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Vitamin D Deficiency

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Endocrinology and Diabetes

Abstract

Vitamin D is derived from skin production through exposure to ultraviolet light and from oral intake of natural foods, fortified foods, and supplements. While the principal source of vitamin D is skin production, oral intake has primacy over sunlight exposure in both the correction and prevention of nutritional vitamin D deficiency. Vitamin D deficiency is associated causally with rickets in childhood and osteomalacia in adulthood, but the evidence for a causal association with cancer, infections, autoimmune diseases, and cardiovascular disease is inconsistent and inconclusive. Measurement of circulating 25-hydroxyvitamin D (25OHD) in serum is the best marker of vitamin D supply. It is not a clinical outcome but is a measure of risk of skeletal disease. A value below 30 nmol/L (12 ng/ml) constitutes an increase in risk of disease. Additional indices of vitamin D deficiency include serum calcium, phosphate, total alkaline phosphatase, parathyroid hormone (PTH), and bone turnover markers, as well as bone densitometry, bone imaging, and rarely dynamic bone histomorphometry. The clinician must distinguish nutritional vitamin D deficiency from malabsorptive disorders and hypophosphatemic bone disease, especially that mediated by excessive fibroblast growth factor 23 (FGF23). Nutritional vitamin D deficiency should be managed according to the Institute of Medicine (IOM) recommendations with respect to vitamin D and calcium requirements: average intakes of 10 μg (400 IU) and 800 mg, respectively, in adults. Patients with malabsorptive disorders may need activated vitamin D. High-dose vitamin D therapy, daily or intermittent, should be avoided. Food solutions to endemic problems of either low vitamin D status or low calcium intake, such as fortification and biofortification, should diminish the need for supplementation.

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References

  1. Committee to Review Dietary Reference Intakes for Vitamin D and Calcium, Institute of Medicine. Dietary reference intakes for calcium and vitamin D. Washington, DC: The National Academies Press; 2011.

    Google Scholar 

  2. Scientific Advisory Committee on Nutrition (2016) Vitamin D and health. Crown.

    Google Scholar 

  3. McKenna MJ. Differences in vitamin D status between countries in young adults and the elderly. Am J Med. 1992;93:69–77.

    Article  CAS  PubMed  Google Scholar 

  4. Ross AC, Manson JE, Abrams SA, et al. The 2011 report on dietary reference intakes for calcium and vitamin D from the Institute of Medicine: what clinicians need to know. J Clin Endocrinol Metab. 2011;96:53–8.

    Article  CAS  PubMed  Google Scholar 

  5. Mokry LE, Ross S, Ahmad OS, Forgetta V, Smith GD, Leong A, Greenwood CMT, Thanassoulis G, Richards JB. Vitamin D and risk of multiple sclerosis: a Mendelian randomization study. PLoS Med. 2015;12:e1001866.

    Article  PubMed  PubMed Central  Google Scholar 

  6. Aloia JF. The 2011 report on dietary reference intake for vitamin D: where do we go from here? J Clin Endocrinol Metab. 2011;96:2987–96.

    Article  CAS  PubMed  Google Scholar 

  7. Manson JE, Brannon PM, Rosen CJ, Taylor CL. Vitamin D deficiency - is there really a pandemic? N Engl J Med. 2016;375:1817–20.

    Article  CAS  PubMed  Google Scholar 

  8. Parfitt AM, Gallagher JC, Heaney RP, Johnston CC, Neer R, Whedon GD. Vitamin D and bone health in the elderly. Am J Clin Nutr. 1982;36:1014–31.

    Article  CAS  PubMed  Google Scholar 

  9. McKenna MJ, Freaney R. Secondary hyperparathyroidism in the elderly: means to defining hypovitaminosis D. Osteoporos Int. 1998;8(Suppl 2):S3–6.

    Article  CAS  PubMed  Google Scholar 

  10. Parfitt AM, Rao DS, Stanciu J, Villanueva AR, Kleerekoper M, Frame B. Irreversible bone loss in osteomalacia. Comparison of radial photon absorptiometry with iliac bone histomorphometry during treatment. J Clin Invest. 1985;76:2403–12.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  11. Parfitt AM. Osteomalacia and related disorders. In: Avioli LV, Krane SM, editors. Metabolic bone disease and clinically related disorders. Third ed. Boston: Academic Press; 1998. p. 327–86.

    Chapter  Google Scholar 

  12. Jones KS, Assar S, Harnpanich D, Bouillon R, Lambrechts D, Prentice A, Schoenmakers I. 25(OH)D2 half-life is shorter than 25(OH)D3 half-life and is influenced by DBP concentration and genotype. J Clin Endocrinol Metab. 2014;99:3373–81.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  13. Roth HJ, Schmidt-Gayk H, Weber H, Niederau C. Accuracy and clinical implications of seven 25-hydroxyvitamin D methods compared with liquid chromatography-tandem mass spectrometry as a reference. Ann Clin Biochem. 2008;45:153–9.

    Article  CAS  PubMed  Google Scholar 

  14. Farrell CJ, Martin S, McWhinney B, Straub I, Williams P, Herrmann M. State-of-the-art vitamin D assays: a comparison of automated immunoassays with liquid chromatography-tandem mass spectrometry methods. Clin Chem. 2012;58:531–42.

    Article  CAS  PubMed  Google Scholar 

  15. Sempos CT, Vesper HW, Phinney KW, Thienpont LM, Coates PM, Vitamin DSP. Vitamin D status as an international issue: national surveys and the problem of standardization. Scand J Clin Lab Invest Suppl. 2012;243:32–40.

    PubMed  Google Scholar 

  16. Binkley N, Sempos CT, Vitamin DSP. Standardizing vitamin D assays: the way forward. J Bone Miner Res. 2014;29:1709–14.

    Article  CAS  PubMed  Google Scholar 

  17. Tai SS, Nelson MA, Bedner M, Lang BE, Phinney KW, Sander LC, Yen JH, Betz JM, Sempos CT, Wise SA. Development of standard reference material (SRM) 2973 vitamin D metabolites in frozen human serum (high level). J AOAC Int. 2017;100:1294–303.

    Article  CAS  PubMed  Google Scholar 

  18. Stepman HC, Vanderroost A, Van Uytfanghe K, Thienpont LM. Candidate reference measurement procedures for serum 25-hydroxyvitamin D3 and 25-hydroxyvitamin D2 by using isotope-dilution liquid chromatography-tandem mass spectrometry. Clin Chem. 2011;57:441–8.

    Article  CAS  PubMed  Google Scholar 

  19. Stockl D, Sluss PM, Thienpont LM. Specifications for trueness and precision of a reference measurement system for serum/plasma 25-hydroxyvitamin D analysis. Clin Chim Acta. 2009;408:8–13.

    Article  CAS  PubMed  Google Scholar 

  20. Durazo-Arvizu RA, Tian L, Brooks SPJ, Sarafin K, Cashman KD, Kiely M, Merkel J, Myers GL, Coates PM, Sempos CT. The vitamin D standardization program (VDSP) manual for retrospective laboratory standardization of serum 25-hydroxyvitamin D data. J AOAC Int. 2017;100:1234–43.

    Article  CAS  PubMed  Google Scholar 

  21. Carter GD, Berry J, Durazo-Arvizu R, et al. Hydroxyvitamin D assays: an historical perspective from DEQAS. J Steroid Biochem Mol Biol. 2017;177:30–5.

    Article  PubMed  Google Scholar 

  22. Heijboer AC, Blankenstein MA, Kema IP, Buijs MM. Accuracy of 6 routine 25-hydroxyvitamin D assays: influence of vitamin D binding protein concentration. Clin Chem. 2012;58:543–8.

    Article  CAS  PubMed  Google Scholar 

  23. Coldwell RD, Trafford DJ, Makin HL, Varley MJ, Kirk DN. Specific estimation of 24,25-dihydroxyvitamin D in plasma by gas chromatography-mass spectrometry. Clin Chem. 1984;30:1193–8.

    Article  CAS  PubMed  Google Scholar 

  24. Lensmeyer G, Poquette M, Wiebe D, Binkley N. The C-3 epimer of 25-hydroxyvitamin D(3) is present in adult serum. J Clin Endocrinol Metab. 2012;97:163–8.

    Article  CAS  PubMed  Google Scholar 

  25. Carter GD, Berry J, Durazo-Arvizu R, et al. Quality assessment of vitamin D metabolite assays used by clinical and research laboratories. J Steroid Biochem Mol Biol. 2017;173:100–4.

    Article  CAS  PubMed  Google Scholar 

  26. Taylor CL, Carriquiry AL, Bailey RL, Sempos CT, Yetley EA. Appropriateness of the probability approach with a nutrient status biomarker to assess population inadequacy: a study using vitamin D. Am J Clin Nutr. 2013;97:72–8.

    Article  CAS  PubMed  Google Scholar 

  27. Rosen CJ, Abrams SA, Aloia JF, et al. IOM committee members respond to Endocrine Society Vitamin D guideline. J Clin Endocrinol Metab. 2012;97:1146–52.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  28. McKenna MJ, Freaney R, Casey OM, Towers RP, Muldowney FP. Osteomalacia and osteoporosis: evaluation of a diagnostic index. J Clin Pathol. 1983;36:245–52.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  29. Sai AJ, Walters RW, Fang X, Gallagher JC. Relationship between vitamin D, parathyroid hormone, and bone health. J Clin Endocrinol Metab. 2011;96:E436–46.

    Article  CAS  PubMed  Google Scholar 

  30. Szulc P, Delmas PD. Biochemical markers of bone turnover: potential use in the investigation and management of postmenopausal osteoporosis. Osteoporos Int. 2008;19:1683–704.

    Article  CAS  PubMed  Google Scholar 

  31. Adams JE. Radiology of rickets and osteomalacia. In: Feldman D, Pike JW, Adams JS, editors. Vitamin D. Third ed. London: Academic Press; 2011. p. 861–89.

    Chapter  Google Scholar 

  32. Pettifor JM. Vitamin D deficiency and nutritional rickets in children. In: Feldman D, Pike JW, Adams JS, editors. Vitamin D. Third ed. London: Academic Press; 2011. p. 1107–28.

    Chapter  Google Scholar 

  33. McKenna MJ, Heffernan E, Hurson C, McKiernan FE. Clinician approach to diagnosis of stress fractures including bisphosphonate-associated fractures. QJM. 2014;107:99–105.

    Article  CAS  PubMed  Google Scholar 

  34. McKenna MJ, Kleerekoper M, Ellis BI, Rao DS, Parfitt AM, Frame B. Atypical insufficiency fractures confused with Looser zones of osteomalacia. Bone. 1987;8:71–8.

    Article  CAS  PubMed  Google Scholar 

  35. Imel EA, Econs MJ. Approach to the hypophosphatemic patient. J Clin Endocrinol Metab. 2012;97:696–706.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  36. Recker R. Bone biopsy and histomorphometry in clinical practice. In: Rosen CR, editor. Primar on the metabolic bone diseases and disorders of mineral metabolism. Eight ed. Ames: Wiley-Blackwell; 2013. p. 307–16.

    Chapter  Google Scholar 

  37. Lee JC, Su SY, Changou CA, et al. Characterization of FN1-FGFR1 and novel FN1-FGF1 fusion genes in a large series of phosphaturic mesenchymal tumors. Mod Pathol. 2016;29:1335–46.

    Article  CAS  PubMed  Google Scholar 

  38. Walton RJ, Bijvoet OL. Nomogram for derivation of renal threshold phosphate concentration. Lancet. 1975;2:309–10.

    Article  CAS  PubMed  Google Scholar 

  39. Molin A, Wiedemann A, Demers N, et al. Vitamin D–dependent rickets type 1B (25-hydroxylase deficiency): a rare condition or a misdiagnosed condition? J Bone Miner Res. 2017;32:1893–9.

    Article  CAS  PubMed  Google Scholar 

  40. Thacher TD, Smith L, Fischer PR, Isichei CO, Cha SS, Pettifor JM. Optimal dose of calcium for treatment of nutritional rickets: a randomized controlled trial. J Bone Miner Res. 2016;31:2024–31.

    Article  CAS  PubMed  Google Scholar 

  41. Aggarwal V, Seth A, Aneja S, Sharma B, Sonkar P, Singh S, Marwaha RK. Role of calcium deficiency in development of nutritional rickets in Indian children: a case control study. J Clin Endocrinol Metab. 2012;97:3461–6.

    Article  CAS  PubMed  Google Scholar 

  42. Dhanwal DK, Sahoo S, Gautam VK, Saha R. Hip fracture patients in India have vitamin D deficiency and secondary hyperparathyroidism. Osteoporos Int. 2013;24:553–7.

    Article  CAS  PubMed  Google Scholar 

  43. Whyte MP. Hypophosphatasia: an overview for 2017. Bone. 2017;102:15–25.

    Article  CAS  PubMed  Google Scholar 

  44. Whyte MP. Hypophosphatasia: enzyme replacement therapy brings new opportunities and new challenges. J Bone Miner Res. 2017;32:667–75.

    Article  CAS  PubMed  Google Scholar 

  45. Gallagher JC, Sai A, Templin T, Smith L. Dose response to vitamin D supplementation in postmenopausal women. Ann Intern Med. 2012;156:425–37.

    Article  PubMed  Google Scholar 

  46. Tripkovic L, Wilson LR, Hart K, et al. Daily supplementation with 15 μg vitamin D2 compared with vitamin D3 to increase wintertime 25-hydroxyvitamin D status in healthy South Asian and white European women: a 12-wk randomized, placebo-controlled food-fortification trial. Am J Clin Nutr. 2017;106:481–90.

    Article  CAS  PubMed  Google Scholar 

  47. Smith TJ, Tripkovic L, Damsgaard CT, et al. Estimation of the dietary requirement for vitamin D in adolescents aged 14–18 y: a dose-response, double-blind, randomized placebo-controlled trial. Am J Clin Nutr. 2016;104:1301–9.

    Article  CAS  PubMed  Google Scholar 

  48. Mortensen C, Damsgaard CT, Hauger H, et al. Estimation of the dietary requirement for vitamin D in white children aged 4-8 y: a randomized, controlled, dose-response trial. Am J Clin Nutr. 2016;104:1310–7.

    Article  CAS  PubMed  Google Scholar 

  49. Ohlund I, Lind T, Hernell O, Silfverdal SA, Karlsland Akeson P. Increased vitamin D intake differentiated according to skin color is needed to meet requirements in young Swedish children during winter: a double-blind randomized clinical trial. Am J Clin Nutr. 2017;106:105–12.

    Article  PubMed  Google Scholar 

  50. Gaffney-Stomberg E, Lutz LJ, Shcherbina A, Ricke DO, Petrovick M, Cropper TL, Cable SJ, McClung JP. Association between single gene polymorphisms and bone biomarkers and response to calcium and vitamin D supplementation in young adults undergoing military training. J Bone Miner Res. 2017;32:498–507.

    Article  CAS  PubMed  Google Scholar 

  51. Oliveri B, Mastaglia SR, Brito GM, Seijo M, Keller GA, Somoza J, Diez RA, Di Girolamo G. Vitamin D3 seems more appropriate than D2 to sustain adequate levels of 25OHD: a pharmacokinetic approach. Eur J Clin Nutr. 2015;69:697–702.

    Article  CAS  PubMed  Google Scholar 

  52. Jakobsen J, Andersen E, Christensen T, Andersen R, Bügel S. Vitamin D vitamers affect vitamin D status differently in young healthy males. Nutrients. 2018;10:12.

    Article  Google Scholar 

  53. Itkonen ST, Skaffari E, Saaristo P, Saarnio EM, Erkkola M, Jakobsen J, Cashman KD, Lamberg-Allardt C. Effects of vitamin D2-fortified bread v. supplementation with vitamin D2 or D3 on serum 25-hydroxyvitamin D metabolites: an 8-week randomised-controlled trial in young adult Finnish women. Br J Nutr. 2016;115:1232–9.

    Article  CAS  PubMed  Google Scholar 

  54. Munns CF, Shaw N, Kiely M, et al. Global consensus recommendations on prevention and management of nutritional rickets. J Clin Endocrinol Metab. 2016;101:394–415.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  55. Jaaskelainen T, Itkonen ST, Lundqvist A, et al. The positive impact of general vitamin D food fortification policy on vitamin D status in a representative adult Finnish population: evidence from an 11-y follow-up based on standardized 25-hydroxyvitamin D data. Am J Clin Nutr. 2017;105:1512–20.

    PubMed  Google Scholar 

  56. Bogdan Y, Tornetta P 3rd, Einhorn TA, et al. Healing time and complications in operatively treated atypical femur fractures associated with bisphosphonate use: a multicenter retrospective cohort. J Orthop Trauma. 2016;30:177–81.

    Article  PubMed  Google Scholar 

  57. Akkermans MD, Eussen SR, van der Horst-Graat JM, van Elburg RM, van Goudoever JB, Brus F. A micronutrient-fortified young-child formula improves the iron and vitamin D status of healthy young European children: a randomized, double-blind controlled trial. Am J Clin Nutr. 2017;105:391–9.

    Article  CAS  PubMed  Google Scholar 

  58. Hayes A, Duffy S, O’Grady M, et al. Vitamin D–enhanced eggs are protective of wintertime serum 25-hydroxyvitamin D in a randomized controlled trial of adults. Am J Clin Nutr. 2016;104:629–37.

    Article  CAS  PubMed  Google Scholar 

  59. Barnkob LL, Argyraki A, Petersen PM, Jakobsen J. Investigation of the effect of UV-LED exposure conditions on the production of vitamin D in pig skin. Food Chem. 2016;212:386–91.

    Article  CAS  PubMed  Google Scholar 

  60. McKenna MJ, Murray BF, O'Keane M, Kilbane MT. Rising trend in vitamin D status from 1993 to 2013: dual concerns for the future. Endocr Connect. 2015;4:163–71.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  61. McKenna MJ, Murray BF. Vitamin D dose response is underestimated by Endocrine Society’s Clinical Practice Guideline. Endocr Connect. 2013;2:87–95.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  62. Chel V, Wijnhoven HA, Smit JH, Ooms M, Lips P. Efficacy of different doses and time intervals of oral vitamin D supplementation with or without calcium in elderly nursing home residents. Osteoporos Int. 2008;19:663–71.

    Article  CAS  PubMed  Google Scholar 

  63. Smith LM, Gallagher JC, Suiter C. Medium doses of daily vitamin D decrease falls and higher doses of daily vitamin D3 increase falls: a randomized clinical trial. J Steroid Biochem Mol Biol. 2017;173:317–22.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  64. Bischoff-Ferrari HA, Dawson-Hughes B, Orav E, et al. Monthly high-dose vitamin d treatment for the prevention of functional decline: a randomized clinical trial. JAMA Intern Med. 2016:1–10.

    Google Scholar 

  65. Sanders KM, Stuart AL, Williamson EJ, Simpson JA, Kotowicz MA, Young D, Nicholson GC. Annual high-dose oral vitamin D and falls and fractures in older women: a randomized controlled trial. JAMA. 2010;303:1815–22.

    Article  CAS  PubMed  Google Scholar 

  66. Smith H, Anderson F, Raphael H, Maslin P, Crozier S, Cooper C. Effect of annual intramuscular vitamin D on fracture risk in elderly men and women—a population-based, randomized, double-blind, placebo-controlled trial. Rheumatology. 2007;46:1852–7.

    Article  CAS  PubMed  Google Scholar 

  67. Hansen KE, Johnson R, Chambers KR, et al. Treatment of vitamin d insufficiency in postmenopausal women: a randomized clinical trial. JAMA Intern Med. 2015;175:1612–21.

    Article  PubMed  PubMed Central  Google Scholar 

  68. Litonjua AA, Carey VJ, Laranjo N, et al. Effect of prenatal supplementation with vitamin D on asthma or recurrent wheezing in offspring by age 3 years: the VDAART randomized clinical trial. JAMA. 2016;315:362–70.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  69. Chawes BL, Bonnelykke K, Stokholm J, et al. Effect of vitamin D3 supplementation during pregnancy on risk of persistent wheeze in the offspring: a randomized clinical trial. JAMA. 2016;315:353–61.

    Article  CAS  PubMed  Google Scholar 

  70. Jorde R, Sollid ST, Svartberg J, Schirmer H, Joakimsen RM, Njolstad I, Fuskevag OM, Figenschau Y, Hutchinson MY. Vitamin D 20,000 IU per week for five years does not prevent progression from prediabetes to diabetes. J Clin Endocrinol Metab. 2016;101:1647–55.

    Article  CAS  PubMed  Google Scholar 

  71. El-Hajj Fuleihan G, Baddoura R, Habib RH, et al. Effect of vitamin D replacement on indexes of insulin resistance in overweight elderly individuals: a randomized controlled trial. Am J Clin Nutr. 2016;104:315–23.

    Article  PubMed  PubMed Central  Google Scholar 

  72. Scragg R, Stewart AW, Waayer D, Lawes CMM, Toop L, Sluyter J, Murphy J, Khaw KT, Camargo CA Jr. Effect of monthly high-dose vitamin D supplementation on cardiovascular disease in the vitamin D assessment study: a randomized clinical trial. JAMA Cardiol. 2017;2:608–16.

    Article  PubMed  PubMed Central  Google Scholar 

  73. Jorde R, Sollid ST, Svartberg J, Joakimsen RM, Grimnes G, Hutchinson MY. Prevention of urinary tract infections with vitamin D supplementation 20,000 IU per week for five years. Results from an RCT including 511 subjects. Infect Dis (Lond). 2016:1–6.

    Google Scholar 

  74. Amrein K. Vitamin D status in critical care: contributor or marker of poor health? Lung India. 2014;31:299–300.

    Article  PubMed  PubMed Central  Google Scholar 

  75. Manaseki-Holland S, Maroof Z, Bruce J, Mughal MZ, Masher MI, Bhutta ZA, Walraven G, Chandramohan D. Effect on the incidence of pneumonia of vitamin D supplementation by quarterly bolus dose to infants in Kabul: a randomised controlled superiority trial. Lancet. 2012;379:1419–27.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  76. 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.

    Article  PubMed  PubMed Central  Google Scholar 

  77. Jolliffe DA, Greenberg L, Hooper RL, et al. Vitamin D supplementation to prevent asthma exacerbations: a systematic review and meta-analysis of individual participant data. Lancet Respir Med. 2017;5(11):881–90.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  78. Pradhan AD, Manson JE. Update on the Vitamin D and OmegA-3 trial (VITAL). J Steroid Biochem Mol Biol. 2016;155:252–6.

    Article  CAS  PubMed  Google Scholar 

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Authors and Affiliations

  1. Department of Endocrinology, St. Vincent’s University Hospital, Dublin, Ireland

    Malachi J. McKenna

  2. UCD School of Medicine and Medical Sciences, University College Dublin, Dublin, Ireland

    Malachi J. McKenna

  3. Department of Clinical Chemistry, St. Vincent’s University Hospital, Elm Park, Dublin 4, Ireland

    Mark Kilbane

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  1. Malachi J. McKenna
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Correspondence to Malachi J. McKenna .

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Editors and Affiliations

  1. Division of Endocrinology, Agamenon Magalhães Hospital, University of Pernambuco Medical School, Recife, Pernambuco, Brazil

    Francisco Bandeira

  2. Division of Endocrinology, Mayo Clinic College of Medicine, Rochester, MN, USA

    Hossein Gharib

  3. School of Medicine, University of Pernambuco, Recife, Brazil

    Luiz Griz

  4. School of Medicine, University of Maranhao, Sao Luis, Brazil

    Manuel Faria

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McKenna, M.J., Kilbane, M. (2022). Vitamin D Deficiency. In: Bandeira, F., Gharib, H., Griz, L., Faria, M. (eds) Endocrinology and Diabetes. Springer, Cham. https://doi.org/10.1007/978-3-030-90684-9_23

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