Racial/ethnic considerations in making recommendations for vitamin D for adult and elderly men and women

Vitamin D is acquired through diet and skin exposure to ultraviolet B light. Skin production is determined by length of exposure, latitude, season, and degree of skin pigmentation. Blacks produce less vitamin D-3 than do whites in response to usual levels of sun exposure and have lower 25-hydroxyvitamin D [25(OH)D] concentrations in winter and summer. Blacks in the United States also use dietary supplements less frequently than do whites. However, blacks and whites appear to have similar capacities to absorb vitamin D and to produce vitamin D after repeated high doses of ultraviolet B light. There is a growing consensus that serum 25(OH)D concentrations of at least 75-80 nmol/L are needed for optimal bone health, on the basis of studies of older white subjects living in Europe and the United States. The studies show that increasing serum 25(OH)D concentrations to this level decreases parathyroid hormone (PTH) concentrations, decreases rates of bone loss, and reduces rates of fractures. Among US blacks, low 25(OH)D concentrations are associated with higher concentrations of PTH, which are associated with lower bone mineral density. Vitamin D supplements decrease PTH and bone turnover marker concentrations among blacks. These findings suggest that improving vitamin D status would benefit blacks as well as whites. On the basis of studies conducted in the temperate zone, the intake of vitamin D-3 needed to maintain a group average 25(OH)D concentration of 80 nmol/L in winter is similar to 1000 IU/d. Broad-based vitamin D supplementation is needed to remove vitamin D insufficiency as a contributing cause of osteoporosis.