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inadequacy at serum 25OHD levels between 30 and 50 nmol/L (12 and 20 ng/mL). Practically all persons are sufficient at serum 25OHD levels of at least 50 nmol/L (20 ng/mL). Serum 25OHD concentrations above 75 nmol/L (30 ng/mL) are not consistently associated with increased benefit. There may be reason for concern at serum 25OHD levels above 125 nmol/L (50 ng/mL). Given the concern about high levels of serum 25OHD as well as the desirability of avoiding mis-classification of vitamin D deficiency, there is a critical public health and clinical practice need for consensus cut-points for serum 25OHD measures relative to vitamin D deficiency as well as excess. The current lack of evidence-based consensus guidelines is problematic and of concern because individuals with serum 25OHD levels above 50 nmol/L (20 ng/mL) may at times be classified as deficient and treated with high-dose supplements of vitamin D containing many times the levels of intake recommended by this report.

Closing Remarks

At this time, the scientific data available indicate a key role for calcium and vitamin D in skeletal health and provide a sound basis for DRIs. The data do not, however, provide compelling evidence that either nutrient is causally related to extra-skeletal health outcomes or that intakes greater than those established in the DRI process have benefits for health. The last chapter of this report specifies the research needs and reflects an urgent and worthwhile agenda. If carried out, this research will assist greatly in clarifying DRIs for vitamin D and calcium in the future.

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