Does vitamin D supplementation alter outcomes? Although there is considerable debate over the definitions, Vitamin D deficiency is defined by the Endocrine Society as a level < 20 ng/ml while Vitamin D insufficiency is defined as a level of 21–29 ng/ml. [43] Applying these definitions, the occurrence of vitamin D insufficiency in the general population is as high as 50 to 80%. [44] A systematic review of studies examining Vitamin D levels and outcomes after surgery reported that the majority (but not all) the studies showed significantly worse outcome in patients with low vitamin D status. [45] In a small study, preoperative supplementation of Vitamin D in spine surgery patients decreased inflammation and the intensity of pain after surgery. [46] Vitamin D supplementation might also play an important role in prevention of skeletal muscle injuries following exercise. [47, 48] What is the suggested dose of Vitamin D? The Food and Nutrition Board at the National Academies of Sciences, Engineering, and Medicine has established that the maximum daily intake unlikely to cause adverse health effects (i.e. upper limit) for adults older than 18 years is 100 micrograms or 4000 International Units. [39]
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