Vitamin D

3 imperatives to transform health care in America. You're invited to watch it live

Free

E-newsletter

Subscribe to Housecall

Our weekly general interest
e-newsletter keeps you up to date on a wide variety of health topics.

Sign up now

Evidence

These uses have been tested in humans or animals. Safety and effectiveness have not always been proven. Some of these conditions are potentially serious, and should be evaluated by a qualified healthcare provider.

Familial hypophosphatemia
Familial hypophosphatemia (low blood levels of phosphate in the blood) is a rare inherited disorder that consists of impaired phosphate transport in the blood and diminished vitamin D metabolism in the kidneys. Familial hypophosphatemia is a form of rickets. Taking calcitriol or dihydrotachysterol by mouth along with phosphate supplements is effective for treating bone disorders in people with familial hypophosphatemia. Its management should be under medical supervision. 		A
Fanconi syndrome-related hypophosphatemia
Fanconi syndrome is a defect of the proximal tubules of the kidney and is associated with renal tubular acidosis. Taking ergocalciferol orally is effective for treating hypophosphatemia associated with Fanconi syndrome. 		A
Hyperparathyroidism due to low vitamin D levels
Some patients may develop secondary hyperparathyroidism (overactive parathyroid) due to low levels of vitamin D. The initial treatment for this type of hyperparathyroidism is vitamin D. For patients with primary or refractory hyperparathyroidism, surgical removal of the parathyroid glands is commonly recommended. Studies also suggest that vitamin D supplementation may reduce the incidence of hypoparathyroidism following surgery for primary hyperparathyroidism (partial or total removal of the parathyroid glands). 		A
Hypocalcemia due to hypoparathyroidism
Hypoparathyroidism (low blood levels of parathyroid hormone) is rare and often due to surgical removal of the parathyroid glands. High oral doses of the vitamin D analogs dihydrotachysterol (DHT), calcitriol, or ergocalciferol can assist in increasing serum calcium concentrations in people with hypoparathyroidism or pseudohypoparathyroidism. 		A
Osteomalacia (adult rickets)
Adults with severe vitamin D deficiency lose bone mineral content (this is called "hypomineralization") and experience bone pain, muscle weakness, and osteomalacia (soft bones). Osteomalacia may be found among elderly patients with vitamin D-deficient diets, individuals with decreased absorption of vitamin D, individuals with inadequate sun exposure (such as those living in latitudes with seasonal lack of sunlight), patients with gastric or intestinal surgery, patients with aluminum-induced bone disease, patients with chronic liver disease, or patients with kidney disease with renal osteodystrophy. Treatment for osteomalacia depends on the underlying cause of the disease and often includes pain control and orthopedic surgical intervention, as well as vitamin D and phosphate-binding agents. 		A
Psoriasis (vitamin D analogs)
A number of different approaches are used in the treatment of psoriasis skin plaques. Mild approaches include light therapy, stress reduction, moisturizers, or salicylic acid to remove scaly skin areas. For more severe cases, treatments may include UVA light, psoralen plus UVA light (PUVA), retinoids such as isotretinoin (Accutane), corticosteroids, or cyclosporine (Neoral®, Sandimmune®). The synthetic vitamin D3 analog calcipotriene (Dovonex®) appears to control skin cell growth and is used for moderately severe skin plaques, particularly for skin lesions resistant to other therapies or those located on the face. Vitamin D3 (tacalcitol) ointment has been reported as being safe and well tolerated. High doses of becocalcidiol (a vitamin D analog) used on the skin may be beneficial in the treatment of psoriasis. 		A
Rickets
Rickets (weak bones) develop in children with vitamin D deficiency due to a vitamin D-deficient diet, a lack of sunlight, or both. Infants fed only breast milk (without supplemental vitamin D) may also develop rickets. Although now rare, partially due to the availability of vitamin D-fortified milk, there has been a recent increase in rickets among children in latitudes with periodic, seasonal lack of sunlight. Ergocalciferol or cholecalciferol is effective for treating vitamin D deficiency rickets. Calcitriol should be used in patients with renal (kidney) failure. Treatment should be under medical supervision. 		A
Vitamin D deficiency
Vitamin D deficiency is associated with various diseases, such as bone loss, osteoarthritis, cognitive issues, kidney disease, respiratory concerns, diabetes, gastrointestinal issues, cardiovascular disease, etc. Vitamin D supplementation can help prevent or treat vitamin D deficiency. 		A
Fall prevention
Multiple trials have found positive results for the effects of vitamin D in the prevention of falls, especially in the elderly. More studies are needed to confirm these results and determine populations of interest. 		B
Muscle weakness/pain
Vitamin D deficiency has been associated with muscle weakness and pain in both adults and children. Limited research has reported vitamin D deficiency in patients with low-back pain, and supplementation may reduce pain in many patients. 		B
Osteoporosis (general)
Without sufficient vitamin D, inadequate calcium is absorbed, and this may weaken bones and increase the risk of fracture. Vitamin D supplementation has been shown to slow bone loss and reduce fracture, particularly when taken with calcium. 		B
Renal osteodystrophy
Renal osteodystrophy is a term that refers to all of the bone problems that occur in patients with chronic kidney failure. Oral calcifediol or ergocalciferol may help manage hypocalcemia and prevent renal osteodystrophy in people with chronic renal failure undergoing dialysis. 		B
Anticonvulsant-induced osteomalacia
Supplementation with vitamin D2 has been reported to reduce seizure frequency in initial research. Further research is needed to confirm these results. 		C
Asthma
There is a high prevalence of vitamin D deficiency in individuals with asthma. Experts suggest that vitamin D supplementation in patients with asthma may improve the severity of the disease and improve treatment. However, rigorous studies are needed before a conclusion can be made. 		C
Autoimmune diseases
Vitamin D has been found to have anti-inflammatory and immunomodulating effects, and it may play a role in preventing autoimmune disorders. Further research is needed to confirm these results. 		C
Bone density (pediatric)
Vitamin D improves bone density in children who are vitamin D deficient. However, the data are not clear for healthy children. Further research in healthy children is required. 		C
Bone diseases (kidney disease or kidney transplant)
Vitamin D is of interest for patients with chronic kidney disease. Use of vitamin D analogs has been found to increase bone density in patients with kidney disease. The effect of vitamin D itself is not clear. Vitamin D increases vitamin D status and decreases PTH levels but clinical study is lacking. Further research is required before conclusions can be drawn. 		C
Cancer prevention (breast, colorectal, prostate, other)
Use of vitamin D supplements, alone or in combination with calcium, has been associated with a decreased risk of certain types of cancers. Studies have suggested an inverse association between vitamin D intake (with or without calcium) and colorectal, cervical, breast, and prostate cancers. Overall, there is a lack of consistent evidence to support claims that vitamin D reduces the risk of ovarian or pancreatic cancer occurrence. Also, some research has shown that elevated vitamin D levels or intakes may increase the risk of certain cancers (prostate, breast, pancreatic, and esophageal). Continued evaluation is needed before a clear conclusion can be made. 		C
Cardiovascular disease
Vitamin D is recognized as being important for cardiovascular health, and deficiency of vitamin D is a potential risk factor for several cardiovascular disease processes. Overall, research is not consistent, and further research is required. 		C
Cognition
In older patients, intake of vitamin D is associated with better cognitive test performance. Further research is needed. 		C
Corticosteroid-induced osteoporosis
Some evidence implies that steroids may impair vitamin D metabolism, further contributing to the loss of bone and development of osteoporosis associated with steroid medications. There is limited evidence that vitamin D may be beneficial to bone strength in patients taking long-term steroids. 		C
Fractures (prevention)
Conflicting results have been observed in studies of fracture prevention with vitamin D, with or without calcium. 		C
Fractures (treatment)
Studies have suggested that vitamin D status can decrease following hip fracture. However, there is a lack of evidence in support of vitamin D following fractures. Further research is needed. 		C
Hepatic osteodystrophy (bone disease in patients with liver disease)
Metabolic bone disease is common among patients with chronic liver disease, and osteoporosis accounts for the majority of cases. Varying degrees of calcium malabsorption may occur in patients with chronic liver disease due to malnutrition and vitamin D deficiency. Oral or injected vitamin D may play a role in the management of this condition. 		C
HIV
Although there is a high prevalence of vitamin D deficiency in HIV-positive men, there is lack of strong evidence to support the use of supplementation in this population. Additional research is warranted before a conclusion can be made. 		C
Hyperlipidemia (high levels of fatty acid compounds or cholesterol in the blood)
The effects of vitamin D, alone or in combination with other agents, on lipid parameters have been inconsistent. Further research is needed to evaluate the effects of vitamin D alone or in combination with calcium on lipids before a conclusion can be made. 		C
Hypertension
Low levels of vitamin D may play a role in the development of high blood pressure. It has been noted that blood pressure is often elevated under the following conditions: during the winter season, at a further distance from the equator, and in individuals with dark skin pigmentation (all of which are associated with lower production of vitamin D via sunlight). However, the evidence is not clear, and a comparison with more proven methods to reduce blood pressure has not been conducted. Patients with elevated blood pressure should be managed by a licensed healthcare professional. 		C
Immunomodulation
Preliminary human evidence suggests that vitamin D and its analogs, such as alfacalcidol, may act as immunomodulatory agents (agents that affect the immune system). More studies are needed to confirm these results. 		C
Kidney disease (chronic)
Use of vitamin D analogs has been found to increase bone density in patients with kidney disease. The effect of vitamin D itself is not clear, and vitamin D intake may be associated with increased mortality in hemodialysis patients. Further research is required before conclusions can be drawn. 		C
Mood disorders
Some studies suggest an association between low vitamin D levels in the blood and various mood disorders, including depression, seasonal affective disorder (SAD), and premenstrual syndrome. Also vitamin D supplementation may improve symptoms of depression associated with seasonal affective disorder. Additional research is needed before a conclusion can be made. 		C
Mortality reduction
Intake of vitamin D may be associated with a reduction in total mortality. Additional evidence is needed to confirm this association. 		C
Multiple sclerosis (MS)
Scientists have detected MS rates to be lower in areas with greater sunlight and higher consumption of vitamin D rich fish. Preliminary research suggests that long-term vitamin D supplementation decreases the risk of MS. However, additional research is necessary before a firm conclusion can be reached. 		C
Muscle strength
Evidence is mixed with respect to the effect of vitamin D on strength in the elderly. Further research is required in order to confirm these results. 		C
Myelodysplastic syndrome
Although vitamin D is commonly used by patients with myelodysplastic syndrome, there is insufficient evidence in this area. 		C
Osteogenesis imperfecta (OI)
OI is a genetic disease that consists of unusually fragile bones that break easily, often under loads that normal bones bear daily, due to a malfunction in the body's production of collagen. Proper calcium and vitamin D intake is essential to maintaining strong bones. 		C
Osteoporosis (cystic fibrosis patients)
Osteoporosis is common in patients with cystic fibrosis (due to fat malabsorption, which leads to a deficiency of fat-soluble vitamins such as vitamin D). Oral calcitriol administration appears to increase the absorption of calcium and decrease parathyroid concentrations. 		C
Proximal myopathy
There is insufficient evidence in this area, and further research is needed. 		C
Rickets (hypophosphatemic vitamin D-resistant)
There are insufficient data to support a role for vitamin D in this condition. 		C
Seasonal affective disorder (SAD)
SAD is a form of depression that occurs during the winter months, possibly due to reduced exposure to sunlight. In one study, vitamin D was found to be better than light therapy in the treatment of SAD. Further studies are necessary to confirm these findings. 		C
Senile warts
In early research, senile warts have been treated with topical vitamin D3. 		C
Sexual dysfunction
The evidence in support of vitamin D supplementation for sexual dysfunction is mixed. Additional research is needed before a conclusion can be made. 		C
Skin conditions
Calcipotriol (Dovonex®) is a synthetic vitamin D3 analog with a high affinity for the vitamin D receptor for the active form of 1,24-hydroxyvitamin D3. It is widely used for the treatment of plaque psoriasis. Calcipotriol may also be effective for skin conditions other than psoriasis. 		C
Skin pigmentation disorders (pigmented lesions)
Application of vitamin D3 ointment on the skin, in combination with intense pulsed-radio frequency, may be beneficial in the treatment of pigmented lesions associated with neurofibromatosis 1 (NF1). 		C
Tooth retention
Oral bone and tooth loss are correlated with bone loss at nonoral sites. Research suggests that intake levels of calcium and vitamin D aimed at preventing osteoporosis may have a beneficial effect on tooth retention. 		C
Type 1 diabetes
It has been reported that infants given calcitriol during the first year of life are less likely to develop type 1 diabetes than infants fed lesser amounts of vitamin D. Other related studies have suggested using cod liver oil as a source of vitamin D to reduce the incidence of type 1 diabetes. There is currently insufficient evidence to form a clear conclusion in this area. 		C
Type 2 diabetes
In recent studies, adults given vitamin D supplementation were shown to improve insulin sensitivity. Further research is needed to confirm these results. 		C
Vitamin D deficiency (infants and nursing mothers)
High-quality clinical trial evidence suggests that high doses of supplemental vitamin D provided to breastfeeding mothers may improve the vitamin D status of both mother and child. More research is needed to confirm these findings. 		C
Vitiligo (analogs)
The effectiveness of vitamin D analogs for vitiligo is controversial, and data are limited. Additional research is needed before a conclusion can be made. 		C
Weight gain (postmenopausal)
Vitamin D supplementation (in combination with calcium) may have an effect on postmenopausal weight gain. Evidence suggests that this may be particularly true in women consuming inadequate calcium, and this warrants further research. 		C

Key to grades
A Strong scientific evidence for this use
B Good scientific evidence for this use
C Unclear scientific evidence for this use
D Fair scientific evidence against this use (it may not work)
F Strong scientific evidence against this use (it likely does not work)

Grading rationale

Uses based on tradition or theory

The below uses are based on tradition or scientific theories. They often have not been thoroughly tested in humans, and safety and effectiveness have not always been proven. Some of these conditions are potentially serious, and should be evaluated by a qualified healthcare provider.

Actinic keratosis, ankylosing spondylitis, atopic dermatitis, autism, autoimmune diseases (otosclerosis), bone loss (drug-induced), chemotherapy side effects (aromatase inhibitor-induced bone loss), dementia, ear infections, exercise performance, Graves' disease, hyperparathyroidism in renal dialysis, hypocalcemic tetany, inflammatory bowel disease, kidney transplant-related bone loss, knee osteoarthritis, learning disabilities, metabolic disorders (metabolic syndrome), metabolic syndrome (coronary heart disease), muscle atrophy, nervous system disorders (hemichorea), osteitis fibrosa in dialysis, pain, pre-eclampsia, psoriasis (native vitamin D), respiratory tract infections, rheumatoid arthritis, sarcoidosis, schizophrenia, scleroderma, spinal cord injury, stroke, systemic lupus erythematosus, systemic sclerosis, vaginal disorders (atrophy).

Dosing Related terms
NS_patient-vitamind Portions of this document last updated: Sept. 1, 2012

THIS EVIDENCE-BASED MONOGRAPH WAS PREPARED BY
THE NATURAL STANDARD RESEARCH COLLABORATION
(www.naturalstandard.com)

Advertisement


Text Size: smaller largerlarger