Vitamin D in adult health and disease: a review and guideline statement from Osteoporosis Canada

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Abstract
T he 2002 guidelines for the management of osteoporosis published by Osteoporosis Canada 1 identified adequate vitamin D status, in addition to calcium from diet or supplements, as essential for the prevention of osteoporosis. Recent large clinical trials and meta-analyses have expanded our knowledge of the role of vitamin D in fractures, falls and other health outcomes, as well as its effect on disorders such as diabetes mellitus, autoimmune and infectious diseases, malignancies and cardiovascular disease. Current Canadian recommendations for "adequate intake" and "tolerable upper level" of vitamin D, which are more than 10 years old, were derived mainly from early nutritional science estimates of the minimal intake necessary to prevent florid deficiency states (rickets or osteomalacia). However, these levels have never been supported by adequately conducted dose-finding studies. 2 This review is an update to the 2002 recommendations on vitamin D and is specific for adults, excluding times of pregnancy and lactation.

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