The long awaited Institute of Medicine report on "Dietary Reference Intakes for Calcium and Vitamin D" was released November 30th and is available
The long awaited Institute of Medicine report on "Dietary Reference Intakes for Calcium and Vitamin D" was released November 30th and is available at http://www.iom.edu/Reports/2010/Dietary-Reference-Intakes-for-Calcium-and-Vitamin-D.aspx. Key features of the report and implications for clinical practice include: 1. Vitamin D levels: IOM report: A 25-OH vitamin D level of about 20 ng/ml is adequate for bone health. It is not clear if higher levels are of benefit for other medical conditions, since most present studies are based on associations and do not prove causality. A level above 50 ng/ml has the potential for adverse health effects. Based on this report, a 25-OH vitamin D level of between 20 to 50 ng/ml is safe and effective for bone health. AACE recommendation:Since many physicians have used 30 ng/ml as minimum level based on potential non-bone benefits, it would be appropriate to use a range from 30-50 for most patients as an optimal and safe range. 2. Vitamin D supplementation in the general population: IOM report: Established a Recommended Dietary Allowance (RDA) for vitamin D of 600 IU daily between the ages of 9 and 70 and 800 IU for people over age 70. The Tolerable Upper Intake Limit (EL) was set at no more than 4000 IU daily. AACE recommendations: For many patients, 1000-2000 IU of vitamin D daily is required to maintain a 25-OH vitamin D level at 30 ng/ml or above. Since this recommendation is well within the EL of 4000 IU daily, the common use of vitamin D in the 1000-2000 IU daily dosing range would be reasonable. Certain patients may have vitamin D requirements that are significantly higher based on underlying medical conditions (malabsorption, bariatric surgery etc.) and dosing should be determined based on 25-OH vitamin D measurements. 3. Calcium recommendations: IOM report: The RDA for ages 9-13 was set at 1300 mg daily with an upper limit (EL) of 3000 mg for boys and girls. For women between 19 and 50, the RDA was set at 1000 mg daily with an EL of 2500 mg and for women over 50, the RDA was set at 1200 mg with an EL of 2000 mg. No adjustments to the above were recommended in pregnancy. For men between 19 and 70 year old, the RDA was set at 1000 mg with an EL of 2500 up to age 50 and EL of 2000 above age 50 with an RDA of 1200 mg for men over age 70. The risk of kidney stones increases with higher doses of calcium. AACE recommendations: The IOM report recommendations are reasonable based on existing data. The measurement of a 24 hour urine calcium should be strongly considered to determine the calcium balance in any given patient if this will make a difference in patient management. The IOM report will hopefully lead to robust research studies designed to address the important questions of the role of vitamin D in medical conditions other than bone health. For now, it is important to use the recommendations in conjunction with clinical judgment to determine the proper calcium and vitamin D requirements for any given patient.