Relevanz der Vitamin D-Messung in der Patientenbetreuung

Zusammenfassung

Vitamin D und seine Metaboliten sind für den Knochen- und Mineralstoffwechsel, aber auch für andere Organsysteme, von großer Bedeutung. Zur Diagnostik eines Vitamin D Mangels wird die Bestimmung des 25-hydroxyvitamin D im Serum oder Plasma verwendet. Allerdings sind die Messmethoden (Assays) nicht sehr gut standardisiert und anfällig für Störfaktoren. Überdies wird von vielen Methoden nicht nur das 25-hydroxyvitamin D erfasst, sondern auch andere Vitamin D-Metaboliten. Ein generelles Screening auf Vitamin D-Mangel wird für die allgemeine Bevölkerung nicht empfohlen, sondern nur für Risikogruppen und für ältere Menschen. Auch für Patienten mit Osteoporose wird die Messung von 25-hydroxyvitamin D nur bei V.a. Vitamin-D-Mangel und Osteomalazie empfohlen. Im Verlauf einer medikamentösen Behandlung mit Vitamin D kann bei V.a. Malabsorption oder anderen Problemen ein Monitoring von 25-hydroxyvitamin D im Therapieverlauf sinnvoll sein. Bei speziellen Fragestellung (z. B. Hypercalciämie) kann auch die Bestimmung von 1,25-dihydroxyvitamin D und 24,25-dihydroxyvitamin D notwendig sein.

ABSTRACT

Vitamin D and its metabolites are of great importance for bone and mineral metabolism and for other organs. The diagnosis of vitamin D deficiency is made by measuring 25-hydroxyvitamin D in serum or plasma. However, assay methodology is not very well standardized and may be influenced by interfering factors. Moreover, many assays do not detect only 25-hydroxyvitamin D but also other metabolites. A general screening for vitamin D deficiency in the population is not recommended, but only for people at risk and for the elderly. Accordingly, also for osteoporosis patients the measurement of 25-hydroxyvitamin D is only suggested in the case of suspected vitamin D deficiency and osteomalacia. During the course of vitamin D-treatment a monitoring of 25-hydroxyvitamin D may be useful if malabsorption or other problems are suspected. In case of special clinical situations such as hypercalcemia of unknown origin the measurement of 1,25- dihydroxyvitamin D and 24,25-dihydroxyvitamin D may be necessary.

Schlüsselwörter

Vitamin D - 25-OH-Vitamin D-Messung - Osteoporose - Osteomalazie - Patientenbetreuung

Key words

Vitamin D - 25-OH-D Measurement - osteoporosis - osteomalacia - patient care

Publication History

Received: 31 July 2023

Accepted: 10 October 2023

Article published online:
04 December 2023

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