Osteoporosis International

, Volume 20, Issue 11, pp 1807–1820 | Cite as

Global vitamin D status and determinants of hypovitaminosis D

  • A. MithalEmail author
  • D. A. Wahl
  • J.-P. Bonjour
  • P. Burckhardt
  • B. Dawson-Hughes
  • J. A. Eisman
  • G. El-Hajj Fuleihan
  • R. G. Josse
  • P. Lips
  • J. Morales-Torres
  • on behalf of the IOF Committee of Scientific Advisors (CSA) Nutrition Working Group



This review describes the vitamin D status in different regions of the world with the objective of understanding the scope of hypovitaminosis D and the factors related to its prevalence that may contribute to the pathogenesis of osteoporosis and fragility fractures.


Vitamin D status has been linked to the pathogenesis of hip fractures as well as other skeletal and non-skeletal disorders. The purpose of this review is to provide a global perspective of vitamin D status across different regions of the world and to identify the common and significant determinants of hypovitaminosis D.


Six regions of the world were reviewed—Asia, Europe, Middle East and Africa, Latin America, North America, and Oceania—through a survey of published literature.


The definition of vitamin D insufficiency and deficiency, as well as assay methodology for 25-hydroxyvitamin D or 25(OH)D, vary between studies. However, serum 25(OH)D levels below 75 nmol/L are prevalent in every region studied whilst levels below 25 nmol/L are most common in regions such as South Asia and the Middle East. Older age, female sex, higher latitude, winter season, darker skin pigmentation, less sunlight exposure, dietary habits, and absence of vitamin D fortification are the main factors that are significantly associated with lower 25(OH)D levels.


Reports from across the world indicate that hypovitaminosis D is widespread and is re-emerging as a major health problem globally.


Prevalence Serum 25-hydroxyvitamin D Vitamin D deficiency 



The authors wish to thank the scientific contributions made for regional reports: Asia: Dr. Nidhi Malhotra; Middle East and Africa: Ms. Aida Farha, Ms. Rola El-Rassi, and Mr. Ghassan Baliki; Oceania: Drs. Jacqueline R. Center, Sunita Kaur Sandhu, and Paul J. Lee. The Nutrition Working Group of the IOF Committee of Scientific Advisors was supported by the International Osteoporosis Foundation.

Conflicts of interest



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Copyright information

© International Osteoporosis Foundation and National Osteoporosis Foundation 2009

Authors and Affiliations

  • A. Mithal
    • 1
    Email author
  • D. A. Wahl
    • 2
  • J.-P. Bonjour
    • 4
  • P. Burckhardt
    • 5
  • B. Dawson-Hughes
    • 3
  • J. A. Eisman
    • 6
  • G. El-Hajj Fuleihan
    • 7
  • R. G. Josse
    • 8
  • P. Lips
    • 9
  • J. Morales-Torres
    • 10
  • on behalf of the IOF Committee of Scientific Advisors (CSA) Nutrition Working Group
  1. 1.Indraprastha Apollo HospitalsNew DelhiIndia
  2. 2.International Osteoporosis FoundationNyonSwitzerland
  3. 3.Department of Agriculture Human Nutrition, Research Center on AgingTufts UniversityBostonUSA
  4. 4.Division of Bone DiseasesGeneva Hospitals and Faculty of MedicineGenevaSwitzerland
  5. 5.Association Suisse contre l’OstéoporoseClinique Bois-CerfLausanneSwitzerland
  6. 6.Garvan Institute of Medical ResearchSt Vincent’s Hospital and University of New South WalesSydneyAustralia
  7. 7.Department of Internal MedicineAmerican University of Beirut Medical CenterBeirutLebanon
  8. 8.St Michael’s Hospital Health CentreTorontoCanada
  9. 9.Division of Internal Medicine, Endocrine SectionVU University Medical CenterAmsterdamThe Netherlands
  10. 10.Hospital Aranda de la ParraLeónMexico

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