Vitamin D Deficiency and Related Disorders Workup

1. Hollis BW, Wagner CL. Normal serum vitamin D levels. N Engl J Med. 2005 Feb 3. 352(5):515-6; author reply 515-6. [QxMD MEDLINE Link].

2. Holick MF, Binkley NC, Bischoff-Ferrari HA, et al. Evaluation, Treatment, and Prevention of Vitamin D Deficiency: an Endocrine Society Clinical Practice Guideline. J Clin Endocrinol Metab. 2011 Jun 6. [QxMD MEDLINE Link].

3. Weishaar T, Rajan S, Keller B. Probability of Vitamin D Deficiency by Body Weight and Race/Ethnicity. J Am Board Fam Med. 2016 Mar-Apr. 29 (2):226-32. [QxMD MEDLINE Link]. [Full Text].

4. Haddad JG, Matsuoka LY, Hollis BW, Hu YZ, Wortsman J. Human plasma transport of vitamin D after its endogenous synthesis. J Clin Invest. 1993 Jun. 91(6):2552-5. [QxMD MEDLINE Link]. [Full Text].

5. Holick MF, Chen TC. Vitamin D deficiency: a worldwide problem with health consequences. Am J Clin Nutr. 2008 Apr. 87(4):1080S-6S. [QxMD MEDLINE Link].

6. Tangpricha V, Koutkia P, Rieke SM, et al. Fortification of orange juice with vitamin D: a novel approach for enhancing vitamin D nutritional health. Am J Clin Nutr. 2003 Jun. 77(6):1478-83. [QxMD MEDLINE Link]. [Full Text].

7. Holick MF. Vitamin D deficiency: what a pain it is. Mayo Clin Proc. 2003 Dec. 78(12):1457-9. [QxMD MEDLINE Link].

8. Heaney RP, Dowell MS, Hale CA, et al. Calcium absorption varies within the reference range for serum 25-hydroxyvitamin D. J Am Coll Nutr. 2003 Apr. 22(2):142-6. [QxMD MEDLINE Link]. [Full Text].

9. Armas LA, Hollis BW, Heaney RP. Vitamin D2 is much less effective than vitamin D3 in humans. J Clin Endocrinol Metab. 2004 Nov. 89(11):5387-91. [QxMD MEDLINE Link]. [Full Text].

10. Trang HM, Cole DE, Rubin LA, et al. Evidence that vitamin D3 increases serum 25-hydroxyvitamin D more efficiently than does vitamin D2. Am J Clin Nutr. 1998 Oct. 68(4):854-8. [QxMD MEDLINE Link]. [Full Text].

11. Holick MF, Biancuzzo RM, Chen TC, et al. Vitamin D2 is as effective as vitamin D3 in maintaining circulating concentrations of 25-hydroxyvitamin D. J Clin Endocrinol Metab. 2008 Mar. 93(3):677-81. [QxMD MEDLINE Link].

12. Phillips D. Maternal Vitamin D Status Tied to Long-term Outcomes in Kids. Medscape. 2014 Dec 16. [Full Text].

13. Hart PH, Lucas RM, Walsh JP, Zosky GR, Whitehouse AJ, Zhu K, et al. Vitamin D in Fetal Development: Findings From a Birth Cohort Study. Pediatrics. 2014 Dec 15. [QxMD MEDLINE Link].

14. Kamudoni P, Poole C, Davies SJ. An estimate of the economic burden of vitamin D deficiency in pregnant women in the United Kingdom. Gynecol Endocrinol. 2016 Mar 29. 1-6. [QxMD MEDLINE Link].

15. Bouillon R, Marcocci C, Carmeliet G, et al. Skeletal and extra-skeletal actions of vitamin D: current evidence and outstanding questions. Endocr Rev. 2018 Oct 12. [QxMD MEDLINE Link].

16. Liu BA, Gordon M, Labranche JM, et al. Seasonal prevalence of vitamin D deficiency in institutionalized older adults. J Am Geriatr Soc. 1997 May. 45(5):598-603. [QxMD MEDLINE Link].

17. Tangpricha V, Luo M, Fernández-Estívariz C, et al. Growth hormone favorably affects bone turnover and bone mineral density in patients with short bowel syndrome undergoing intestinal rehabilitation. J Parenter Enteral Nutr. Nov-Dec 2006. 30:480-6. [QxMD MEDLINE Link].

18. Koutkia P, Lu Z, Chen TC, Holick MF. Treatment of vitamin D deficiency due to Crohn's disease with tanning bed ultraviolet B radiation. Gastroenterology. 2001 Dec. 121(6):1485-8. [QxMD MEDLINE Link].

19. Gartner LM, Greer FR. Prevention of rickets and vitamin D deficiency: new guidelines for vitamin D intake. Pediatrics. 2003 Apr. 111(4 Pt 1):908-10. [QxMD MEDLINE Link]. [Full Text].

20. Elliott ME, Binkley NC, Carnes M, et al. Fracture risks for women in long-term care: high prevalence of calcaneal osteoporosis and hypovitaminosis D. Pharmacotherapy. 2003 Jun. 23(6):702-10. [QxMD MEDLINE Link].

21. Thomas MK, Lloyd-Jones DM, Thadhani RI, et al. Hypovitaminosis D in medical inpatients. N Engl J Med. 1998 Mar 19. 338(12):777-83. [QxMD MEDLINE Link]. [Full Text].

22. Tangpricha V, Pearce EN, Chen TC, et al. Vitamin D insufficiency among free-living healthy young adults. Am J Med. 2002 Jun 1. 112(8):659-62. [QxMD MEDLINE Link].

23. Karalius VP, Zinn D, Wu J, et al. Prevalence of risk of deficiency and inadequacy of 25-hydroxyvitamin D in US children: NHANES 2003-2006. J Pediatr Endocrinol Metab. 2014 Mar 12. [QxMD MEDLINE Link].

24. Reuters Staff. Vitamin D levels suboptimal for 1 in 10 US children. Reuters Health Information. April 10, 2014. [Full Text].

25. Shoben AB, Kestenbaum B, Levin G, Hoofnagle AN, Psaty BM, Siscovick DS, et al. Seasonal variation in 25-hydroxyvitamin d concentrations in the cardiovascular health study. Am J Epidemiol. 2011 Dec 15. 174(12):1363-72. [QxMD MEDLINE Link].

26. van der Wielen RP, Löwik MR, van den Berg H, et al. Serum vitamin D concentrations among elderly people in Europe. Lancet. 1995 Jul 22. 346(8969):207-10. [QxMD MEDLINE Link].

27. Gannagé-Yared MH, Chemali R, Yaacoub N, et al. Hypovitaminosis D in a sunny country: relation to lifestyle and bone markers. J Bone Miner Res. 2000 Sep. 15(9):1856-62. [QxMD MEDLINE Link].

28. Looker AC, Gunter EW. Hypovitaminosis D in medical inpatients. N Engl J Med. 1998 Jul 30. 339(5):344-5; author reply 345-6. [QxMD MEDLINE Link].

29. Fuleihan GE, Deeb M. Hypovitaminosis D in a sunny country. N Engl J Med. 1999 Jun 10. 340(23):1840-1. [QxMD MEDLINE Link].

30. Mishal AA. Effects of different dress styles on vitamin D levels in healthy young Jordanian women. Osteoporos Int. 2001. 12(11):931-5. [QxMD MEDLINE Link].

31. Clemens TL, Adams JS, Henderson SL, et al. Increased skin pigment reduces the capacity of skin to synthesise vitamin D3. Lancet. 1982 Jan 9. 1(8263):74-6. [QxMD MEDLINE Link].

32. Harris SS, Soteriades E, Coolidge JA, et al. Vitamin D insufficiency and hyperparathyroidism in a low income, multiracial, elderly population. J Clin Endocrinol Metab. 2000 Nov. 85(11):4125-30. [QxMD MEDLINE Link]. [Full Text].

33. Nesby-O'Dell S, Scanlon KS, Cogswell ME, et al. Hypovitaminosis D prevalence and determinants among African American and white women of reproductive age: third National Health and Nutrition Examination Survey, 1988-1994. Am J Clin Nutr. 2002 Jul. 76(1):187-92. [QxMD MEDLINE Link]. [Full Text].

34. Holick MF. Vitamin D: importance in the prevention of cancers, type 1 diabetes, heart disease, and osteoporosis. Am J Clin Nutr. 2004 Mar. 79(3):362-71. [QxMD MEDLINE Link]. [Full Text].

35. Chapuy MC, Arlot ME, Duboeuf F, et al. Vitamin D3 and calcium to prevent hip fractures in the elderly women. N Engl J Med. 1992 Dec 3. 327(23):1637-42. [QxMD MEDLINE Link].

36. Trivedi DP, Doll R, Khaw KT. Effect of four monthly oral vitamin D3 (cholecalciferol) supplementation on fractures and mortality in men and women living in the community: randomised double blind controlled trial. BMJ. 2003 Mar 1. 326(7387):469. [QxMD MEDLINE Link]. [Full Text].

37. Boonen S, Lips P, Bouillon R, et al. Need for additional calcium to reduce the risk of hip fracture with vitamin d supplementation: evidence from a comparative metaanalysis of randomized controlled trials. J Clin Endocrinol Metab. 2007 Apr. 92(4):1415-23. [QxMD MEDLINE Link]. [Full Text].

38. Bischoff-Ferrari HA, Willett WC, Wong JB, et al. Prevention of nonvertebral fractures with oral vitamin D and dose dependency: a meta-analysis of randomized controlled trials. Arch Intern Med. 2009 Mar 23. 169(6):551-61. [QxMD MEDLINE Link].

39. Heaney RP. Vitamin D depletion and effective calcium absorption. J Bone Miner Res. 2003 Jul. 18(7):1342; author reply 1343. [QxMD MEDLINE Link].

40. Dawson-Hughes B, Harris SS, Krall EA, et al. Effect of calcium and vitamin D supplementation on bone density in men and women 65 years of age or older. N Engl J Med. 1997 Sep 4. 337(10):670-6. [QxMD MEDLINE Link]. [Full Text].

41. Harwood RH, Sahota O, Gaynor K, et al. A randomised, controlled comparison of different calcium and vitamin D supplementation regimens in elderly women after hip fracture: The Nottingham Neck of Femur (NONOF) Study. Age Ageing. 2004 Jan. 33(1):45-51. [QxMD MEDLINE Link]. [Full Text].

42. Bischoff-Ferrari HA, Dietrich T, Orav EJ, et al. Positive association between 25-hydroxy vitamin D levels and bone mineral density: a population-based study of younger and older adults. Am J Med. 2004 May 1. 116(9):634-9. [QxMD MEDLINE Link].

43. Bischoff HA, Stahelin HB, Dick W, et al. Effects of vitamin D and calcium supplementation on falls: a randomized controlled trial. J Bone Miner Res. 2003 Feb. 18(2):343-51. [QxMD MEDLINE Link].

44. Bischoff-Ferrari HA, Dawson-Hughes B, Staehelin HB, et al. Fall prevention with supplemental and active forms of vitamin D: a meta-analysis of randomised controlled trials. BMJ. 2009 Oct 1. 339:b3692. [QxMD MEDLINE Link]. [Full Text].

45. Muir SW, Montero-Odasso M. Effect of vitamin d supplementation on muscle strength, gait and balance in older adults: a systematic review and meta-analysis. J Am Geriatr Soc. 2011 Dec. 59(12):2291-300. [QxMD MEDLINE Link].

46. Lappe JM, Travers-Gustafson D, Davies KM, et al. Vitamin D and calcium supplementation reduces cancer risk: results of a randomized trial. Am J Clin Nutr. 2007 Jun. 85(6):1586-91. [QxMD MEDLINE Link]. [Full Text].

47. Chen TC, Holick MF. Vitamin D and prostate cancer prevention and treatment. Trends Endocrinol Metab. 2003 Nov. 14(9):423-30. [QxMD MEDLINE Link].

48. Garland CF, Comstock GW, Garland FC, et al. Serum 25-hydroxyvitamin D and colon cancer: eight-year prospective study. Lancet. 1989 Nov 18. 2(8673):1176-8. [QxMD MEDLINE Link].

49. Garland CF, Garland FC, Gorham ED. Calcium and vitamin D. Their potential roles in colon and breast cancer prevention. Ann N Y Acad Sci. 1999. 889:107-19. [QxMD MEDLINE Link].

50. Garland FC, Garland CF, Gorham ED, et al. Geographic variation in breast cancer mortality in the United States: a hypothesis involving exposure to solar radiation. Prev Med. 1990 Nov. 19(6):614-22. [QxMD MEDLINE Link].

51. Chen TC, Wang L, Whitlatch LW, et al. Prostatic 25-hydroxyvitamin D-1alpha-hydroxylase and its implication in prostate cancer. J Cell Biochem. 2003 Feb 1. 88(2):315-22. [QxMD MEDLINE Link].

52. Freedman DM, Rajaraman P, Fuhrman B, et al. Sunlight, hormone replacement status and colorectal cancer risk in post-menopausal women. Int J Cancer. 2009 Sep 30. [QxMD MEDLINE Link]. [Full Text].

53. Tangpricha V, Flanagan JN, Whitlatch LW, et al. 25-hydroxyvitamin D-1alpha-hydroxylase in normal and malignant colon tissue. Lancet. 2001 May 26. 357(9269):1673-4. [QxMD MEDLINE Link].

54. Mathieu C, Gysemans C, Giulietti A, et al. Vitamin D and diabetes. Diabetologia. 2005 Jul. 48(7):1247-57. [QxMD MEDLINE Link].

55. Scragg R, Sowers M, Bell C. Serum 25-hydroxyvitamin D, ethnicity, and blood pressure in the Third National Health and Nutrition Examination Survey. Am J Hypertens. 2007 Jul. 20(7):713-9. [QxMD MEDLINE Link].

56. Joergensen C, Hovind P, Schmedes A, Parving HH, Rossing P. Vitamin d levels, microvascular complications, and mortality in type 1 diabetes. Diabetes Care. 2011 May. 34(5):1081-5. [QxMD MEDLINE Link].

57. Li J, Lai H, Yang L, Zhu H, Chen S, Lai S. Age and Gender Differences in the Association between Serum 25-Hydroxyvitamin D and Stroke in the General US Population: The National Health and Nutrition Examination Survey, 2001-2006. J Stroke Cerebrovasc Dis. 2017 Nov. 26 (11):2510-8. [QxMD MEDLINE Link].

58. Busko, M. Lack of Vitamin D Linked to CVD Biomarkers, Inflammation. Medscape. 2014 Feb 27. [Full Text].

59. Laird E, McNulty H, Ward M et al. Vitamin D deficiency is associated with inflammation in older Irish adults. J Clin Endocrinol Metab. February 2014.

60. Lee YH, Bae SC. Vitamin D level in rheumatoid arthritis and its correlation with the disease activity: a meta-analysis. Clin Exp Rheumatol. 2016 Apr 6. [QxMD MEDLINE Link].

61. Autier P, Gandini S. Vitamin D supplementation and total mortality: a meta-analysis of randomized controlled trials. Arch Intern Med. 2007 Sep 10. 167(16):1730-7. [QxMD MEDLINE Link].

62. Correia LC, Sodré F, Garcia G, Sabino M, Brito M, Kalil F, et al. Relation of Severe Deficiency of Vitamin D to Cardiovascular Mortality During Acute Coronary Syndromes. Am J Cardiol. 2012 Nov 20. [QxMD MEDLINE Link].

63. Bjelakovic G, Gluud LL, Nikolova D, et al. Vitamin D supplementation for prevention of mortality in adults. Cochrane Database Syst Rev. 2011 Jul 6. CD007470. [QxMD MEDLINE Link].

64. Manson JE, Cook NR, Lee IM, et al. Vitamin D Supplements and Prevention of Cancer and Cardiovascular Disease. N Engl J Med. 2019 Jan 3. 380 (1):33-44. [QxMD MEDLINE Link]. [Full Text].

65. Busko M. Low vitamin D in COVID-19 predicts ICU admission, poor survival. MDedge. 2020 Sep 18. [Full Text].

66. Jude EB, Ling SF, Allcock R, Yeap BXY, Pappachan JM. Vitamin D Deficiency Is Associated With Higher Hospitalization Risk From COVID-19: A Retrospective Case-control Study. J Clin Endocrinol Metab. 2021 Oct 21. 106 (11):e4708-15. [QxMD MEDLINE Link]. [Full Text].

67. McCall B. Vitamin D Deficiency in COVID-19 Quadrupled Death Rate. Medscape Medical News. 2020 Dec 11. [Full Text].

68. De Smet D, De Smet K, Herroelen P, Gryspeerdt S, Martens GA. Serum 25(OH)D Level on Hospital Admission Associated With COVID-19 Stage and Mortality. Am J Clin Pathol. 2020 Nov 25. [QxMD MEDLINE Link]. [Full Text].

69. Dror AA, Morozov N, Daoud A, et al. Pre-infection 25-hydroxyvitamin D3 levels and association with severity of COVID-19 illness. PLoS One. 2022. 17 (2):e0263069. [QxMD MEDLINE Link]. [Full Text].

70. Jolliffe DA, Holt H, Greenig M, et al. Effect of a test-and-treat approach to vitamin D supplementation on risk of all cause acute respiratory tract infection and covid-19: phase 3 randomised controlled trial (CORONAVIT). BMJ. 2022. 378:e071230. [Full Text].

71. Chapuy MC, Preziosi P, Maamer M, et al. Prevalence of vitamin D insufficiency in an adult normal population. Osteoporos Int. 1997. 7(5):439-43. [QxMD MEDLINE Link].

72. Herrmann M, Farrell CL, Pusceddu I, Fabregat-Cabello N, Cavalier E. Assessment of vitamin D status - a changing landscape. Clin Chem Lab Med. 2016 Jun 30. [QxMD MEDLINE Link]. [Full Text].

73. Nainggolan L. Safe upper limit of vitamin D identified for first time. Medscape Medical News. May 1, 2013. [Full Text].

74. Dror Y, Giveon SM, Hoshen M, Feldhamer I, Balicer RD, Feldman BS. Vitamin d levels for preventing acute coronary syndrome and mortality: evidence of a nonlinear association. J Clin Endocrinol Metab. 2013 May. 98(5):2160-7. [QxMD MEDLINE Link].

75. Bogh MK, Gullstrand J, Svensson A, Ljunggren B, Dorkhan M. Narrowband UVB three times a week more effective in treating vitamin D deficiency than 1600 IU oral vitamin D(3) /day: a randomized clinical trial. Br J Dermatol. 2012 May 25. [QxMD MEDLINE Link].

76. Lu Z, Chen TC, Zhang A, et al. An evaluation of the vitamin D3 content in fish: is the vitamin D content adequate to satisfy the dietary requirement for vitamin D?. J Steroid Biochem Mol Biol. 2007 Mar. 103(3-5):642-4. [QxMD MEDLINE Link].

77. Holick MF, Shao Q, Liu WW, et al. The vitamin D content of fortified milk and infant formula. N Engl J Med. 1992 Apr 30. 326(18):1178-81. [QxMD MEDLINE Link].

78. Fox S. Vitamin D Supplements Found to Vary Widely in Potency. Medscape. 2013 Feb 11. [Full Text].

79. Hollis BW. Short-term and long-term consequences and concerns regarding valid assessment of vitamin D deficiency: comparison of recent food supplementation and clinical guidance reports. Curr Opin Clin Nutr Metab Care. 2011 Nov. 14(6):598-604. [QxMD MEDLINE Link].

80. Brooks M. Proof Lacking for Routine Vitamin D Screening: US Task Force. Medscape Medical News. Jun 24 2014. [Full Text].

81. Perna L, Schöttker B, Holleczek B, Brenner H. Serum 25-hydroxyvitamin D and incidence of fatal and nonfatal cardiovascular events: a prospective study with repeated measurements. J Clin Endocrinol Metab. 2013 Dec. 98(12):4908-15. [QxMD MEDLINE Link].

82. Tucker M. Vitamin D Deficiency Linked to Fatal CVD. Medscape. 2013 Dec 23. [Full Text].

Vin Tangpricha, MD, PhD Professor of Medicine, Division of Endocrinology, Metabolism and Lipids, Emory University School of Medicine

Vin Tangpricha, MD, PhD is a member of the following medical societies: American Association of Clinical Endocrinologists, Endocrine Society

Disclosure: Received grant/research funds from NIH for co-investigator; Received grant/research funds from Cystic Fibrosis for other, Appointed Journal Editor of Endocrine Practice (Elsevier publishers) for: Elsevier.

Romesh Khardori, MD, PhD, FACP (Retired) Professor, Division of Endocrinology, Diabetes and Metabolism, Department of Internal Medicine, Eastern Virginia Medical School

Romesh Khardori, MD, PhD, FACP is a member of the following medical societies: American Association of Clinical Endocrinologists, American College of Physicians, American Diabetes Association, Endocrine Society

Disclosure: Nothing to disclose.

Natasha B Khazai, MD Instructor of Medicine, Division of Endocrinology, Emory University School of Medicine

Natasha B Khazai, MD is a member of the following medical societies: American Association of Clinical Endocrinologists, Endocrine Society

Disclosure: Nothing to disclose.

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Medscape Salary Employment

• Print this section
• Print the entire contents of
• Print the entire contents of article