Cited by 1,472Vitamin D Research StudiesBone health and osteoporosis researchVitamin K Research Studies

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Global vitamin D status and determinants of hypovitaminosis D

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on behalf of the IOF Committee of Scientific Advisors (CSA) Nutrition Working Group, Mithal, A., Wahl, D. A., Bonjour, J.-P., Burckhardt, P., Dawson-Hughes, B., Eisman, J. A., El-Hajj Fuleihan, G., Josse, R. G., Lips, P., Morales-Torres, J.·2009·Osteoporosis International

DOI 10.1007/s00198-009-0954-6

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Abstract

Unlabelled This review describes the vitamin D status in different regions of the world with the objective of understanding the scope of hypovitaminosis D and the factors related to its prevalence that may contribute to the pathogenesis of osteoporosis and fragility fractures.Introduction Vitamin D status has been linked to the pathogenesis of hip fractures as well as other skeletal and non-skeletal disorders. The purpose of this review is to provide a global perspective of vitamin D status across different regions of the world and to identify the common and significant determinants of hypovitaminosis D.Methods Six regions of the world were reviewed-Asia, Europe, Middle East and Africa, Latin America, North America, and Oceania-through a survey of published literature.Results The definition of vitamin D insufficiency and deficiency, as well as assay methodology for 25-hydroxyvitamin D or 25(OH)D, vary between studies. However, serum 25(OH)D levels below 75 nmol/L are prevalent in every region studied whilst levels below 25 nmol/L are most common in regions such as South Asia and the Middle East. Older age, female sex, higher latitude, winter season, darker skin pigmentation, less sunlight exposure, dietary habits, and absence of vitamin D fortification are the main factors that are significantly associated with lower 25(OH)D levels.Conclusion Reports from across the world indicate that hypovitaminosis D is widespread and is re-emerging as a major health problem globally.

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Result
Vitamin D levels in 87 Asian patients with cutaneous lupus erythematosus: a case-control study
Grönhagen, C. M., Tang, M., Tan, V. W. D., Tan, K. W., & Lim, Y. L. (2016) · Clinical and Experimental Dermatology · doi:10.1111/ced.12884 · Cited by 7
Dysfunctional immunometabolic effects of vitamin D deficiency, increased cardiometabolic risk. Potential epidemiological alert in America?
Rosas-Peralta, M., Holick, M. F., Borrayo–Sánchez, G., Madrid-Miller, A., Ramírez-Árias, E., & Arizmendi-Uribe, E. (2017) · Endocrinología Diabetes y Nutrición (English ed ) · doi:10.1016/j.endien.2017.04.006 · Cited by 8
An Unusual Cause of a Pancreatic Mass: Pancreatic Tuberculosis
Rehman, A., Maliyakkal, A. M., Farfar, K. L., Shaath, N. M., & Naushad, V. A. (2019) · Cureus · doi:10.7759/cureus.4732 · Cited by 7
Factors associated with the prevalence of hypovitaminosis D in pregnant women and their newborns
Blarduni, E., Arrospide, A., Galar, M., Castaño, L. A., & Mar, J. (2019) · Anales de Pediatría (English Edition) · doi:10.1016/j.anpede.2018.11.014 · Cited by 7
Vitamin D deficiency and degree of coronary artery luminal stenosis in women undergoing coronary angiography: a prospective observational study.
Morgan, C., Kyvernitakis, A., Cho, R. J., Pappas, O., Ranganathan, K., Fischer, M. R., & Srinivasan, V. (2018) · Europe PMC (PubMed Central) · Cited by 7
Vitamin D deficiency associated with reproductive factors in northern Iranian women: The PERSIAN Guilan Cohort Study (PGCS)
Joukar, F., Naghipour, M., Hassanipour, S., Asl, S. F., Pourshams, A., & Mansour‐Ghanaei, F. (2020) · Clinical Nutrition ESPEN · doi:10.1016/j.clnesp.2020.03.022 · Cited by 7
Posicionamento atual sobre vitamina D na prática clínica: Posicionamento da Associação Brasileira de Nutrologia (Abran)
Filho, D. R., Nogueira‐de‐Almeida, C. A., & Filho, A. E. D. O. (2019) · International Journal of Nutrology · doi:10.1055/s-0040-1709661 · Cited by 8
Vitamins K and D deficiency in severe motor and intellectually disabled patients
Sakai, T., Shirai, T., & Oishi, T. (2020) · Brain and Development · doi:10.1016/j.braindev.2020.09.011 · Cited by 7
Vitamin D deficiency as the primary cause of musculoskeletal complaints in patients referred to rheumatology clinic: A clinical study
Kumar, A., Gopal, H., Khamkar, K., Prajapati, P. K., Mendiratta, N., Misra, A., Vaidya, B., & Abrol, A. (2012) · Indian Journal of Rheumatology · doi:10.1016/j.injr.2012.09.003 · Cited by 7
Socioeconomic status predicts vitamin D status in a large cohort of Irish children
Scully, H. A., Laird, E. J., Healy, M., Crowley, V., Walsh, J. B., & McCarroll, K. G. (2022) · Proceedings of The Nutrition Society · doi:10.1017/s0029665122001161 · Cited by 6
From cultural dispositions to biological dimensions: a narrative review on the synergy between oral health and vitamin D through the lens of Indian habitus
Maitra, S., Behera, H. C., Bose, A., Chatterjee, D., & Bandyopadhyay, A. R. (2025) · Frontiers in Oral Health · doi:10.3389/froh.2025.1569940 · Cited by 10
“The main sources of vitamin D-sunlight and dietary intake-are heavily in ﬂ uenced by cultural practices, particularly in sun exposure and dietary habits (66, 67).”
Personalizing denosumab therapy in postmenopausal Indian women with osteoporosis: predictive role of bone turnover markers and body mass index in determining dosing interval
Jha, V., Bhadada, S. K., Pal, R., Kharbanda, C., & Rao, S. D. (2025) · Osteoporosis International · doi:10.1007/s00198-025-07703-x · Cited by 7
“ROC, receiver operating characteristic; AUC, area under the curve; CTX, C-terminal telopeptide of type I collagen dietary calcium intake, widespread vitamin D deficiency, and distinct bone remodelling dynamics [6, 7].”
Prevalence and determinants of vitamin D deficiency in Iranian children and adolescents: the CASPIAN-V study
Rastad, H., Gorabi, A. M., Qorbani, M., Seif, E., Asayesh, H., Motlagh, M. E., Heshmat, R., & Kelishadi, R. (2021) · Journal of Diabetes & Metabolic Disorders · doi:10.1007/s40200-021-00757-8 · Cited by 6
Seasonal variation and Vitamin-D status in ostensibly healthy Indian population: An experience from a tertiary care institute
Sreenivasulu, K., Banerjee, M., Tomo, S., Shukla, K., Selvi, M. K., Garg, M. K., Banerjee, S., Sharma, P., & Shukla, R. K. G. (2024) · Metabolism Open · doi:10.1016/j.metop.2024.100298 · Cited by 6
“Furthermore, across Europe, Latin America, North America, Asia, the Middle East, and Oceania, a seasonal variance in 25(OH)D levels and a significant tendency for hypovitaminosis D are higher in the winter months for all age groups [11].”
Background
Nutrient Intakes in Vegans, Lacto-Ovo-Vegetarians, Orthodox Fasters, and Omnivores in Russia: A Cross-Sectional Study
Galchenko, A. V., Rizzo, G., & Baroni, L. (2025) · Foods · doi:10.3390/foods14061062 · Cited by 6
Severe Osteomalacia with Dent Disease Caused by a Novel Intronic Mutation of the CLCN5 gene
Matsumoto, A., Matsui, I., Mori, T., Sakaguchi, Y., Mizui, M., Ueda, Y., Takahashi, A., Doi, Y., Shimada, K., Yamaguchi, S., et al. (2018) · Internal Medicine · doi:10.2169/internalmedicine.1272-18 · Cited by 6
Vitamin D deficiency in long‐term hospitalization psychiatric wards in an equatorial nation
Suri, T., Suri, S., Poremski, D., Fang, T., & Su, A. (2020) · Asia-Pacific Psychiatry · doi:10.1111/appy.12390 · Cited by 6
“While exposure to sunlight is a major source of vitamin D, variations exist even within zones of high sun intensity (Chailurkit, Aekplakorn, & Ongphiphadhanakul, 2011; Mithal et al., 2009), and studies document no appreciable effect of latitude, but highlight possible racial differences linked to skin pigmentation (Ha…”
BackgroundInfluential
Viral Infections and Nutrition: Influenza Virus as a Case Study
Green, W. D., Karlsson, E. A., & Beck, M. A. (2020) · Springer eBooks · doi:10.1007/978-3-030-56913-6_5 · Cited by 6
Association of two types of dietary pattern scores with cardiovascular disease risk factors and serum 25 hydroxy vitamin D levels in Saudi Arabia
Aljefree, N. M., Almoraie, N. M., & Shatwan, I. M. (2021) · Food & Nutrition Research · doi:10.29219/fnr.v65.5481 · Cited by 7
Global View of Per Capita Daily Vitamin D Supply Estimates as Proxy Measures for Vitamin D Intake Data
Cashman, K. D. (2021) · JBMR Plus · doi:10.1002/jbm4.10547 · Cited by 7
Atmospheric pollution and solar ultraviolet radiation in Asia
Singh, S., Mishra, A. K., Jose, S., & Lodhi, N. K. (2021) · Elsevier eBooks · doi:10.1016/b978-0-12-816693-2.00004-4 · Cited by 6
Knowledge and Attitudes towards Vitamin D among Health Educators in Public Schools in Jeddah, Saudi Arabia: A Cross-Sectional Study
Hamhoum, A. S., & Aljefree, N. M. (2022) · Healthcare · doi:10.3390/healthcare10122358 · Cited by 6
Melanin levels in relation to vitamin D among first-generation immigrants from different ethnic groups and origins: A comparative national Canadian cross-sectional study
Yousef, S., Papadimitropoulos, M., Faris, M. E., Hasan, H. A., Hossain, A., Colman, I., Manuel, D. G., & Wells, G. A. (2023) · Frontiers in Medicine · doi:10.3389/fmed.2022.992554 · Cited by 6
Cholecalciferol Supplementation Induced Up-Regulation of SARAF Gene and Down-Regulated miR-155-5p Expression in Slovenian Patients with Multiple Sclerosis
Gselman, S., Fabjan, T. H., Bizjak, A., Potočnik, U., & Gorenjak, M. (2023) · Genes · doi:10.3390/genes14061237 · Cited by 7
“is responsible for maintaining the extracellular calcium concentrations by controlling the absorption of calcium and by directly exerting effects on bone and parathormone secretion [41].”
Background
The structural and functional dynamics of vitamin D and its receptor with their associated genes targeting diseases
Balaji, H., & Logesh, R. (2023) · Obesity Medicine · doi:10.1016/j.obmed.2023.100508 · Cited by 7
The effectiveness of vitamin D3 supplementation in improving functional outcome of non-surgically treated symptomatic lumbar spinal stenosis: Randomized controlled clinical trial – Pilot study
Ko, S., Kim, H. C., & Kwon, J. (2023) · Medicine · doi:10.1097/md.0000000000032672 · Cited by 6
Factors Associated with Vitamin D Deficiency and Their Relative Importance among Indian Adolescents: An Application of Dominance Analysis
Mustafa, A., & Shekhar, C. (2023) · International Journal of Endocrinology · doi:10.1155/2023/4209369 · Cited by 6
Seasonal Serum 25(OH) Vitamin D Level and Reproductive or Immune Markers in Reproductive-Aged Women with Infertility: A Cross-Sectional Observational Study in East Japan
Ota, K., Mitsui, J., Katsumata, S., Takayanagi, Y., Nako, Y., Tajima, M., Komiya, A., Takahashi, T., & Kawai, K. (2023) · Nutrients · doi:10.3390/nu15245059 · Cited by 6
“As the results of future research on vitamin D and reproduction accumulate with well-designed interventional studies, a re-examination of the current periconceptual screening and treatment guidelines may be warranted.”
BackgroundInfluential
Persistence of vitamin D deficiency among Italian patients with acute myocardial infarction
Aleksova, A., Janjusevic, M., Zhou, X. N. O., Zandonà, L., Chicco, A., Stenner, E., Beltrami, A. P., D’Errico, S., Sinagra, G., Marketou, M. E., et al. (2024) · Nutrition Metabolism and Cardiovascular Diseases · doi:10.1016/j.numecd.2024.02.007 · Cited by 6
Causal effect of serum 25 hydroxyvitamin D concentration on cardioembolic stroke: Evidence from two-sample Mendelian randomization
Habibi, D., Teymoori, F., Ebrahimi, N., Fateh, S. T., Bonab, L. N. H., Saeidian, A. H., Taloubaghi, A. S., Asgarian, S., Hosseinpanah, F., Hakonarson, H. H., et al. (2024) · Nutrition Metabolism and Cardiovascular Diseases · doi:10.1016/j.numecd.2024.02.013 · Cited by 6
Vitamin D Efficiency in Pregnancy: An Updated Viewpoint in Indian Scenario
Maladkar, M. N., Sankar, S., & Kamat, K. (2015) · International Journal of Clinical Medicine · doi:10.4236/ijcm.2015.63026 · Cited by 6
¿Cómo utilizar la vitamina D y qué dosis de suplementación sería la más idónea para tener el mejor balance eficacia/seguridad?
del Pliego, E. T., & Nogués, X. (2014) · Revista de Osteoporosis y Metabolismo Mineral · doi:10.4321/s1889-836x2014000500001 · Cited by 6
The potential of eHealth Apps to Support Targeted Complex Health Messages
Heffernan, K. J. (2014) · Journal of General Practice · doi:10.4172/2329-9126.1000182 · Cited by 5
“[14] found that advice patients received differed from expert recommendations.”
BackgroundResultInfluential
Farming, Foreign Holidays, and Vitamin D in Orkney
Weiss, E., Zgaga, L., Read, S. H., Wild, S. H., Dunlop, M. G., Campbell, H., McQuillan, R., & Wilson, J. F. (2016) · PLoS ONE · doi:10.1371/journal.pone.0155633 · Cited by 6
Association between Vitamin D Status and Cardio-Metabolic Risk Factors among Adults with and without Coronary Heart Disease in Saudi Arabia
Aljefree, N. M., Lee, P. J., Saqqaf, J. M. A., & Ahmed, F. (2016) · Journal of Diabetes & Metabolism · doi:10.4172/2155-6156.1000707 · Cited by 6
Association of Sunlight Exposure and Consumption of Vitamin D-Rich Foods During Pregnancy with Adverse Birth Outcomes in an African Population
Balogun, H., Jaakkola, J. J. K., & Amegah, A. K. (2019) · Journal of Tropical Pediatrics · doi:10.1093/tropej/fmz001 · Cited by 6
Assessment of alveolar bone mass using radio morphometric indices in urban and rural postmenopausal women and their correlation with serum vitamin D3 level
Chowdhury, R., Nasreen, S., Ramesh, D. S. V., Rukmangada, T., Bayatnal, A., Kattimani, S., & Saba, R. (2019) · Indian Journal of Dental Research · doi:10.4103/ijdr.ijdr_369_18 · Cited by 6
Prediction models and questionnaires developed to predict vitamin D status in adults: a systematic review
Naureen, G., Sanders, K. M., Busija, L., Scott, D. S., Lim, K., Talevski, J., Connaughton, C., & Brennan-Olsen, S. L. (2020) · Osteoporosis International · doi:10.1007/s00198-020-05539-1 · Cited by 7
COVID-19: the older adult and the importance of vitamin D sufficiency
O’Shea, P. M., Griffin, T. P., Brennan, M., & Mulkerrin, E. C. (2020) · Journal of Nutritional Science · doi:10.1017/jns.2020.36 · Cited by 6
“Vitamin D deficiency is a major global health problem((46,47)), worse in Northern latitudes((21,48)) without good programmes for supplementation of vitamin D or fortification of foodstuffs, as occurs in some Nordic countries with reduced mortality from COVID-19((49)).”
Background
Actualités sur la vitamine D
Souberbielle, J. (2013) · Cahiers de Nutrition et de Diététique · doi:10.1016/j.cnd.2013.01.001 · Cited by 6
The effect of standard-dose wintertime vitamin D supplementation on influenza infection in immunized nursing home elderly residents
Hauptman, A. G., Lukić-Grlić, A., Vraneš, J., Milošević, M., & Gagro, A. (2021) · Croatian Medical Journal · doi:10.3325/cmj.2021.62.495 · Cited by 6
Association between serum 25-hydroxyvitamin D and physical performance measures in middle-aged and old Japanese men and women: The Unzen study
Uchiyama, M., Mizukami, S., Arima, K., Nishimura, T., Tomita, Y., Abe, Y., Tanaka, N., Honda, Y., Goto, H., Hasegawa, M., et al. (2021) · PLoS ONE · doi:10.1371/journal.pone.0261639 · Cited by 6
“Serum 25(OH)D concentrations tended to be lower in women than in men [14].”
Background

Authors: on behalf of the IOF Committee of Scientific Advisors (CSA) Nutrition Working Group, Mithal, A., Wahl, D. A., Bonjour, J.-P., Burckhardt, P., Dawson-Hughes, B., Eisman, J. A., El-Hajj Fuleihan, G., Josse, R. G., Lips, P., & Morales-Torres, J.
Affiliations: Indraprastha Apollo Hospitals (IN)
International Osteoporosis Foundation (CH)
University of Geneva (CH)
Hirslanden Clinique Bois-Cerf (CH)
Garvan Institute of Medical Research (AU)
St. Michael's Hospital (CA)
Amsterdam UMC Location Vrije Universiteit Amsterdam (NL)
Corresponding author: Mithal, A.
ORCID: Mithal, A.
Burckhardt, P.
Eisman, J. A.
Josse, R. G.
Lips, P.
Venue: Osteoporosis International
Publisher: Springer Science and Business Media LLC
Published: 2009-06-19
Volume: 20
Issue: 11
Pages: 1807-1820
ISSN: 0937-941X (ISSN-L)
1433-2965
DOI: 10.1007/s00198-009-0954-6
OpenAlex: W2106647095
Cited by: 1,472
References: 156
Citations by year: 2026: 31 · 2025: 49 · 2024: 63 · 2023: 67 · 2022: 87 · 2021: 97 · 2020: 103 · 2019: 93 · 2018: 99 · 2017: 103 · 2016: 100 · 2015: 116 · 2014: 121 · 2013: 123 · 2012: 94
FWCI: 8.67
Type: journal article
Language: en
Open access: green
research.vumc.nl
Licence: other-oa
www.springer.com/tdm (tdm)
Locations: Osteoporosis International (publishedVersion)
PubMed (publishedVersion)
Archive ouverte UNIGE (University of Geneva) (publishedVersion)
Amsterdam UMC (VU Amsterdam) - Institutional Repository (submittedVersion, other-oa)
Digital Academic REpository of VU University Amsterdam (Vrije Universiteit Amsterdam) (submittedVersion)
Pure Amsterdam UMC (submittedVersion, other-oa)
Archive ouverte UNIGE (University of Geneva) (submittedVersion, cc-by)
Data Archiving and Networked Services (DANS) (submittedVersion, other-oa)
Funders: International Osteoporosis Foundation
Topics: Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Vitamin D Research Studies
Health Sciences › Medicine › Orthopedics and Sports Medicine › Bone health and osteoporosis research
Health Sciences › Nursing › Nutrition and Dietetics › Vitamin K Research Studies
Keywords: vitamin D status, vitamin D deficiency, 25-hydroxyvitamin D, osteoporosis, fragility fractures, hip fracture, risk factors, sun exposure, skin pigmentation, latitude, seasonal variation, dietary habits, vitamin D fortification, global prevalence
MeSH terms: Adolescent, Adult, Age Factors, Aged, Child, Child, Preschool, Cross-Cultural Comparison, Female, Humans, Infant, Infant, Newborn, Male, Middle Aged, Risk Factors, Sex Factors, Vitamin D, Vitamin D Deficiency, Global Health, Prevalence, Genetic Predisposition to Disease, Young Adult

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Global vitamin D status and determinants of hypovitaminosis D

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