Background: Vitamin D is associated with a variety of health outcomes, but the exact definition of vitamin D sufficiency remains controversial. Aim: We sought to define skeletal-related vitamin D sufficiency by estimating maximum PTH suppression in the U.S. population. Methods: We performed a cross-sectional analysis of the National Health and Nutrition Examination Survey (NHANES), 2003–2006. We examined the association between serum 25-hydroxyvitamin D (25OHD) level and serum PTH level in 14, 681 participants aged ≥6 yr. We also evaluated the 25OHD-PTH association using 2 thresholds of hyperparathyroidism: PTH≥45 pg/ml and ≥75 pg/ml. Results: The mean 25OHD level was 24 ng/ml and mean PTH was 42 pg/ml. PTH≥45 pg/ml was present in 35% of the population, while PTH≥75 pg/ml was present in 7%. The prevalence of 25OHD levels <40 ng/ml and <30 ng/ml was 95% and 77%, respectively. In both unadjusted and adjusted models, there was a strong inverse relationship between 25OHD and PTH. Compared to 25OHD≥40 ng/ml, the 25OHD-PTH association was 2.36 [95% confidence interval (CI), 2.08–2.67] times greater for 25OHD<5 ng/ml and 1.12 (95%CI, 1.07–1.17) times greater for 25OHD 30–39.9 ng/ml. Compared to 25OHD≥40 ng/ml, 25OHD levels of 20–29.9 ng/ml [odds ratio (OR) 2.0 (95%CI, 1.4–2.8)] but not 30–39.9 ng/ml [OR 1.1 (95%CI, 0.8–1.6)] were independently associated with PTH≥45 pg/ml. Conclusions: Optimal vitamin D status, defined by estimated maximum PTH suppression, does not occur until at least 25OHD levels ≥40 ng/ml. Using these thresholds, most of the U.S. population needs more vitamin D. Large, prospective studies are needed to determine optimal vitamin D supplementation.
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Ginde, A.A., Wolfe, P., Camargo, C.A. et al. Defining vitamin D status by secondary hyperparathyroidism in the U.S. population. J Endocrinol Invest 35, 42–48 (2012). https://doi.org/10.3275/7742
- hypovitaminosis D
- parathyroid hormone
- vitamin D