Vitamin D management update: evidence-based guidelines for vitamin D optimization by the Egyptian Academy for bone and muscle health

Background: Vitamin D plays a crucial role in bone health, calcium homeostasis, and prevention of chronic diseases. Deficiency and insufficiency of vitamin D poses a global health concern, particularly in specific populations such as the elderly, individuals with limited sun exposure, and those with dietary restrictions. The Egyptian Academy for bone and muscle health is issuing an updated guidelines influenced by a substantial body of research conducted in recent years. For the diagnosis, prevention, and management of vitamin D deficiency. Aim of the work: To establish clear, evidence-based guidelines for healthcare professionals and the public on the why, how and when to recommend vitamin D supplementation with objectives to optimize vitamin D levels, prevent deficiency, minimize adverse effects, and inform public health policies. Results: A systematic review of 28 studies and five major international guidelines was conducted, with expert consensus recommendations was achieved through a Delphi process among experts. Key findings highlight daily intake guidelines, testing protocols, management of deficiency, and public health interventions. The role of empirical vitamin D dosing in high-risk individuals was emphasized. Key considerations include age, body weight, lifestyle, dietary habits, individual health risks as well as comorbidities. Testing is recommended for symptomatic individuals or those with specific conditions such as osteoporosis or renal impairment. The guideline highlights the role of FGF23 in high dosing of vitamin D, relation between vitamin D deficiency and fall risk, it encourages oral over intramuscular administration and discourages routine population-wide screening. Conclusion: Effective management of vitamin D levels involves tailored supplementation strategies based on individual needs and risk factors. Maintenance of serum 25(OH)D levels above 30 ng/mL is advised for optimal health outcomes. Public health efforts should focus on lifestyle modifications, safe sun exposure, and dietary education, alongside targeted supplementation for at-risk groups.