topics within the past 12 months, generating much debate and discussion in the scientific literature and lay media.

The role of vitamin D in skeletal and extraskeletal health

Vitamin D has an established and important role in skeletal health through its actions in mediating intestinal calcium absorption and, therefore, its effects on extracellular calcium homeostasis and bone mineralisation. Consequently, severe vitamin D deficiency results in under-mineralisation of bone (osteomalacia in adults, rickets in children) that requires treatment with vitamin D and calcium supplementation. Vitamin D deficiency is also associated with secondary hyperparathyroidism and increased bone turnover, which may contribute to osteoporosis and fracture risk.

Since the publication of a landmark randomised, placebo-controlled trial that showed that vitamin D (cholecalciferol) and calcium supplementation reduced hip and non-vertebral fractures in a group of elderly, vitamin D-deficient women,1 the correction of vitamin D deficiency…