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Vitamin D and Rehabilitation: Improving Functional Outcomes
Leonid Shinchuk, MD*
Michael F. Holick, MD, PhD
* Spaulding Rehabilitation Hospital and
Boston University Medical Center, Boston,
Massachusetts
Correspondence: Correspondence: Michael F. Holick, MD, Boston University Medical Center, 715
Albany Street, M-1013, Boston, MA 02118. Electronic mail may be sent to
mfholick{at}bu.edu.
Vitamin D inadequacy is pandemic among rehabilitation patients in both
inpatient and outpatient settings. Male and female patients of all ages and
ethnic backgrounds are affected. Vitamin D deficiency causes osteopenia,
precipitates and exacerbates osteoporosis, causes the painful bone disease
osteomalacia, and worsens proximal muscle strength and postural sway. Vitamin
D inadequacy can be prevented by sensible sun exposure and adequate dietary
intake with supplementation. Vitamin D status is determined by measurement of
serum 25-hydroxyvitamin D. The recommended healthful serum level is between 30
and 60 ng/mL. 25-Hydroxyvitamin D levels of >30 ng/mL are sufficient to
suppress parathyroid hormone production and to maximize the efficiency of
dietary calcium absorption from the small intestine. This can be accomplished
by ingesting 1000 IU of vitamin D3 per day, or by taking 50,000 IU
of vitamin D2 every 2 weeks. Vitamin D toxicity is observed when
25-hydroxyvitamin D levels exceed 150 ng/mL. Identification and treatment of
vitamin D deficiency reduces the risk of vertebral and nonvertebral fractures
by improving bone health and musculoskeletal function. Vitamin D deficiency
and osteomalacia should be considered in the differential diagnosis of
patients with musculoskeletal pain, fibromyalgia, chronic fatigue syndrome, or
myositis. There is a need for better education of health professionals and the
general public regarding the optimization of vitamin D status in the care of
rehabilitation patients.
Nutrition in Clinical Practice, Vol. 22, No. 3,
297-304 (2007)
DOI: 10.1177/0115426507022003297
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