Andrea Giustina1, Robert A Adler2, Neil Binkley3, Roger Bouillon4, Peter R Ebeling5, Marise Lazaretti-Castro6, Claudio Marcocci7, Rene Rizzoli8, Christopher T Sempos9, John P Bilezikian10. 1. Endocrinology and Metabolism, Vita-Salute San Raffaele University, Milano, Italy. 2. McGuire Veterans Affairs Medical Center and Virginia Commonwealth University School of Medicine, Richmond, Virginia. 3. Osteoporosis Clinical Research Program and Institute on Aging, University of Wisconsin-Madison, Madison, Wisconsin. 4. Department of Chronic Diseases, Metabolism and Ageing, Laboratory of Clinical and Experimental Endocrinology, Katholieke Universiteit Leuven, Leuven, Belgium. 5. Department of Medicine, School of Clinical Sciences, Monash University, Clayton, Victoria, Australia. 6. Division of Endocrinology, Escola Paulista de Medicina, Universidade Federal de Sao Paulo, Sao Paulo, Brazil. 7. Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy. 8. Division of Bone Diseases, Geneva University Hospitals and Faculty of Medicine, Geneva, Switzerland. 9. Department of Population Health Sciences, University of Wisconsin-Madison, Madison, Wisconsin. 10. Endocrinology Division, Department of Medicine, College of Physicians and Surgeons, Columbia University, New York, New York.
Abstract
Context: Vitamin D is classically recognized as a regulator of calcium and phosphorus metabolism. Recent advances in the measurement of vitamin D metabolites, diagnosis of vitamin D deficiency, and clinical observations have led to an appreciation that along with its role in skeletal metabolism, vitamin D may well have an important role in nonclassical settings. Measurement of the circulating form of vitamin D that best describes total body stores, namely 25-hydroxyvitamin D, can be unreliable despite many sophisticated methodologies that have been proposed and implemented. Likewise, evidence from clinical studies showing a beneficial role of vitamin D in different disease states has been controversial and at times speculative. Moreover, the target concentrations of 25-hydroxyvitamin D to address a number of putative links between vitamin D inadequacy and nonskeletal diseases are further areas of uncertainty. Setting: To address these issues, an international conference on "Controversies in Vitamin D" was held in Pisa, Italy, in June 2017. Three main topics were addressed: (i) vitamin D assays and the definition of hypovitaminosis D; (ii) skeletal and extraskeletal effects of vitamin D; (iii) therapeutics of vitamin D. Results: This report provides a summary of the deliberations of the expert panels of the conference. Conclusions: Despite great advances in our appreciation of vitamin D metabolism, measurements, biological actions on classical and nonclassical tissues, and therapeutics, all of which this report summarizes, much more work remains to be done so that our knowledge base can become even more secure.
Context:Vitamin D is classically recognized as a regulator of calcium and phosphorus metabolism. Recent advances in the measurement of vitamin D metabolites, diagnosis of vitamin D deficiency, and clinical observations have led to an appreciation that along with its role in skeletal metabolism, vitamin D may well have an important role in nonclassical settings. Measurement of the circulating form of vitamin D that best describes total body stores, namely 25-hydroxyvitamin D, can be unreliable despite many sophisticated methodologies that have been proposed and implemented. Likewise, evidence from clinical studies showing a beneficial role of vitamin D in different disease states has been controversial and at times speculative. Moreover, the target concentrations of 25-hydroxyvitamin D to address a number of putative links between vitamin D inadequacy and nonskeletal diseases are further areas of uncertainty. Setting: To address these issues, an international conference on "Controversies in Vitamin D" was held in Pisa, Italy, in June 2017. Three main topics were addressed: (i) vitamin D assays and the definition of hypovitaminosis D; (ii) skeletal and extraskeletal effects of vitamin D; (iii) therapeutics of vitamin D. Results: This report provides a summary of the deliberations of the expert panels of the conference. Conclusions: Despite great advances in our appreciation of vitamin D metabolism, measurements, biological actions on classical and nonclassical tissues, and therapeutics, all of which this report summarizes, much more work remains to be done so that our knowledge base can become even more secure.
Authors: Heike Luttmann-Gibson; Samia Mora; Carlos A Camargo; Nancy R Cook; Olga V Demler; Amit Ghoshal; Jay Wohlgemuth; Kris Kulkarni; Julia Larsen; James Prentice; Michael Cobble; Vadim Bubes; Chunying Li; Georgina Friedenberg; I-Min Lee; Julie E Buring; JoAnn E Manson Journal: Contemp Clin Trials Date: 2019-10-24 Impact factor: 2.226