Hopp til innhold
NHI.no
Annonse

Vitamin D-mangel: Diagnosen

Innhold i artikkelen

Uten tilskudd av D-vitamin vil de fleste som oppholder seg i Norden utvikle vitamin D-mangel i løpet av vinterhalvåret. Derfor anbefales det å ta tilskudd som forebyggende behandling (se under). Måling av vitamin D anbefales kun for risikogrupper og personer med symptomer. 

Annonse

D-vitamin-mangel gjennom lengre tid rammer i første rekke muskler og skjelett. Muskelplager viser seg ved tretthet og muskelverk. I uttalte tilfeller kan muskulaturen bli så svak at man ikke klarer å gå trapper eller reise seg fra en stol. Beinsmerter er sjeldnere og begynner typisk over veikryggen og sprer seg senere til bekken, hofter, lår, rygg og brystkassen. Symptomene kan ledsages av depressive tanker og følelse av maktesløshet. Plagene kan da lett mistolkes som forårsaket av psykisk sykdom (somatisering). Disse symptomene forsvinner med D-vitamin-behandling.

Diagnosen stilles ved å måle mengden av D-vitamin i blodet. Dersom det påvises lave verdier, vil legen ta noen flere blodprøver for å kartlegge tilstanden. 

Vil du vite mer

Dette dokumentet er basert på det profesjonelle dokumentet Vitamin D-mangel . Referanselisten for dette dokumentet vises nedenfor

  1. Bakke Å, Tazmini K, Pretorius M, Lima K. Vitamin D-mangel. Nasjonal veileder i endokrinologi. Versjon 1.10. Dato publisert 05.03.2021. www.endokrinologi.no
  2. Holick MF. Vitamin D deficiency. BestPractice, last reviewed 12 Sep 2020.
  3. Legeforeningen. Gjør kloke valg. Fagmedisinske anbefalinger. Norsk forening for medisinsk biokjemi. Siden besøkt 10.03.2021 www.legeforeningen.no
  4. Lips P. Vitamin D deficiency and secondary hyperparathyroidism in the elderly: consequences for bone loss and fractures and therapeutic implica- tions. Endocrine Reviews 2001; 22: 477-501. PubMed
  5. Knutsen KV, Brekke M, Gjelstad S, Lagerløv P. Vitamin D status iin patients wuth musculoskeletal pain and headache: A cross-sectional descriptive study in a multi-ethnic general practice in Norway. Scand J Prim Health Care 2010; 28: 166-71. PubMed
  6. Brembech P, Winkvist A, Olausson H. Determinants of vitamin D status in pregnant fair-skinned women in Sweden. Br J Nutr 2013; 110: 856-64. pmid:23388180 PubMed
  7. Holick MF, Brinkley NC, Bischoff-Ferrari HA, et al. Evaluation, treatment, and prevention of vitamin D deficiency: an Endocrine Society clinical practice guideline. J Clin Endocrinol Metab 2011;96:1911-1930. PubMed
  8. Holick MF. Vitamin D deficiency. N Engl J Med 2007; 357: 266-81. PubMed
  9. Kennel KA, Drake MT, Hurley DL. Vitamin D deficiency in adults: when to test and how to treat. Mayo Clin Proc. 2010;85(8):752-758. PMID: 20675513. PubMed
  10. Holick MF, Siris ES, Binkley N, et al. Prevalence of vitamin D inadequacy among postmenopausal North American women receiving osteoporosis therapy. J Clin Endocrinol Metab 2005; 90: 3215-24. PubMed
  11. Holick MF. Resurrection of vitamin D deficiency and rickets. J Clin Invest 2006; 116: 2062-72. PubMed
  12. DeLuca HF. Overview of general physiologic features and functions of vitamin D. Am J Clin Nutr 2004; 80(Suppl): 1689-96.
  13. Lehmann U, Hirche F, Stangl GI, et al. Bioavailability of vitamin D2 and D3 in healthy volunteers, a randomized placebo-controlled trial. J Clin Endocrinol Metab 2013; 98: 4339. doi:10.1210/jc.2012-4287 DOI
  14. Heaney RP, Dowell MS, Hale CA, Bendich A. Calcium absorption varies within the reference range for serum 25-hydroxyvitamin D. J Am Coll Nutr 2003; 22: 142-6. PubMed
  15. Mosekilde L, Nielsen LR, Larsen ER, Moosgaard B, Heickendorff L. Vitamin D-mangel. Definition og prævalens i Danmark. Ugeskr Læger 2005; 167: 29-34. Ugeskrift for Læger
  16. Melhus H, Snellman G, Gedeborg R, et al. Plasma 25-hydroxyvitamin D levels and fracture risk in a community-based cohort of elderly men in Sweden. J Clin Endocrinol Metab 2010; 95: 2637-45. PubMed
  17. Shah S, Chiang C, Sikaris K, et al. Serum 25-hydroxyvitamin D insufficiency in search of a bone disease. J Clin Endocrinol Metab 2017; 102: 2321-8. doi:10.1210/jc.2016-3189 DOI
  18. Chung M, Lee J, Terasawa T, et al. Vitamin D with or without calcium supplementation for prevention of cancer and fractures: An updated meta-analysis for the U.S. preventive services task force. Ann Intern Med 2011; 155: 827-38. PMID: 22184690 PubMed
  19. Stewart JW, Alekel DL, Ritland LM, et al. Serum 25-hydroxyvitamin D is related to indicators of overall physical fitness in healthy postmenopausal women. Menopause 2009; 16: 1093-101. PubMed
  20. Bischoff-Ferrari HA, Dawson-Huhges B, Staehelin OB, et al. Fall prevention with supplemental and active form of vitamin D: meta-analysis of randomised controlled trials. BMJ 2009; 339: b3692. BMJ (DOI)
  21. Boonon S, Lips P, Bouillon R, et al. Need for aditional calcium to reduce the risk of hip fracture with vitamin d supplementation: evidence from a comparative meta analysis of randomised controlled trials. J Clin Endocrinol Metab 2007; 92: 1415-23. PubMed
  22. Hey H, Schmedes A, Horn P, Brandslund I. Vitamin D-mangel. Ugeskr Læger 2009; 171: 2179. Ugeskrift for Læger
  23. Melamed ML, Michos ED, Post W, et al. 25-hydroxyvitamin D levels and the risk of mortality in the general population. Arch Intern Med 2008; 168: 1629-37. PubMed
  24. Grant WB. An ecologic study of dietary and solar ultraviolet-B links to breast carcinoma mortality rates. Cancer 2002; 94: 272-81. PubMed
  25. Theodoratou E, Tzoulaki I, Zgaga L, Ioannidis JPA. Vitamin D and multiple health outcomes: umbrella review of systematic reviews and meta-analyses of observational studies and randomised trials. BMJ 2014; 348: g2035. PubMed
  26. Chowdhury R, Kunutsor S, Vitezova A, et al. Vitamin D and risk of cause specific death: systematic review and meta-analysis of observational cohort and randomised intervention studies. BMJ 2014; 348: g1903. BMJ (DOI)
  27. Lagunova Z, Porojnicu AC, Lindberg F, Hexeberg S, Moan J. The dependency of vitamin D status on body mass index, gender, age and season. Anticancer Res 2009: 29: 3713–3720
  28. Bischoff-Ferrari HA, Giovannucci E, Willett WC, Dietrich T, Dawson-Hughes B. Estimation of optimal serum concentrations of 25-hydroxyvitamin D for multiple health outcomes. Am J Clin Nutr 2006; 84: 18-28. PubMed
  29. Jacobsen AT, Mosekilde L. D-vitamin-mangel hos etniske minoriteter. Ugeskr Læger 2005; 167: 33-4. PubMed
  30. Aloia J, Mikhail M, Dhaliwal R, et al. Free 25(OH)D and the Vitamin D paradox in african americans. J Clin Endocrinol Metab 2015; 100: 3356-63. pmid:26161453 PubMed
  31. LeFevre ML, LeFevre NM. Vitamin D Screening and Supplementation in Community-Dwelling Adults: Common Questions and Answers. Am Fam Physician. 2018;97(4):254-260. PMID: 29671532. PubMed
  32. Nordic Nutrition Recommendations 2012. Integrating nutrition and physical activity. Utgitt 11.03.2014. www.norden.org
  33. Scragg R, Khaw K-T, Toop L, et al. Monthly High-Dose Vitamin D Supplementation and Cancer Risk A Post Hoc Analysis of the Vitamin D Assessment Randomized Clinical Trial. JAMA Oncology 2018. doi:10.1001/jamaoncol.2018.2178 DOI
  34. Reid IR, Bolland MJ, Grey A. Effects of vitamin D supplements on bone mineral density: a systematic review and meta-analysis. Lancet 2013. doi:10.1016/S0140-6736(13)61647-5 DOI
  35. Rosendahl J, Valkama S, Holmlund-Suila E, et al. Effect of Higher vs Standard Dosage of Vitamin D3 Supplementation on Bone Strength and Infection in Healthy Infants: A Randomized Clinical Trial. JAMA Pediatr. 2018. PMID: 29813149 PubMed
  36. Bjelakovic G, Gluud LL, Nikolova D, et al. Vitamin D supplementation for prevention of mortality in adults. Cochrane Database Syst Rev. 2014; 1: CD007470. PMID: 24414552 PubMed
  37. Martineau AR, Jolliffe DA, Hooper RL, et al. Vitamin D supplementation to prevent acute respiratory tract infections: systematic review and meta-analysis of individual participant data. BMJ. 2017; PMID: 28202713 PubMed
  38. Aglipay M, Birken CS, Parkin PC, et al. Effect of High-Dose vs Standard-Dose Wintertime Vitamin D Supplementation on Viral Upper Respiratory Tract Infections in Young Healthy Children. JAMA 2017; 318: 245-54. pmid:28719693 PubMed
  39. Li G, Mbuagbaw L, Samaan Z, et al. Efficacy of vitamin D supplementation in depression in adults: a systematic review. J Clin Endocrinol Metab 2014; 99: 757. pmid:24423304 PubMed
  40. Hansen KE, Johnson RE, Chambers KR, et al. Treatment of Vitamin D Insufficiency in Postmenopausal Women: A Randomized Clinical Trial. JAMA Intern Med. 2015. DOI: 10.1001/jamainternmed.2015.3874 DOI
  41. LeFevre ML. Screening for vitamin D deficiency in adults: U.S. Preventive Services Task Force Recommendation Statement. Ann Intern Med 2014. doi:10.7326/M14-2450 DOI
  42. Tripkovic L, Wilson LR, Hart K. Daily supplementation with 15 mg vitamin D2 compared with vitamin D3 to increase wintertime 25-hydroxyvitamin D status in healthy South Asian and white European women: a 12-wk randomized, placebo-controlled food-fortification trial.’ Am J Clin Nutr. 2017 Aug;106(2):481-490. Doi: 10.3945/ajcn.116.138693 DOI
  43. Helsedirektoratet. Spedbarnsernæring. Anbefalinger for tilførsel av energi og næringsstoffer til spedbarn 6-11 måneder. www.helsedirektoratet.no
  44. Sanders KM, Stuart AL, Williamson EJ, et al. Annual high-dose oral vitamin D and falls and fractures in older women. A randomized controlled trial. JAMA 2010; 303: 1815-22. PubMed
  45. Webb AR. Who, what, where and when-influences on cutaneous vitamin D synthesis. Prog Biophys Mol Biol 2006; 92: 17-25. PubMed
  46. Den norske legeforening. Nyheter 2019. Solarium uegnet som kilde til vitamin D. www.legeforeningen.no
  47. Budhathoki S. Plasma 25-hydroxyvitamin D concentration and subsequent risk of total and site specific cancers in Japanese population: Large case-cohort study within Japan Public Health Center-based Prospective Study cohort. BMJ 2018; 360: k671. pmid:29514781 PubMed
  48. Lappe J, Watson P, Gravers-Gustafson D, et al. Effect of vitamin D and calcium supplmentation on cancer incidence in older women. A randomized trial. JAMA 2017; 317: 1234-43. doi:10.1001/jama.2017.2115 DOI
  49. Zhu K, Austin N, Devine A, et al. A randomized controlled trial of the effects of vitamin D on muscle strength and mobility in older women with vitamin D insufficiency. J Am Geriatr Soc 2010; 58: 2063-8. PubMed
  50. Muir SW, Montero-Odasso M. Effect of vitamin D supplementation on muscle strength, gait and balance in older adults: a systematic review and meta-analysis. J Am Geriatr Soc 2011; 59: 2291-300. PubMed
Annonse
Annonse