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Evidence Lacking for Vitamin D Deficiency Screening, says Task Force

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December 18, 2014

The U.S. Preventive Services Task Force (USPSTF) recently issued a final recommendation on screening for vitamin D deficiency in adults that found that there is not enough evidence to determine whether screening would be beneficial.

Screening refers to testing any person (sometimes in defined groups, such as all adults or persons over a particular age) for a particular disease, even though the person does not have signs or symptoms of the disease. Examples of common conditions for which screening is recommended are diabetes and colon and breast cancers.

The USPSTF recommendation applies to healthy adults with no signs of vitamin D deficiency, not to people who may have conditions that require vitamin D supplementation. At present, no national health organization recommends general population screening. However, several organizations, including the National Osteoporosis Foundation, the Institute of Medicine, and the Endocrine Society recommend vitamin D testing for people who may be at risk for a deficiency. These include elderly people who are in nursing homes and home-bound or likely to get less sunlight exposure for any reason, people with darker skin, breastfed babies, and people who are obese or who have had bariatric surgery.

The USPSTF undertook the review of the latest evidence as the number of people taking vitamin D supplements as well as the number of patients being screened for deficiency has increased in the last few years. "The Task Force recognizes the increasing interest in how vitamin D impacts health. However, there is not enough clear evidence at this time for us to recommend for or against screening for vitamin D deficiency," said Task Force member Linda Baumann, Ph.D., R.N., a Professor at the University of Wisconsin-Madison School of Nursing.

The USPSTF is an independent group of national experts in the fields of prevention and evidence-based medicine who deliberate on and release evidence-based recommendations about clinical preventive services such as screening. In this latest review, the USPSTF examined twelve studies that evaluated the direct benefit of vitamin D screening but concluded that the evidence is insufficient at this time. "More research is needed to help the Task Force determine the benefits and harms of screening for vitamin D deficiency," says Task Force co-vice chair Albert L. Siu, M.D., M.S.P.H., a professor of geriatrics at the Mount Sinai Health System in New York City.

Vitamin D is essential for regulating blood calcium and phosphorus levels among other functions and is important for the health of bones and teeth. The body produces vitamin D in the skin when exposed to sunlight. Foods containing or enriched with the vitamin and supplements are other important sources. Vitamin D deficiency can occur in several ways, including not eating enough foods rich in vitamin D, too little exposure to sunlight, or medical conditions that keep a person from absorbing or using vitamin D. Laboratory tests can be used to check vitamin D levels in the blood (see Vitamin D Tests).

However, there is currently no consensus among experts on how to define or assess vitamin D deficiency, a problem the USPSTF recognized in its latest review. The studies that the USPSTF examined used varying threshold levels to define deficiency. Another problem is that laboratories use different methods for vitamin D analysis and the tests have not been standardized. Additional research is needed first to establish a definition of vitamin D deficiency and to standardize screening tests before considering a recommendation to screen all adults.

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(November 2014) U.S. Preventive Services Task Force. Final Recommendation Statement: Screening for Vitamin D Deficiency in Adults. Available online at http://www.uspreventiveservicestaskforce.org/Announcements/News/Item/final-recommendation-statement-screening-for-vitamin-d-deficiency-in-adults accessed through http://www.uspreventiveservicestaskforce.org. Accessed December 4, 2014.

U.S. Preventive Services Task Force. USPSTF Bulletin: U.S. Preventive Services Task Force Finds Insufficient Evidence on Screening for Vitamin D Deficiency in Adults. November 25, 2014. Available online through http://www.uspreventiveservicestaskforce.org. Accessed December 4, 2014.