October 19, 2020
National Center for Health Research’s Comments on the United States Preventive Services Task Force’s Draft Recommendation Statement Regarding Vitamin D Deficiency Screening in Adults
We are writing to express our views on the United States Preventive Services Task Force’s (USPSTF) draft recommendation statement regarding vitamin D deficiency screening in adults.
The National Center for Health Research (NCHR) is a nonprofit think tank that conducts, analyzes, and scrutinizes research on a range of health issues, with particular focus on which prevention strategies and treatments are most effective for which patients and consumers. We do not accept funding from companies that make products that are the subject of our work, so we have no conflicts of interest.
We support the update to again give the “I” grade recommendation, since the available evidence is still insufficient to assess the benefits and harms of vitamin D screening for asymptomatic adults. Currently, there are no randomized control trials or controlled observational studies that examine the potential harms of screening directly. Research on early detection and treatment of vitamin D deficiency is inconclusive with respect to what adverse events can result from treatment. Furthermore, there is no evidence that treatment reduces health risks of asymptomatic vitamin D deficiency. Additionally, the studies examined had various defined levels of vitamin D deficiency with no standardization, a wide range of study durations, and the levels of vitamin D deficiency differed across individuals and subpopulations. Finally, benefits or harms of different vitamin D doses, formulations, or durations of treatment were not assessed.
We agree with the recommendations that future studies should determine the best measure of vitamin D levels, as well as examine the cutpoints of vitamin D deficiency in various subgroups such as race, ethnicity, and sex. Furthermore, many of the trials reviewed in the recommendation were conducted prior to the implementation of the Vitamin D Standardization Program (VDSP). We agree with the recommendations that future studies should follow VDSP standardization as well as assess the benefit and harm of treatment of vitamin D deficiency including dose, formulation, and duration of treatment.