Vitamin D Deficiency and Possible Role in Multiple Sclerosis

TOUCH MEDICAL MEDIA • Despite a lack of consensus, vitamin D deficiency and insufficiency have been defined as a serum level of 25-hydroxyvitamin D (25[OH]D) <50 nmol/L or 52.5–72.5 nmol/L respectively. • Vitamin D deficiency is widespread. • Vitamin D is probably involved in the prevention of numerous disease states. • Most primary care clinicians are unaware of the recommended dose for vitamin D supplementation or the optimum serum level in multiple sclerosis (MS) patients. • In the general population management of vitamin D deficiency in children and adults can be effectively achieved by administering 50,000 IU vitamin D2 or vitamin D3 once a week for 6 or 8 weeks respectively: – In the general population 600–1,000 IU/d is effective to prevent recurrence in children and 50,000 IU vitamin D3 or vitamin D2 every 2 weeks (equivalent to approximately 3,600 IU daily) in adults. This strategy maintains blood levels of 25(OH)D at approximately 100–150 nmol/L for up to 6 years with no evidence of toxicity. – In pregnant women supplementation with 2,000 and 4,000 IU/d during pregnancy improve maternal/ neonatal vitamin D status. • Considerable evidence exists for the protective effects of vitamin D in MS, with higher sun exposure and vitamin D intake associated with a lower risk of MS. • Improvement in 25(OH)D status appears to additively enhance the beneficial effects of interferon-beta. To date, this effect has not as yet been observed with glatiramer acetate. • Results from the Betaferon/Betaseron in Newly Emerging multiple sclerosis For Initial Treatment (BENEFIT) study showed that patients with vitamin D levels (25[OH]D) <50 nmol/L had more prominent clinical and MRI disease activity.