Vitamin D deficiency: time for actionBMJ 1998; 317 doi: https://doi.org/10.1136/bmj.317.7171.1466 (Published 28 November 1998) Cite this as: BMJ 1998;317:1466
Evidence supports routine supplementation for elderly people and others at risk
- J E Compston, University lecturer and honorary consultant physician.
- Department of Medicine, Addenbrooke's Hospital, Cambridge CB2 2QQ
Vitamin D is both a vitamin and a hormone and has diverse actions. The major biologically active metabolite, 1,25-dihydroxyvitamin D, plays a central part in maintaining calcium and phosphate homoeostasis and also has antiproliferative, prodifferentiation, and immunosuppressive effects; its receptors are distributed in various tissues, including bone, pancreas, stomach, gonads, brain, skin, and breast.1 Vitamin D is essential for skeletal health, and severe deficiency is associated with defective mineralisation resulting in rickets or its adult equivalent, osteomalacia. More subtle degrees of insufficiency lead to secondary hyperparathyroidism and increased bone turnover, which play an important part in age related bone loss and osteoporotic fractures.
Over recent decades a wealth of evidence has accumulated documenting vitamin D deficiency in elderly populations in Europe and elsewhere. 2 3 A recent study from the United States has added further evidence that vitamin D deficiency continues to be neglected and also raised questions about how best to combat it.4
Vitamin D status is most commonly assessed by measuring serum concentrations of 25-hydroxyvitamin D (25-OHD), the major circulating form of …