Vitamin D (25-OH-D): when to test it, and when not to
BioMG follows French guidelines. Adapt it to the guidelines and the tests available where you practise.
Testing for one of the six reimbursed indications (France)
Laboratory tests
- 25-hydroxyvitamin D (D2 + D3) (reimbursed in France)
- State the reason on the request (suspected rickets or osteomalacia, repeated falls in older people, bariatric surgery, kidney transplant more than 3 months ago, SmPC of a drug that requires it).
Also consider
- High serum calcium? For hypercalcaemia, see the page "Hypercalcaemia".
Do not order
- 1,25-dihydroxyvitamin D to assess vitamin status: it does not reflect it, 25-hydroxyvitamin D is the one to measure [3].
- 25-hydroxyvitamin D before or during supplementation: pointless according to the fee schedule (and not reimbursed in France) [2].
- 25-hydroxyvitamin D as screening, including in obese or dark-skinned people: no demonstrated benefit, the Endocrine Society advises against it [4].
- 25-hydroxyvitamin D in everyone over 65: not reasonable according to the HAS working group; in institutions, supplement without testing [3].
- 25-hydroxyvitamin D in a healthy child: screening not recommended [5].
Suspected rickets (child) or osteomalacia (adult)
Laboratory tests
- 25-hydroxyvitamin D (D2 + D3) (reimbursed in France)
- Serum calcium
- Serum phosphate
- Alkaline phosphatase
- PTH (on the same sample as the serum calcium)
- Serum creatinine with eGFR
- Serum magnesium (if serum calcium low)if neededLow calcium: for any hypocalcaemia, the PNDS (French national protocol for diagnosis and care) for hypoparathyroidism asks for calcium, magnesium and fasting PTH; hypomagnesaemia can be a curable cause of functional hypoparathyroidism [13]. See the page "Hypocalcaemia".
- IgA anti-tissue transglutaminase antibodies (tTG-IgA)if needednon-French guidelineNICE considers coeliac serology for a metabolic bone disorder, including osteomalacia [14], and the UK NOGG guideline cites it as second-line for osteoporosis or fragility fracture [12]. See the page "Coeliac disease".
- Total IgAif needednon-French guidelineNICE considers coeliac serology for a metabolic bone disorder, including osteomalacia [14], and the UK NOGG guideline cites it as second-line for osteoporosis or fragility fracture [12]. See the page "Coeliac disease".
- Sample in the morning, fasting, without haemolysis; without waiting for fasting if symptomatic hypocalcaemia requires rapid treatment.
Also consider
- Low calcium? For low serum calcium, see the page "Hypocalcaemia".
- Raised alkaline phosphatase? For isolated raised alkaline phosphatase, see the page "Raised alkaline phosphatase".
Do not order
- Screening for rickets by 25-hydroxyvitamin D, alkaline phosphatase or X-rays in the general population: not indicated; screening is based on clinical findings [5].
Sources (20)
- Assurance maladie. Convention médicale – Focus pertinence et qualité des soins : recommandation HAS du dosage de la vitamine D. Revue des dépenses (diaporama, 2023). Tableau 45 : évolution des dosages de vitamine D, d'après Cnam (SNDS-DCIR), laboratoires privés.
- Assurance maladie. Nomenclature des actes de biologie médicale (NABM), version 105 : actes 1139 (25-OH-vitamine D) et 0983 (parathormone).
- Haute Autorité de santé. Utilité clinique du dosage de la vitamine D. Rapport d'évaluation technologique, texte court, octobre 2013.
- Demay MB, Pittas AG, Bikle DD, et al. Vitamin D for the Prevention of Disease: An Endocrine Society Clinical Practice Guideline. J Clin Endocrinol Metab. 2024;109(8):1907-47.
- Munns CF, Shaw N, Kiely M, et al. Global Consensus Recommendations on Prevention and Management of Nutritional Rickets. J Clin Endocrinol Metab. 2016;101(2):394-415.
- Agence nationale de sécurité du médicament (ANSM), Agence nationale de sécurité sanitaire (ANSES). Avis complémentaire au point d'information du 27 janvier 2021 « Vitamine D chez l'enfant : recourir aux médicaments et non aux compléments alimentaires pour prévenir le risque de surdosage ».
- Souberbielle JC, Cormier C, Cavalier E, et al., au nom du Groupe de recherche et d'information sur les ostéoporoses (GRIO). Vitamin D supplementation in France in patients with or at risk for osteoporosis: recent data and new practices. Joint Bone Spine. 2020;87(1):25-29.
- Bacchetta J, Edouard T, Laverny G, et al. Vitamin D and calcium intakes in general pediatric populations: a French expert consensus paper. Arch Pediatr. 2022;29(4):312-325.
- US Preventive Services Task Force. Vitamin D Deficiency in Adults: Screening. Final Recommendation Statement, 13 avril 2021 (I).
- National Institute for Health and Care Excellence. Vitamin D: supplement use in specific population groups. Public health guideline PH56, 2014, mise à jour en 2017.
- Australian Government, Department of Health and Aged Care. Medicare Benefits Schedule, item 66833 (25-hydroxyvitamin D), en vigueur depuis le 1er novembre 2014.
- National Osteoporosis Guideline Group (Royaume-Uni). NOGG 2024: Clinical guideline for the prevention and treatment of osteoporosis. Mise à jour de décembre 2024.
- Haute Autorité de santé, Centre de référence des maladies rares du métabolisme du calcium et du phosphate. Protocole national de diagnostic et de soins (PNDS) : Hypoparathyroïdie. Mars 2025.
- National Institute for Health and Care Excellence. Coeliac disease: recognition, assessment and management. NICE guideline NG20, 2015.
- Haffner D, Emma F, Eastwood DM, et al. Clinical practice recommendations for the diagnosis and management of X-linked hypophosphataemia. Nat Rev Nephrol. 2019;15(7):435-455.
- Aljuraibah F, Bacchetta J, Brandi ML, et al. An expert perspective on phosphate dysregulation with a focus on chronic hypophosphatemia. J Bone Miner Res. 2022;37(1):12-20.
- Kanis JA, Cooper C, Rizzoli R, Reginster JY; Scientific Advisory Board of ESCEO and the Committees of Scientific Advisors and National Societies of the IOF. European guidance for the diagnosis and management of osteoporosis in postmenopausal women. Osteoporos Int. 2019;30(1):3-44.
- Agence européenne des médicaments. Fosavance (alendronate/colécalciférol) : résumé des caractéristiques du produit (information produit EPAR), rubrique 4.4, consulté le 12/10/2026.
- Agence européenne des médicaments. Aclasta (acide zolédronique) : résumé des caractéristiques du produit (information produit EPAR), rubrique 4.4, consulté le 12/10/2026.
- Agence européenne des médicaments. Prolia (dénosumab) : résumé des caractéristiques du produit (information produit EPAR), rubrique 4.4, consulté le 12/10/2026.