The American Journal of Medicine
Volume 123, Issue 2 , Page e19, February 2010

The Reply

Article Outline

 

Although we certainly agree with Bolland and Grey that an epidemiologic association does not prove causality, we do not believe we implied such in our article. In addition to the example proffered about differences in outcomes between observational and interventional studies with respect to hormonal replacement for postmenopausal women, we recall yet other relevant examples with different supplemental vitamins: vitamins E1 and a combination of vitamin A and beta-carotene.2

It is important to highlight that the examples cited by Bolland and Grey that did not demonstrate a benefit of supplemental vitamin D were studies in which oral vitamin D was administered and compared with placebo in populations who were not prespecified to have hypovitaminosis D. Furthermore, the dose of vitamin D used in the study of Jackson et al3 was only 400 IU, which might be less than what is required to meet physiologic needs, particularly those deprived of regular sun exposure.4

We stand by our recommendations that patients with hypovitaminosis D should receive supplemental vitamin D.5 We also strongly believe that oral vitamin D supplementation should be preferred over increasing one's sun exposure. We do agree that the current evidence does not yet support supplemental vitamin D for every adult, just as current guidelines do not justify cholesterol-lowering medication for all adults without knowledge of their baseline cholesterol levels and clinical risk. Given the magnitude of risk, we hope that future studies address whether vitamin D levels should be obtained in all or at-risk patients as a routine screening test, just as we screen for dyslipidemia and diabetes. In this era of cost containment, additional economic analyses of whether routine screening of adults and replacement in those found with hypovitaminosis D would be cost-effective would be welcome.

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References 

  1. The Heart Outcomes Prevention Evaluation Study Investigators. Vitamin E supplementation and cardiovascular events in high-risk patients. N Engl J Med. 2000;342:154–160
  2. Omenn GS, Goodman GE, Thornquist MD, et al. Effects of a combination of beta carotene and vitamin A on lung cancer and cardiovascular disease. N Engl J Med. 1996;334:1150–1155
  3. Jackson RD, LaCroix AZ, Gass M, et al. Calcium plus vitamin D supplementation and risk of fractures. N Engl J Med. 2006;354:669–683
  4. Holick MF. Vitamin D deficiency. N Engl J Med. 2007;357:266–281
  5. Stechschulte SA, Kirsner RS, Federman DG. Vitamin D: bone and beyond, rationale and recommendations for supplementation. Am J Med. 2009;122:793–802

PII: S0002-9343(09)00979-6

doi:10.1016/j.amjmed.2009.11.003

Refers to article:

  • Benefits of Vitamin D?

    Mark J. Bolland, Andrew Grey
    The American Journal of Medicine February 2010 (Vol. 123, Issue 2, Page e17)

The American Journal of Medicine
Volume 123, Issue 2 , Page e19, February 2010

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