USPSTF: Evidence Still Lacking to Support Screening for Vitamin D Deficiency in Asymptomatic Adults

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Current evidence is insufficient to support broad screening for vitamin D deficiency in adults without signs or symptoms, the US Preventive Services Task Force (USPSTF) concluded in a final recommendation statement (I statement) published April 13, 2021, in JAMA.

This new recommendation is consistent with the USPSTF’s 2014 statement on screening for vitamin D deficiency in community-dwelling, nonpregnant, asymptomatic adults aged ≥18 years.

Vitamin D performs an important role in calcium homeostasis, bone metabolism, and other cellular regulatory functions; however, vitamin D requirements can vary by individual, so there is no one 25(OH)D level that defines deficiency.

“We know that vitamin D is an important nutrient for keeping bones healthy and may also have a role in other aspects of good health,” said USPSTF member Michael Silverstein, MD, MPH, professor of pediatrics, chief of the Division of General Academic Pediatrics, vice chair of research, Department of Pediatrics, Boston University School of Medicine, in a press release. “However, we need more research on what level of vitamin D people need to stay healthy before we can make a recommendation for or against screening.”

To update its 2014 statement, the USPSTF examined a 46-study systemic review on screening for vitamin D deficiency, including the benefits and harms of screening and early treatment.

The systemic review found, “treatment with vitamin D has no effect on mortality or the incidence of fractures, falls, depression, diabetes, cardiovascular disease, cancer, or adverse events.”

The new recommendation does not apply to persons who already have health conditions that require vitamin D supplementation. If patients are concerned about their vitamin D levels, they should talk with their physician about their individual health needs, according to the press release.

USPSTF also cautioned that it did not review emerging evidence on vitamin D and COVID-19 outcomes.

The authors concluded by highlighting more research that is needed to address the following areas:

• Determine whether total serum 25(OH)D levels are the best measure of vitamin D deficiency and whether the best measure of vitamin D deficiency varies by subgroups defined by race, ethnicity, or sex.
• Determine the cutoff that defines vitamin D deficiency and whether that cutoff varies by specific clinical outcome or by subgroups defined by race, ethnicity, or sex.
• When vitamin D deficiency is better defined, studies on the benefits and harms of screening for vitamin D deficiency will be helpful.

The article in JAMA ends with a note on recommendations for vitamin D screening made by other professional organizations:

No organization recommends population-based screening for vitamin D deficiency, and the American Society for Clinical Pathology recommends against it. The American Academy of Family Physicians supports the USPSTF 2014 recommendation. The Endocrine Society and the American Association of Clinical Endocrinologists recommend screening for vitamin D deficiency in individuals at risk. The Endocrine Society does not recommend population screening for vitamin D deficiency in individuals not at risk.