Once foods in the United States were fortified with vitamin D, rickets appeared to have been conquered, and many considered major health problems from vitamin D deficiency resolved. But vitamin D deficiency is common. This review considers the role of vitamin D in skeletal and nonskeletal health and suggests strategies for the prevention and treatment of vitamin D deficiency.

Vitamin D Deficiency

XI. STRATEGIES FOR IMPROVING DIABETES CARE D iabetes is a chronic illness that requires continuing medical care and patient self-management education to prevent acute complications and to reduce the risk of long-term complications. Diabetes care is complex and requires that many issues, beyond glycemic control, be addressed. A large body of evidence exists that supports a range of interventions to improve diabetes outcomes. These standards of care are intended to provide clinicians, patients, researchers, payors, and other interested individuals with the components of diabetes care, treatment goals, and tools to evaluate the quality of care. While individual preferences, comorbidities, and other patient factors may require modification of goals, targets that are desirable for most patients with diabetes are provided. These standards are not intended to preclude more extensive evaluation and management of the patient by other specialists as needed. For more detailed information, refer to Bode (Ed.): Medical Management of Type 1 Diabetes (1), Burant (Ed): Medical Management of Type 2 Diabetes (2), and Klingensmith (Ed): Intensive Diabetes Management (3). The recommendations included are diagnostic and therapeutic actions that are known or believed to favorably affect health outcomes of patients with diabetes. A grading system (Table 1), developed by the American Diabetes Association (ADA) and modeled after existing methods, was utilized to clarify and codify the evidence that forms the basis for the recommendations. The level of evidence that supports each recommendation is listed after each recommendation using the letters A, B, C, or E.

Standards of Medical Care in Diabetes

The 11th edition of Harrison's Principles of Internal Medicine welcomes Anthony Fauci to its editorial staff, in addition to more than 85 new contributors. While the organization of the book is similar to previous editions, major emphasis has been placed on disorders that affect multiple organ systems. Important advances in genetics, immunology, and oncology are emphasized. Many chapters of the book have been rewritten and describe major advances in internal medicine. Subjects that received only a paragraph or two of attention in previous editions are now covered in entire chapters. Among the chapters that have been extensively revised are the chapters on infections in the compromised host, on skin rashes in infections, on many of the viral infections, including cytomegalovirus and Epstein-Barr virus, on sexually transmitted diseases, on diabetes mellitus, on disorders of bone and mineral metabolism, and on lymphadenopathy and splenomegaly. The major revisions in these chapters and many

Harrison's Principles of Internal Medicine

Objective: The objective was to provide guidelines to clinicians for the evaluation, treatment, and prevention of vitamin D deficiency with an emphasis on the care of patients who are at risk for deficiency. Participants: The Task Force was composed of a Chair, six additional experts, and a methodologist. The Task Force received no corporate funding or remuneration. Consensus Process: Consensus was guided by systematic reviews of evidence and discussions during several conference calls and e-mail communications. The draft prepared by the Task Force was reviewed successively by The Endocrine Society's Clinical Guidelines Subcommittee, Clinical Affairs Core Committee, and cosponsoring associations, and it was posted on The Endocrine Society web site for member review. At each stage of review, the Task Force received written comments and incorporated needed changes. Conclusions: Considering that vitamin D deficiency is very common in all age groups and that few foods contain vitamin D, the Task Force recomme...

/pdf/evaluation-treatment-and-prevention-of-vitamin-d-deficiency-4wt9apc7iy.pdf

Evaluation, Treatment, and Prevention of Vitamin D Deficiency: an Endocrine Society Clinical Practice Guideline

OBJECTIVE\nThe objective was to provide guidelines to clinicians for the evaluation, treatment, and prevention of vitamin D deficiency with an emphasis on the care of patients who are at risk for deficiency.\n\n\nPARTICIPANTS\nThe Task Force was composed of a Chair, six additional experts, and a methodologist. The Task Force received no corporate funding or remuneration.\n\n\nCONSENSUS PROCESS\nConsensus was guided by systematic reviews of evidence and discussions during several conference calls and e-mail communications. The draft prepared by the Task Force was reviewed successively by The Endocrine Society's Clinical Guidelines Subcommittee, Clinical Affairs Core Committee, and cosponsoring associations, and it was posted on The Endocrine Society web site for member review. At each stage of review, the Task Force received written comments and incorporated needed changes.\n\n\nCONCLUSIONS\nConsidering that vitamin D deficiency is very common in all age groups and that few foods contain vitamin D, the Task Force recommended supplementation at suggested daily intake and tolerable upper limit levels, depending on age and clinical circumstances. The Task Force also suggested the measurement of serum 25-hydroxyvitamin D level by a reliable assay as the initial diagnostic test in patients at risk for deficiency. Treatment with either vitamin D(2) or vitamin D(3) was recommended for deficient patients. At the present time, there is not sufficient evidence to recommend screening individuals who are not at risk for deficiency or to prescribe vitamin D to attain the noncalcemic benefit for cardiovascular protection.

Evaluation, treatment, and prevention of vitamin D deficiency: An endocrine society clinical practice guideline (Journal of Clinical Endocrinology and Metabolism (2011) 96, (1911-1930))

Issues facing bone densitometry in the new century: reflections from the National Institutes of Health Consensus Development Conference on Osteoporosis.

The Institute of Medicine (IOM) criticised inconsistencies and misrepresentations of data in the meta-analysis of vitamin D and fall prevention by Bischoff-Ferrari and colleagues.1 2 The authors replied to the IOM,3 and we respond to them as members of the IOM committee.

In assessing the dose-response relation between vitamin D dose, serum 25-hydroxyvitamin D concentration, and risk of a fall the authors opted to compare subgroups of studies above or below a cut off point of vitamin D dose and serum 25 hydroxyvitamin …

https://www.bmj.com/content/bmj/342/bmj.d4046.full.pdf

Institute of Medicine responds

Metabolic flexibility ( i.e. , the ability to use different fuels for energy) is an inherent property of all cells. Glucose, glutamine, and fatty acids can each meet cellular ATP demands; how, why, and when that choice occurs ultimately may determine cell fate. Nearly a century ago, Otto Warburg

/pdf/new-insights-into-fuel-choices-of-nephron-progenitor-cells-2t22779cq8.pdf

New insights into fuel choices of nephron progenitor cells.

https://www.thelancet.com/article/S2213858714700841/pdf

Vitamin D supplementation and fall risk

Publisher Summary Growth hormone (GH) has distinct effects on the skeleton in terms of both linear growth and bone remodeling. Longitudinal growth results from the activity of GH on the skeleton, particularly at the cartilaginous growth plate. In human bone, proliferating chondrocytes express IGFIRs and are responsive to paracrine insulin-like growth factors (IGFs) secreted by differentiated cartilage cells. GH may also have its own effect on linear growth, independent of IGF-I. IGFs are critical in mediating the GH skeletal response. Remodeling is the sum of several distinct events beginning with activation of lining cells, followed by osteoclast recruitment, osteoblast differentiation, and osteocyte formation. In addition to regulating osteoblast function, several groups have shown that skeletal IGF-I can stimulate osteoclast recruitment and differentiation either directly through the IGF-IR or via RANKL expression. Finally, anti-resorptive agents have been considered as cornerstone therapeutics for osteoporosis. Anabolic agents can directly stimulate bone formation, which might have greater potential than the anti-resorptives to increase bone mass and to decrease fractures. Therefore, there is an emerging interest in developing anabolic agents including PTH, GH, and IGF-I to treat osteoporosis.

Insulin-like Growth Factors and the IGF Binding Proteins: Implications for Bone Biology

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