D-vitaminbrist
Senast uppdaterad: Senast reviderad:
Sakkunnig:Anna Nager
Definition:
D-vitaminbrist är 25-hydroxyvitamin D lägre än <25 nmol/L. 25-hydroxyvitamin mellan 25–50 nmol/L kallas för D-vitamininsufficiens. D-vitaminbrist beror på för lite solexponering och/eller för lågt intag av D-vitamin.
Förekomst:
Oklar förekomst i Sverige. Riskgrupper är bland annat mörkhyade boende i Skandinavien och äldre personer med lite utomhusvistelse.
Symtom:
Långvarig D-vitaminbrist kan ge trötthet, muskelsvaghet, bensmärtor och osteomalaci hos vuxna eller rakit hos barn.
Kliniska fynd:
Kliniska fynd kan vara minskad muskelkraft i benen.
Diagnostik:
Mätning av 25-hydroxyvitamin D i serum eller plasma.
Behandling:
Förebyggande behandling är solexponering under sommarhalvåret och intag av D-vitamin via kosten (fet fisk och D-vitaminberikade livsmedel). D-vitamin tillskott bör tas av vissa riskgrupper. Peroralt D-vitamin ges allltid vid D-vitaminbrist, men även vid D-vitamininsufficiens om symtom och/eller påverkad biokemi (hypokalcemi, högt P/S-PTH och S/P-ALP) finns. Eventuellt kalciumtillskott.
- Lorentzon M, Åkesson K, Mellström D et al. D-vitaminbehandling och skeletthälsa – svenska riktlinjer behövs Rekommendationer från Svenska osteoporossällskapets kliniska expertgrupp. Lakartidningen.se 2014-07-29 lakartidningen.se
- Tørring O, Rönnmark C och Ljungren Ö. Läkemedelsboken, kap Rubbningar i kalciumomsättningen: Läkemedelsverket, 2015. lakemedelsboken.se
- Knutsen KV, Brekke M, Gjelstad S, Lagerløv P. Vitamin D status iin patients wuth musculoskeletal pain and headache: A cross-sectional descriptive study in a multi-ethnic general practice in Norway. Scand J Prim Health Care 2010; 28: 166-71. PubMed
- Holick MF. Vitamin D deficiency. N Engl J Med 2007; 357: 266-81. PubMed
- Glerup H, Mikkelsen K, Poulsen L, et al. Commonly recommended daily intake of vitamin D is not sufficient if sunlight exposure is limited. J Intern Med 2000; 247: 260-8. PubMed
- Holick MF. High prevalence of vitamin D inadequacy and implications for health. Mayo Clin Proc 2006; 81: 353-73. PubMed
- Holick MF, Siris ES, Binkley N, et al. Prevalence of vitamin D inadequacy among postmenopausal North American women receiving osteoporosis therapy. J Clin Endocrinol Metab 2005; 90: 3215-24. PubMed
- Lips P. Vitamin D deficiency and secondary hyperparathyroidism in the elderly: consequences for bone loss and fractures and therapeutic implica- tions. Endocrine Reviews 2001; 22: 477-501. PubMed
- Parfitt AM, Gallagher JC, Heaney RP et al. Vitamin D and bone health in the elderly. Am J Clin Nutr 1982; 36: 1014-31.
- Holick MF. Resurrection of vitamin D deficiency and rickets. J Clin Invest 2006; 116: 2062-72. PubMed
- DeLuca HF. Overview of general physiologic features and functions of vitamin D. Am J Clin Nutr 2004; 80(Suppl): 1689-96.
- Webb AR. Who, what, where and when-influences on cutaneous vitamin D synthesis. Prog Biophys Mol Biol 2006; 92: 17-25. PubMed
- Armas LA, Dowell S, Akhter M et al. Ultraviolet-B radiation increases serum 25-hydroxyvitamin D levels: the effect of UVB dose and skin color. J Am Acad Dermatol 2007; 57: 588-93. PubMed
- Den norske legeforening. Nyheter 2019. Solarium uegnet som kilde til vitamin D. www.legeforeningen.no
- Livsmedelsverket. Brugård Kunde, Å.Råd om D-vitamintillskott till riskgrupper Risk- och nyttohanteringsrapport. Livsmedelverkets rapportserie nr 21 2018. ISSN 1104-7089 www.livsmedelsverket.se
- Lehmann U, Hirche F, Stangl GI, et al. Bioavailability of vitamin D2 and D3 in healthy volunteers, a randomized placebo-controlled trial. J Clin Endocrinol Metab 2013; 98: 4339. doi:10.1210/jc.2012-4287 DOI
- Heaney RP, Dowell MS, Hale CA, Bendich A. Calcium absorption varies within the reference range for serum 25-hydroxyvitamin D. J Am Coll Nutr 2003; 22: 142-6. PubMed
- Lips P. Vitamin D deficiency and secondary hyperparathyroidism in the elderly: consequences for bone loss and fractures and therapeutic implications. Endocr Rev 2001; 22: 477-501. PubMed
- Melhus H, Snellman G, Gedeborg R, et al. Plasma 25-hydroxyvitamin D levels and fracture risk in a community-based cohort of elderly men in Sweden. J Clin Endocrinol Metab 2010; 95: 2637-45. PubMed
- Shah S, Chiang C, Sikaris K, et al. Serum 25-hydroxyvitamin D insufficiency in search of a bone disease. J Clin Endocrinol Metab 2017; 102: 2321-8. doi:10.1210/jc.2016-3189 DOI
- Chung M, Lee J, Terasawa T, et al. Vitamin D with or without calcium supplementation for prevention of cancer and fractures: An updated meta-analysis for the U.S. preventive services task force. Ann Intern Med 2011; 155: 827-38. PubMed
- Rozen F, Yang XF, Huynh H et al. Antiproliferative action of vitamin D-related compounds and insulin-like growth factor-binding protein 5 accumulation. J Natl Cancer Inst 1997; 89: 652-6. PubMed
- Stewart JW, Alekel DL, Ritland LM, et al. Serum 25-hydroxyvitamin D is related to indicators of overall physical fitness in healthy postmenopausal women. Menopause 2009; 16: 1093-101. PubMed
- Bolland MJ, Grey A, Gamble GD, Reid IR. Vitamin D supplementation and falls: a trial sequential meta-analysis. Lancet Diabetes Endocrinol. 2014 Apr 23. PMID: 24768505. PubMed
- Boonon S, Lips P, Bouillon R, et al. Need for aditional calcium to reduce the risk of hip fracture with vitamin d supplementation: evidence from a comparative meta analysis of randomised controlled trials. J Clin Endocrinol Metab 2007; 92: 1415-23. PubMed
- Bischoff-Ferrari HA, Dawson-Huhges B, Staehelin OB, et al. Fall prevention with supplemental and active form of vitamin D: meta-analysis of randomised controlled trials. BMJ 2009; 339: b3692. BMJ (DOI)
- Budhathoki S. Plasma 25-hydroxyvitamin D concentration and subsequent risk of total and site specific cancers in Japanese population: Large case-cohort study within Japan Public Health Center-based Prospective Study cohort. BMJ 2018; 360: k671. pmid:29514781 PubMed
- Lappe J, Watson P, Gravers-Gustafson D, et al. Effect of vitamin D and calcium supplmentation on cancer incidence in older women. A randomized trial. JAMA 2017; 317: 1234-43. PMID: 28350929 PubMed
- Scragg R, Khaw K-T, Toop L, et al. Monthly High-Dose Vitamin D Supplementation and Cancer Risk A Post Hoc Analysis of the Vitamin D Assessment Randomized Clinical Trial. JAMA Oncology 2018. doi:10.1001/jamaoncol.2018.2178 DOI
- Martineau AR, Jolliffe DA, Hooper RL et al. Vitamin D supplementation to prevent acute respiratory tract infections: systematic review and meta-analysis of individual participant data. BMJ 2017; 356: i6583. pmid:28202713. PubMed
- Passeron T, Bouillon R, Callender V, Cestari T, Diepgen TL, Green AC, van der Pols JC, Bernard BA, Ly F, Bernerd F, Marrot L, Nielsen M, Verschoore M, Jablonski NG, Young AR. Sunscreen photoprotection and vitamin D status. Br J Dermatol. 2019 Nov;181(5):916-931. doi: 10.1111/bjd.17992. Epub 2019 Jul 15. PMID: 31069788 PubMed
- Coutinho MdL, Dormandy TL, Yudkin S. Maternal malabsorption presenting as rickets. Lancet 1968; 1: 1048-52. PubMed
- Lagunova Z, Porojnicu AC, Lindberg F, Hexeberg S, Moan J. The dependency of vitamin D status on body mass index, gender, age and season. Anticancer Res 2009: 29: 3713–3720. PMID: 19667169 PubMed
- Holick MF, Brinkley 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;96:1911-1930. PubMed
- Brot C, Vestergaard P, Kolthoff N et al. Vitamin D status and its adequacy in healthy Danish perimenopausal women: relationships to dietary intake, sun exposure and serum parathyroid hormone. Br J Nutr 2001; 86(suppl 1): S97-103.
- SBU kommenterar 2015-06-09 www.sbu.se
- Jacobsen AT, Mosekilde L. D-vitamin-mangel hos etniske minoriteter. Ugeskr Læger 2005; 167: 33-4. PubMed
- Bolland MJ, Grey A, Avenell A. Effects of vitamin D supplementation on musculoskeletal health: a systematic review, meta-analysis, and trial sequential analysis. Lancet Diab & Endocrinology 2018; 6(11): 847-58. doi:https://doi.org/10.1016/S2213-8587(18)30265-1
- de Torrente de la Jara G, Pecoud A, et al. Female asylum seekers with musculoskeletal pain: the importance of diagnosis and treatment of hypovitaminosis D. BMC Fam Pract 2006; 7: 4. PubMed
- Diamond TH, Ho KW et al. Annual intramuscular injection of a megadose of cholecalciferol for treatment of vitamin D deficiency: efficacy and safety data. Med J Aust 2005; 183: 10-2. PubMed
- Ebeling PR. Megadose therapy for vitamin D deficiency editorial. Med J Aust 2005; 183: 4-5. PubMed
- Alyaarubi S, Rodd C. Treatment of malabsorption vitamin D deficiency myopathy with intramuscular vitamin D abstract. J Pediatr Endocrinol Metab 2005; 18: 719-22. PubMed
- Harvey NC, Holroyd C, Ntani G, et al. Vitamin D supplementation in pregnancy: a systematic review. Health Technol Assess. 2014 Jul;18(45):1-190. PMID: 25025896. PubMed
- De-Regil LM1, Palacios C, Ansary A, et al. Vitamin D supplementation for women during pregnancy. Cochrane Database Syst Rev. 2012 Feb 15;2:CD008873. doi: 10.1002/14651858.CD008873.pub2. PMID: 22336854. PubMed
- EFSA Panel on Dietetic Products, Nutrition and Allergies (NDA). Scientific Opinion on the Tolerable Upper Intake Level of vitamin D efsa.onlinelibrary.wiley.com
- Bolland MJ, Grey A, Gamble GD, et al.The effect of vitamin D supplementation on skeletal, vascular, or cancer outcomes: a trial sequential meta-analysis. The Lancet Diabetes & Endocrinology, 2014 Apr;2(4):307-20. PMID: 24703049. PubMed
- LeFevre ML, LeFevre NM. Vitamin D Screening and Supplementation in Community-Dwelling Adults: Common Questions and Answers. Am Fam Physician. 2018 Feb 15;97(4):254-260. PMID: 29671532 PubMed
- LeBlanc ES, Zakher B, Daeges M, et al. Screening for vitamin D deficiency: a systematic review for the U.S. Preventive Services Task Force. Ann Intern Med. 2015 Jan 20;162(2):109-22. doi: 10.7326/M14-1659. DOI
- Zhu K, Austin N, Devine A, et al. A randomized controlled trial of the effects of vitamin D on muscle strength and mobility in older women with vitamin D insufficiency. J Am Geriatr Soc 2010; 58: 2063-8. PubMed
- 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; 59: 2291-300. PubMed
- Anna Nager, med dr och specialist i allmänmedicin, Karolinska institutet
Tidigare sakkunniga
- Maria Sääf, med dr och överläkare, Kliniken för endokrinologi, metabolism och diabetes, Karolinska universitetssjukhuset
- Åke Rundgren, docent och överläkare, Enheten för geriatrik, Göteborgs universitet