Assessment criteria for vitamin D deficiency/insufficiency in Japan: proposal by an expert panel supported by the Research Program of Intractable Diseases, Ministry of Health, Labour and Welfare, Japan, the Japanese Society for Bone and Mineral Research and the Japan Endocrine Society [Opinion]
- 644 Downloads
Vitamin D is indispensable for the maintenance of bone and mineral health. Inadequate vitamin D action increases the risk for various musculoskeletal/mineral events including fracture, fall, secondary hyperparathyroidism, diminished response to antiresorptives, rickets/osteomalacia, and hypocalcemia. Its most common cause in recent years is vitamin D deficiency/insufficiency, clinically defined by a low serum 25-hydroxyvitamin D [25(OH)D] level. Guidelines for vitamin D insufficiency/deficiency defined by serum 25(OH)D concentrations have been published all over the world. In Japan, however, the information on the associations between serum 25(OH)D and bone and mineral disorders has not been widely shared among healthcare providers, partly because its measurement had not been reimbursed with national medical insurance policy until August 2016. We have set out to collect and analyze Japanese data on the relationship between serum 25(OH)D concentration and bone and mineral events. Integrating these domestic data and published guidelines worldwide, here, we present the following assessment criteria for vitamin D sufficiency/insufficiency/deficiency using serum 25(OH)D level in Japan. (1) Serum 25(OH)D level equal to or above 30 ng/ml is considered to be vitamin D sufficient. (2) Serum 25(OH)D level less than 30 ng/ml but not less than 20 ng/ml is considered to be vitamin D insufficient. (3) Serum 25(OH)D level less than 20 ng/ml is considered to be vitamin D deficient. We believe that these criteria will be clinically helpful in the assessment of serum 25(OH)D concentrations and further expect that they will form a basis for the future development of guidelines for the management of vitamin D deficiency/insufficiency.
KeywordsVitamin D Vitamin D deficiency 25-Hydroxyvitamin D Fracture Parathyroid hormone
Funding was provided by the Research Program of Intractable Diseases, Ministry of Health, Labour and Welfare, Japan.
Compliance with ethical standards
Conflict of interest
All authors have no conflicts of interest.
- 2.Institute of Medicine (US) Committee to Review Dietary Reference Intakes for Vitamin D and Calcium (2011) Dietary reference intakes for calcium and vitamin D. The National Academies Press, Washington, DCGoogle Scholar
- 15.Nakamura K, Saito T, Oyama M, Oshiki R, Kobayashi R, Nishiwaki T, Nashimoto M, Tsuchiya Y (2011) Vitamin D sufficiency is associated with low incidence of limb and vertebral fractures in community-dwelling elderly Japanese women: the Muramatsu Study. Osteoporos Int 22:97–103CrossRefPubMedGoogle Scholar
- 17.Tamaki J, Iki M, Sato H, Kajita E, Nishino O, Akiba T, Matsumoto T, Kagamimori S, Kagawa Y, and Yonesima H (2015) Low serum 25(OH)D level increases fracture risk: the Japanese Population-based Osteoporosis (JPOS) cohort study (in Japanese). Dai 33-Kai Nihon Kotsutaisha Gakkai Gakujyutsu Shukai Programu Shoroku Shu (Program of the 33rd Meeting of the Japanese Society for Bone and Mineral Research) 177Google Scholar
- 18.Nakamura K, Tsugawa N, Saito T, Ishikawa M, Tsuchiya Y, Hyodo K, Maruyama K, Oshiki R, Kobayashi R, Nashimoto M, Yoshihara A, Ozaki R, Okano T, Yamamoto M (2008) Vitamin D status, bone mass, and bone metabolism in home-dwelling postmenopausal Japanese women: Yokogoshi Study. Bone 42:271–277CrossRefPubMedGoogle Scholar
- 19.Tsugawa N, Uenishi K, Ishida H, Ozaki R, Takase T, Minekami T, Uchino Y, Kamao M, Okano T (2016) Association between vitamin D status and serum parathyroid hormone concentration and calcaneal stiffness in Japanese adolescents: sex differences in susceptibility to vitamin D deficiency. J Bone Miner Metab 34:464–474CrossRefPubMedGoogle Scholar
- 20.Okazaki R, Sugimoto T, Kaji H, Fujii Y, Shiraki M, Inoue D, Endo I, Okano T, Hirota T, Kurahashi I, Matsumoto T (2011) Vitamin D insufficiency defined by serum 25-hydroxyvitamin D and parathyroid hormone before and after oral vitamin D(3) load in Japanese subjects. J Bone Miner Metab 29:103–110CrossRefPubMedGoogle Scholar
- 21.Yoshimura N, Muraki S, Oka H, Morita M, Yamada H, Tanaka S, Kawaguchi H, Nakamura K, Akune T (2013) Profiles of vitamin D insufficiency and deficiency in Japanese men and women: association with biological, environmental, and nutritional factors and coexisting disorders: the ROAD study. Osteoporos Int 24:2775–2787CrossRefPubMedGoogle Scholar
- 27.Diez-Perez A, Olmos JM, Nogues X, Sosa M, Diaz-Curiel M, Perez-Castrillon JL, Perez-Cano R, Munoz-Torres M, Torrijos A, Jodar E, Del Rio L, Caeiro-Rey JR, Farrerons J, Vila J, Arnaud C, Gonzalez-Macias J (2012) Risk factors for prediction of inadequate response to antiresorptives. J Bone Miner Res 27:817–824CrossRefPubMedGoogle Scholar
- 29.Fukumoto S, Ozono K, Michigami T, Minagawa M, Okazaki R, Sugimoto T, Takeuchi Y, Matsumoto T (2015) Pathogenesis and diagnostic criteria for rickets and osteomalacia–proposal by an expert panel supported by Ministry of Health, Labour and Welfare, Japan, The Japanese Society for Bone and Mineral Research and The Japan Endocrine Society. J Bone Miner Metab 33:467–473CrossRefPubMedGoogle Scholar
- 30.Priemel M, von Domarus C, Klatte TO, Kessler S, Schlie J, Meier S, Proksch N, Pastor F, Netter C, Streichert T, Puschel K, Amling M (2010) Bone mineralization defects and vitamin D deficiency: histomorphometric analysis of iliac crest bone biopsies and circulating 25-hydroxyvitamin D in 675 patients. J Bone Miner Res 25:305–312CrossRefPubMedGoogle Scholar
- 31.The Japan Endocrine Society The Guide for the Differential Diagnosis of Hypocalcemia (in Japanese). http://endocrine.umin.ac.jp/tebiki/003/003001.pdf