J Korean Med Assoc.  2017 Apr;60(4):330-335. 10.5124/jkma.2017.60.4.330.

Pharmacologic supplementation of vitamin D

• Lee JH

• KMID: 2378217
• DOI: http://doi.org/10.5124/jkma.2017.60.4.330

Abstract

Vitamin D deficiency is common among Koreans and worldwide, leading both physicians and patients to become interested in whether vitamin D supplementation is needed. However, current levels of supplementation with vitamin D are insufficient, especially among aging Koreans. The musculoskeletal effects of vitamin D supplementation have been established, and its extraskeletal effects also have drawn particular interest. Nonetheless, more studies are needed to assess its extraskeletal effects with regard to cardiovascular disease, cancer, and diabetes, as well as its adverse effects. Serum 25-hydroxyvitamin D levels greater than 20 ng/mL are generally appropriate for preventing osteoporosis, while serum 25-hydroxyvitamin D levels greater than 30 ng/mL are probably helpful for the management of osteoporosis and the prevention of fractures and falls. The recommended dietary vitamin D intake is at least 800 IU per day, which appears to reduce the risk of fractures.

Keyword

Vitamin D; Osteoporosis; Fracture; Mortality; Cardiovascular diseases

MeSH Terms

Accidental Falls
Aging
Cardiovascular Diseases
Humans
Mortality
Osteoporosis
Vitamin D Deficiency
Vitamin D*
Vitamins*
Vitamin D
Vitamins

Figure

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  Figure 1 Cell signaling and the regulation of protein expression by vitamin D. Active vitamin D (1,25[OH]2 Vit D), which is synthesized by kidney cells and secreted into the blood vessels, combines with vitamin D-binding protein (DBP) in the blood, and then move into the cells which are the target cells of vitamin D. Within the cytosol, vitamin D receptor protein (VDR) can recognize this vitamin D-DBP complexand once vitamin D-DBP complex is detached, then vitamin D combines at this time with VDR to get into the nucleus. Within thenucleus, vitamin D-VDR-retinoid X receptor (RXR) complex combines with a particular vitamin D-dependent DNA elements and regulates the vitamin Ddependentgene expression (transcription). Reproduced from Shin MY, et al. J Nutr Health 2016;49:1-7, according to the Creative Commons license [1].

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  Figure 2 The nutrient and hormone-like roles of vitamin D. Traditionally, vitamin D is well known as the nutrient which promotes bone health by stimulating Ca absorption by upregulating the protein expression and synthesis for Ca absorption and osteoblast differentiation etc. (as nutrient). In these days, numerous studies show that vitamin D is also having various functions of anticancer through up-regulating the proteins for preventing cancer cell proliferation, anti-cardiovascular and anti-diabetic function, which are not considered only as the nutrient but cell signaling molecule (hormone-like nutrient). 25(OH)D, 25-hydroxyvitamin D; VDR, vitamine D receptor protein; RXR, retinoid X receptor; RNA POL II, RNA polymerase II; VDRE, vitamin D response element. Reproduced from Shin MY, et al. J Nutr Health 2016;49:1-7, according to the Creative Commons license [1].

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