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20X increase in vitamin D sold and 36 percent decrease in osteoporosis business in Australia – Nov 2013

Archives of Osteoporosis, November 2013, 8:161
David Rowell, Louisa Gordon

See also VitaminDWiki
Increased use of D category listing has 36 items including the following

Overview Osteoporosis and vitamin D contains the following summary

  • FACT: Bones need Calcium (this has been known for a very long time)
  • FACT: Vitamin D improves Calcium bioavailability (3X ?)
  • FACT: Should not take > 750 mg of Calcium if taking lots of vitamin D (Calcium becomes too bio-available)
  • FACT: Adding vitamin D via Sun, UV, or supplements increased vitamin D in the blood
  • FACT: Vitamin D supplements are very low cost
  • FACT: Many trials, studies. reviews, and meta-analysis agree: adding vitamin D reduces osteoporosis
  • FACT: Toxic level of vitamin D is about 4X higher than the amount needed to reduce osteoporosis
  • FACT: Co-factors help build bones.
  • FACT: Vitamin D Receptor can restrict Vitamin D from getting to many tissues, such as bones
  • It appears that to TREAT Osteoporosis:
  •        Calcium OR vitamin D is ok
  •        Calcium + vitamin D is good
  •        Calcium + vitamin D + other co-factors is great
  •        Low-cost Vitamin D Receptor activators sometimes may be helpful
  • CONCLUSION: To PREVENT many diseases, including Osteoporosis, as well as TREAT Osteoporosis
  • Category Osteoporosis has 190 items
  • Category Bone Health has 267 items

Note: Osteoporosis causes bones to become fragile and prone to fracture
  Osteoarthritis is a disease where damage occurs to the joints at the end of the bones

Summary: This descriptive paper identifies some salient trends in the Australian management of osteoporosis. Changes in pharmaceutical consumption and medical utilisation are analysed. The total national consumption of four pharmaceuticals is estimated. From 2001 to 2011, the consumption of bisphosphonates and vitamin D increased. After 2006, the management rate for osteoporosis decreased.

Purpose: During the first decade of the millennia, the total cost of vitamin D tests has increased significantly within many health care jurisdictions worldwide. Australia reports a 100-fold increase. Legitimately, concerns regarding the economic effectiveness of this test exist. The purpose of this paper is to identify what other salient clinical trends could affect the efficacy of this test when treating osteoporosis.

Methods: Longitudinal data from two Australian datasets are analysed. The first are data obtained from Medicare Australia, which report pharmaceutical consumption. The second are data obtained from a national survey of general practitioners.

Results: The management of osteoporosis has been characterised by a movement away from single to combination formularies. The consumption of calcium carbonate has declined, and the use of bisphosphonates has increased.
While the gross consumption of risedronate increased steadily over the decade (8.4 to 186.5 kg), the consumption of alendronate declined after 2007.
The consumption of vitamin D (over-the-counter and prescription) has increased from 0.58 to 2.8 kg over the decade. While prescription vitamin D comprised just 10 % of the total, its consumption has undergone a 20-fold increase since 2006. Importantly, we can also report that the management of osteoporosis by Australia's general practitioners increased steadily until 2007–2008, before declining by 36 %.

Conclusions: Further research is required to determine possible casual relationships that may exist between these data. Until a formal economic evaluation of vitamin D testing in this clinical setting is completed, no conclusions regarding its economic effectiveness should be drawn.

References

  • Nowson CA, McGrath JJ, Ebeling PR, Haikerwal A, Daly RM, Sanders KM et al (2012) Vitamin D and health in adults in Australia and New Zealand: a position statement. Med J Aust 196(11):686–687 CrossRef
  • Lips P, Bouillon R, Van Schoor NM, Vanderschueren D, Verschueren S, Kuchuk N et al (2010) Review article: reducing fracture risk with calcium and vitamin D. Clin Endocrinol 73(3):277–285 CrossRef
  • Porter R, Kaplan J (2011) The Merck manual online. http://www.merck.com/mmpe/index.html. Accessed June 2013
  • Sattar N, Welsh P, Panarelli M, Forouhi NG (2012) Increasing requests for vitamin D measurement: costly, confusing, and without credibility. Lancet 379(9811):95–96 CrossRef
  • Bilinski KL, Boyages SC (2012) The rising cost of vitamin D testing in Australia: time to establish guidelines for testing. Med J Aust 197(2):90 CrossRef
  • Bilinski K, Boyages S (2012) The rise and rise of vitamin D testing. BMJ 345
  • Britt H, Miller GC, Charles J, Henderson J, Bayram C, Valenti L et al (2008) General practice activity in Australia 2006-07 (general practice series no. 21). Sydney University Press, Sydney. http://www.aihw.gov.au/WorkArea/DownloadAsset.aspx?id=6442456174. Accessed Nov 2012
  • Britt H, Miller GC, Charles J, Henderson J, Bayram C, Valenti L et al (2008) General practice activity in Australia 1999-99 to 2007-08: 10 year data tables (general practice series no. 23). Sydney University Press, Sydney. http://www.aihw.gov.au/WorkArea/DownloadAsset.aspx?id=6442456227. Accessed Nov 2012
  • Britt H, Miller GC, Charles J, Henderson J, Bayram C, Valenti L et al (2009) General practice activity in Australia 1999-00 to 2008-09: 10 year data tables (general practice series no. 26). Sydney University Press, Sydney. http://www.aihw.gov.au/WorkArea/DownloadAsset.aspx?id=6442456294. Accessed Nov 2012
  • Britt H, Miller GC, Charles J, Henderson J, Bayram C, Valenti L et al (2010) General practice activity in Australia 2000-01 to 2009-10: 10 year data tables (general practice series no. 28). Sydney University Press, Sydney. http://www.aihw.gov.au/WorkArea/DownloadAsset.aspx?id=6442472732&libID=6442472713. Accessed Nov 2012
  • Britt H, Miller GC, Charles J, Henderson J, Bayram C, Valenti L et al (2011) A decade of Australian general practice activity 2001-02 To 2010-11 (general practice series no. 30). Sydney University Press, Sydney. http://ses.library.usyd.edu.au/bitstream/2123/7773/4/9781920899875_CDROM.pdf. Accessed Nov 2012
  • Britt H, Miller GC, Charles J, Henderson J, Valenti L, Harrison C et al (2012) A decade of Australian general practice activity 2002–03 to 2011–12. Accessed Aug 2013
  • Euromonitor International (2012) Vitamins and dietary supplements in Australia. Passport Euromonitor International, London
  • Wooldridge JM (2000) Introductory econometrics: a modern approach. Southern-Western College Publishing, Boston
  • Watts NB (2003) Bisphosphonate treatment of osteoporosis. Osteoporosis. Springer, Heidelberg, pp 459–473
  • Australian Bureau of Statistics (ABS) (2012) 4364.0.55.001 Australian health survey: first Results, 2011-12. ABS, Canberra
  • Medicare Australia (2012) Medicare Australia statistics: amalgamated PBS item reports on benefits for alendronate Na (8511Y). https://www.medicareaustralia.gov.au/statistics/pbs_item.shtml. Accessed Nov 2012

Wonder how many other medical interactions/costs also decreased in Australia due to the huge increase in vitamin D
It appears that the wholesale cost of the 3kg of vitamin D (for the entire country of Australia) is less than $100,000

20X increase in vitamin D sold and 36 percent decrease in osteoporosis business in Australia – Nov 2013        
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