{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,29]],"date-time":"2026-10-29T14:21:58Z","timestamp":1793283718672,"version":"4.5.0"},"reference-count":167,"publisher":"MDPI AG","issue":"22","license":[{"start":{"date-parts":[[2025,11,15]],"date-time":"2025-11-15T00:00:00Z","timestamp":1763164800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Nutrients"],"abstract":"<jats:p>Vitamin D (VD), due to its hormonal action, plays a crucial role in calcium homeostasis and bone metabolism, and its deficiency has been associated with musculoskeletal disorders such as osteoporosis, fractures, and osteomalacia, as well as a growing attention of chronic conditions and certain cancers. Despite its physiological relevance and widespread prevalence, particularly among older individuals, patients with chronic diseases, institutionalized populations and pregnant or lactating women, clinical approaches to diagnosing and managing vitamin D deficiency (VDD) remain heterogeneous across guidelines and healthcare settings. This reflects a lack of consensus regarding the benefits and limitations of universal versus selective screening, the definition of adequate serum concentrations, and the clinical indications for supplementation across different patient profiles. This narrative review explores key controversies in the clinical management of VDD, including current perspectives on screening strategies and target populations, indications for empirical supplementation, criteria for biochemical monitoring, and therapeutic goals in bone-related outcomes. In particular, the review discusses the rationale for adopting a 30 ng\/mL (75 nmol\/L) threshold for adequate serum 25(OH) concentrations in skeletal health, the role of vitamin D and calcium in osteoporosis treatment, and the pharmacological advantages of cholecalciferol compared to other vitamin D compounds. Through a synthesis of available evidence and expert consensus, the review aims to support clinical decision-making in the prevention and treatment of VDD and to identify areas that require further clarification or research. This review aims to support evidence-based clinical decision-making.<\/jats:p>","DOI":"10.3390\/nu17223573","type":"journal-article","created":{"date-parts":[[2025,11,18]],"date-time":"2025-11-18T11:05:31Z","timestamp":1763463931000},"page":"3573","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":21,"title":["Rethinking Vitamin D Deficiency: Controversies and Practical Guidance for Clinical Management"],"prefix":"10.3390","volume":"17","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-6845-2933","authenticated-orcid":false,"given":"Manuel","family":"Sosa-Henr\u00edquez","sequence":"first","affiliation":[{"name":"D-Evidence Working Group, Spanish Working Group on Vitamin D"},{"name":"Working Group on Osteoporosis and Bone Metabolic Diseases, Department of Medical and Surgical Sciences, University of Las Palmas de Gran Canaria, 35016 Las Palmas de Gran Canaria, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6618-7988","authenticated-orcid":false,"given":"\u00d3scar","family":"Torregrosa-Suau","sequence":"additional","affiliation":[{"name":"D-Evidence Working Group, Spanish Working Group on Vitamin D"},{"name":"Bone Metabolic Unit, Service of Internal Medicine, Hospital General y Universitario de Elche, 03203 Alicante, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0104-5633","authenticated-orcid":false,"given":"Mar\u00eda Jes\u00fas","family":"G\u00f3mez de Tejada-Romero","sequence":"additional","affiliation":[{"name":"D-Evidence Working Group, Spanish Working Group on Vitamin D"},{"name":"Department of Medicine, University of Seville, 41009 Seville, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2072-7747","authenticated-orcid":false,"given":"Mar\u00eda Jes\u00fas","family":"Cancelo-Hidalgo","sequence":"additional","affiliation":[{"name":"D-Evidence Working Group, Spanish Working Group on Vitamin D"},{"name":"University Hospital of Guadalajara, Alcal\u00e1 University, 28801 Madrid, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3730-6412","authenticated-orcid":false,"given":"Francisco Jos\u00e9","family":"Tarazona-Santabalbina","sequence":"additional","affiliation":[{"name":"D-Evidence Working Group, Spanish Working Group on Vitamin D"},{"name":"Geriatric Service, Hospital University of La Ribera, 46600 Alzira, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2426-5428","authenticated-orcid":false,"given":"I\u00f1igo","family":"Etxebarria-Foronda","sequence":"additional","affiliation":[{"name":"D-Evidence Working Group, Spanish Working Group on Vitamin D"},{"name":"Department of Orthopaedic and Trauma Surgery, 20014 Gipuzkoa, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9498-5979","authenticated-orcid":false,"given":"Guillermo Mart\u00ednez","family":"D\u00edaz-Guerra","sequence":"additional","affiliation":[{"name":"D-Evidence Working Group, Spanish Working Group on Vitamin D"},{"name":"Instituto de Investigaci\u00f3n Sanitaria IMAS 12, Hospital Universitario 12 de Octubre, University Complutense de Madrid, 28040 Madrid, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5910-5101","authenticated-orcid":false,"given":"Carmen","family":"Vald\u00e9s-Llorca","sequence":"additional","affiliation":[{"name":"D-Evidence Working Group, Spanish Working Group on Vitamin D"},{"name":"Health Center of Fuencarral, DA North, SERMAS, 28034 Madrid, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2025,11,15]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"1109","DOI":"10.1210\/er.2018-00126","article-title":"Skeletal and Extraskeletal Actions of Vitamin D: Current Evidence and Outstanding Questions","volume":"40","author":"Bouillon","year":"2019","journal-title":"Endocr. 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