Evidence map›Paper›PMID 40268771›Full record

GuidelineOsteoporosis international : a journal established as result of cooperation between the European Foundation for Osteoporosis and the National Osteoporosis Foundation of the USA2025

The Lebanese GRADE-based vitamin D guidelines: a paradigm for the MENA region.

Marlene Chakhtoura, Elie Akl, Asma Arabi, Hala Ahmadieh, Stephanie Antoun, Paola Atallah, Rafic Baddoura, Maya Barake, Roger Bouillon, Peter Ebeling and 12 more

Abstract readSystematic ReviewPractice Guideline
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In one paragraph

Guideline in Osteoporosis international : a journal established as result of cooperation between the European Foundation for Osteoporosis and the National Osteoporosis Foundation of the USA, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 2 papers.

0numbers the graph read from it
0cells of the map it votes in
2citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

2 citing papers in PubMed.

  1. Article
  2. Article
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

22 authors.

Marlene ChakhtouraCalcium Metabolism and Osteoporosis Program, WHO Collaborating Center for Metabolic Bone Disorders, American University of Beirut Medical Center, P.O. Box 113-6044/C8, Beirut, Lebanon.
Elie AklAmerican University of Beirut, GRADE Center, Beirut, Lebanon.
Asma ArabiCalcium Metabolism and Osteoporosis Program, WHO Collaborating Center for Metabolic Bone Disorders, American University of Beirut Medical Center, P.O. Box 113-6044/C8, Beirut, Lebanon.
Hala AhmadiehBeirut Arab University, Beirut, Lebanon.
Stephanie AntounCalcium Metabolism and Osteoporosis Program, WHO Collaborating Center for Metabolic Bone Disorders, American University of Beirut Medical Center, P.O. Box 113-6044/C8, Beirut, Lebanon.
Paola AtallahSaint George Hospital University Medical Center, Beirut, Lebanon.
Rafic BaddouraHôtel-Dieu de France, Beirut, Lebanon.
Maya BarakeClemenceau Medical Center, Beirut, Lebanon.
Roger BouillonKatholieke Universiteit Leuven, Leuven, Belgium.
Peter EbelingMonash University, Clayton, Australia.
Akram EchtayLebanese University, Beirut, Lebanon.
Imad El-KebbiEmroy University School of Medicine, Atlanta, USA.
Marie Helene Ghannage-YaredHôtel-Dieu de France, Beirut, Lebanon.
Georges HalabyHôtel-Dieu de France, Beirut, Lebanon.
Nadine HilalAmerican University of Beirut, Rheumatology, Beirut, Lebanon.
Joanne KhabsaAmerican University of Beirut, GRADE Center, Beirut, Lebanon.
Malek NayfehCalcium Metabolism and Osteoporosis Program, WHO Collaborating Center for Metabolic Bone Disorders, American University of Beirut Medical Center, P.O. Box 113-6044/C8, Beirut, Lebanon.
Jad OkaisBeirut Arab University, Beirut, Lebanon.
Mona OsmanAmerican University of Beirut, Family Medicine, Beirut, Lebanon.
Muheiddine SeoudAmerican University of Beirut, Obstetrics and Gynecology‎, Beirut, Lebanon.
Imad UthmanAmerican University of Beirut, Rheumatology, Beirut, Lebanon.
Ghada El-Hajj FuleihanCalcium Metabolism and Osteoporosis Program, WHO Collaborating Center for Metabolic Bone Disorders, American University of Beirut Medical Center, P.O. Box 113-6044/C8, Beirut, Lebanon. gf01@aub.edu.lb.

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

backgroundThe Middle East and North Africa region are traditionally known as regions with a high prevalence of vitamin D deficiency. However, serum 25-hydroxyvitamin D (25OHD) levels seem to be increasing lately. We developed guidelines on the screening and supplementation of adult Lebanese patients with vitamin D. These guidelines address community-dwelling and institutionalized individuals.

methodsOur guideline panel consisted of clinical and methodology experts that formulated the guidelines questions. We conducted a systematic review to gather global data on fracture (CRD42019129540), regional data on vitamin D trials (CRD42014010488), and on patients' values and preferences (CRD42022320022). We also complemented the latter with results from a cross-sectional local study. We followed the Grading of Recommendations Assessment, Development and Evaluation (GRADE) methodology to assess the quality and certainty of evidence, and to develop recommendations.

resultsFor community-dwelling and institutionalized Lebanese adult population, the panel suggests no screening for vitamin D deficiency, over screening for vitamin D deficiency (conditional recommendation, based on very low certainty evidence). For community-dwelling Lebanese adult population, the panel suggests no supplementation with calcium and vitamin D, over supplementation (conditional recommendation, based on moderate certainty evidence). For institutionalized Lebanese adult population, the panel suggests supplementation with calcium and vitamin D, over no supplementation (conditional recommendation, based on moderate certainty evidence). The guidelines also identify high-risk subgroups, more likely to benefit from screening and supplementation. In community dwelling and institutionalized Lebanese adult individuals, for whom there is a decision to supplement with calcium and vitamin D, the panel suggests supplementation with a daily vitamin D equivalent of 600-2000 IU, as compared to doses higher than 2000 IU (conditional recommendation, very low certainty evidence).

conclusionThe Lebanese GRADE-based vitamin D guidelines recommend against population screening and vitamin D supplementation. Subgroups at high risk are identified. The guidelines take into account contextual factors, and allow their adoption or adaptation in countries in the region.

Indexed as

Vitamin DVitamin D DeficiencyAdultBone Density Conservation AgentsDietary SupplementsHumansLebanonMass ScreeningOsteoporotic Fractures25-hydroxyvitamin DBone Density Conservation AgentsVitamin DGRADE methodologyGuidelinesLebanonVitamin D

Identifiers

PMID40268771

What Socratic holds

Textmetadata
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the Socratic graph.