Treatment of vitamin D deficiency: divergence between clinical practice and expert advice
- 1Department of Medicine, Dumfries and Galloway Royal Infirmary, Dumfriesshire, UK
- 2Department of Biochemistry, Dumfries and Galloway Royal Infirmary, Dumfriesshire, UK
- 3Pharmacy Department, Dumfries and Galloway Royal Infirmary, Dumfriesshire, UK
- 4Renal Unit, Dumfries and Galloway Royal Infirmary, Dumfriesshire, UK
- Correspondence to Professor Chris Isles, Medical Unit, Dumfries Infirmary, Dumfriesshire DG1 4AP, UK;
Contributors CI and MF had the idea and wrote the first draft. JA extracted the results from the biochemistry lab browser. SR is the guarantor of the pharmacy data. JA, SR and AA provided comments on the first draft and all five authors contributed to the final draft.
- Received 8 August 2011
- Accepted 16 January 2012
- Published Online First 23 February 2012
Background Current recommendations for the treatment of vitamin D deficiency vary from calciferol 800 IU per day to loading doses of vitamin D followed by maintenance therapy of up to 2000 IU per day.
Objective To assess the preparations and doses of vitamin D used to load and maintain patients with serum 25-hydroxyvitamin D (25OHD) <25 nmol/l.
Methods We examined all requests for serum 25OHD over a 12-month period, from September 2009 to 2010 in southwest Scotland. We wrote to all 33 general practices asking whether they usually started replacement therapy with a loading dose and/or recommended over-the-counter maintenance preparations. We accessed the Emergency Care Summary for all patients with serum 25OHD <25 nmol/l to determine whether they had been prescribed maintenance therapy.
Results Serum 25OHD was requested in 1162 patients. Levels were <25 nmol/l in 282 (24%) patients, only 173 (61%) of whom were receiving vitamin D replacement therapy 3–15 months after diagnosis. Only four (1.4%) were prescribed a loading dose. One hundred and fifty-three (54%) were treated with cholecalciferol or ergocalciferol and 19 (7%) with alfacalcidol or calcitriol. The median dose of chole/ergocalciferol was 800 IU per day, usually in combination with 1200 mg calcium per day.
Conclusions We have shown a divergence between clinical practice and even the most conservative expert advice for vitamin D replacement therapy. Possible explanations are conflicting advice on treatment and difficulty obtaining suitable vitamin D preparations, particularly high dose vitamin D and vitamin D without calcium, in the UK.
Competing interests None.
Ethics approval Ethics approval was provided by the Medical Director.
Provenance and peer review Not commissioned; externally peer reviewed.