Sinn und Unsinn der Vitamin-D- Bestimmung

M. E. Kraenzlin; C. Meier

doi:10.1055/s-0037-1622070

Osteologie, Table of Contents

Osteologie 2015; 24(04): 225-230
DOI: 10.1055/s-0037-1622070

Labordiagnostik bei metabolischen Knochenerkrankungen

Schattauer GmbH

Sinn und Unsinn der Vitamin-D- Bestimmung

Analytische Bestimmung von Vitamin D, optimaler Status und SupplementationCurrent status on 25(OH) vitamin D measurementtarget levels and supplementation

M. E. Kraenzlin

¹Endonet Basel, Schweiz

,

C. Meier

¹Endonet Basel, Schweiz

²Klinik für Endokrinologie, Diabetologie und Metabolismus Universitätsspital Basel, Schweiz

› Author Affiliations

Abstract

Zusammenfassung

In den letzten Jahren ist das Interesse an Vitamin D stark gestiegen, dies aufgrund der nachgewiesenen Wirkung von Vitamin D auf den Mineralstoffwechsel und die neuromuskulären Funktionen, aber auch aufgrund anderer, pleiotroper Effekte. Die Konsequenz dieses gesteigerten Interesses spiegelt sich in der zunehmenden Verordnung für die Bestimmung des 25(OH)-Vitamin-D-Spiegels wider, um den Vitamin-D-Versorgungsstatus zu erfassen und um über eine allfällige Vitamin-D-Supplementation zu entscheiden. Die 25(OH)D-Messung wird aber durch verschiede Faktoren beeinflusst. Einerseits die Variabilität und die Tatsache, dass andere Vitamin-D-Metaboliten, wie das 3-epimer von 25(OH)D einen gemessenen Wert für das 25(OH)D beeinflussen können. Ein weiterer Störfaktor für die 25(OH)D-Bestimmung kann der Vitamin-D-Metabolit 24,25(OH)₂-D sein. Aufgrund dieser Interferenzen und Variabilität der Vitamin-D-Bestimmung ist es nicht erstaunlich, dass unterschiedliche Assays auch unterschiedliche 25(OH)D-Resultate ergeben, was es schwierig macht, einen genauen Schwellenwert für den Vitamin-D-Mangel bzw. für die Vitamin-D-Insuffizienz zu definieren. Aus diesem Grunde sind auch Anstrengungen im Gange, die Vitamin-D-Bestimmung zu standardisieren. Eine liberale Anwendung einer 25(OH)D-Messung ist nicht zu empfehlen. Es scheint aber vernünftig bei Patienten, die ein erhöhtes Risiko für einen Vitamin-D-Mangel, ein erhöhtes Sturz- oder Frakturrisiko aufweisen, das 25(OH)D zu bestimmen.

Summary

Over the past years interest in vitamin D is growing because of its effect on bone and neuromuscular function and more recently because of its pleitropic effects. Measurement of circulating 25(OH)D concentration is accepted as the best clinical indicator of an individual’s vitamin D status. As such, 25(OH)D measurement is increasingly being obtained by clinicians who utilize this value to assess a patients vitamin D status, and subsequently make decisions regarding supplementation. However, 25(OH)D measurements are affected by other vitamin D metabolites such as the 3-epimer of 25(OH)D and 24,25(OH)₂D. A substantial within assay variation in 25(OH)D measurement and between-assay variability has been recognized. Furthermore, existing 25(OH)D assays may include other vitamin D metabolites such as the 3-epimer of 25(OH)D and 24,25(OH)₂D. This assay variation confounds attempts to define what constitutes the diagnosis of vitamin D deficiency. Efforts to standardize vitamin D measurement are ongoing. Liberal 25(OH)D measurements are not recommended. However, it does seem reasonable to measure 25(OH)D in those patients identified as being at risk for vitamin D deficiency and in those at risk for falls and fractures.

Schlüsselwörter

Vitamin D - 25(OH)D-Messung - Assay-Variabilität - Vitamin-D-Mangel - Vitamin-D-Supplementation

Keywords

Vitamin D - 25(OH) measurement - assay variability - vitamin D deficiency - vitamin D supplementation

Full Text

References

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