In recent times, vitamin D has acquired a certain charm, and many people and doctors recommend it even to those who do not suffer from deficiencies. This discrepancy in criteria has led bone health experts to advocate for unified agreement on the appropriate dosage, target population, and when supplementation is necessary.

"The right thing is to look for the deficiency in specific cases and, when it is detected, correct it, but generalized, no; not everyone; Preventively, no. Coffee for everyone, no. You have to specify and select who," says Manuel Sosa, Professor of Medicine at the University of Las Palmas de Gran Canaria and head of the Bone Metabolic Unit of the Insular University Hospital.

Traditionally, and until not long ago, it was thought that the only utility of vitamin D, which this expert prefers to call hormone D, was to help mineralize bone in cases of osteoporosis and that its lack produced bone diseases such as osteomalacia or rickets.

However, knowledge about it has grown exponentially in recent years and it is already known that, in addition to bone, it acts "in practically all cells of the body"; are the so-called extra-skeletal effects of vitamin D and that "are enormous", since they go from the field of immunity to infectious and cardiovascular diseases, muscle pathologies, falls, etc.

As knowledge about it has increased, associations with diseases have been found, so that vitamin D deficiency has been linked to autism, dementia, heart attack, hypertension, diabetes, multiple sclerosis, colon cancer, and so on "up to 200 more".

"But association does not mean causation: that a certain deficiency is associated with a disease does not mean that that deficiency causes the disease, it is often a consequence rather than a cause," Sosa points out.

And what has happened, he continues, is that "that has been misinterpreted" by professionals, to whom this association between deficit and disease has led them to think that, if the first is corrected, the second is improved.

"The culmination of this was covid", when numerous scientific articles published especially the first year of the pandemic pointed to a higher number of admissions and mortality in patients with deficiency of this vitamin, who improved after receiving a vitamin D supplement.

However, Sosa again specifies that this does not mean that it was a treatment against covid, but that the deficit of a vitamin that in any case "must have optimal stable levels" in blood was being corrected; The correction did not lead to that optimal state, but it did lead to normal.

What is the difference between the two? Well, there is no clear answer: normal values vary according to age, geographical area and seasonality, and optimal values are associated with the prevention of disease or adverse event such as fractures.

What is desirable, be that as it may, is between 20 and 40 nanograms of vitamin D per milliliter of blood. "Giving more doesn't help," says the doctor.

However, "now everyone is asking for vitamin D, everyone prescribes vitamin D, and that's not right." The problem is the huge disparity that exists about who should take vitamin D, in what doses, and at what levels.

The Spanish Society of Internal Medicine (Semi), which this week held its XI meeting of Osteoporosis in which Sosa has participated, will prepare a clinical guide, although this expert already advances that he advocates selecting deficient patients, who are elderly, who do not leave home, who do not catch sun and who have had osteoporosis or a fracture.

"

Looking for deficits in healthy people is not worth it, it is necessary to individualize seeing it in patients according to their lower sun exposure, their lower mobility, the coexistence of other diseases. What you have to do is play 7 and a half, not go over or fall short, but identify people at risk. This is haute couture, not 'Prêt-à-porter', every person needs their tailor-made suit."

Because the deficit is as bad as the excess: "You can fall into a hypervitaminosis, which at the outset causes a paradoxical effect, and is a greater number of falls", as well as hypercalcemia and hypercalciuria, which is the increase in calcium in blood and urine.

Several experts gathered at the meeting on osteoporosis of the Semi, such as Guillermo Martínez Díaz, president of the Spanish Society of Bone Research and Mineral Metabolism (SEIOMM), head of the Endocrinology service of the Doce de Octubre University Hospital, agreed on all this.

"The vitamin D soufflé is going down. We are in a phase in which we must reflect on what it is really for and not lose focus on which patients we should treat, "said the doctor, who concluded by appealing to his colleagues to finally find a consensus on his indication.

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