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Consequences of Italy’s decision to restrict Vitamin D reimbursement for Osteoporosis prevention – April 2022

The Potential Impact of Inducing a Restriction in Reimbursement Criteria on Vitamin D Supplementation in Osteoporotic Patients with or without Fractures

Nutrients 2022, 14(9), 1877; https://doi.org/10.3390/nu14091877
by Luca Degli Esposti 1,Valentina Perrone 1,Stefania Sella 2,Gaetano Arcidiacono 2ORCID,Francesco Bertoldo 3,Andrea Giustina 4,Salvatore Minisola 5ORCID,Nicola Napoli 6,Giovanni Passeri 7ORCID,Maurizio Rossini 8ORCID andSandro Giannini 2,*,†ORCID on behalf of the LHU

Statistically significant consequences

Increased strokes, use of antipsychotics etc.
VKA = vitamin K antagonist

In October 2019, the Italian Drug Agency (AIFA) restricted reimbursement criteria for vitamin D (VD) use outside the osteoporosis setting (Note 96). However, whether this restriction could also have involved patients at risk for or with osteoporotic fractures has not yet been investigated. We retrospectively analyzed databases from five Italian Local Health Units. Patients aged ≥50 years with either at least one prescription for osteoporosis treatment or with fragility fractures and evidence of osteoporosis from 2011 to 2020 were included. The proportion of subjects with an interruption in VD treatment before and after the introduction of the new reimbursement criteria and predictors of this interruption were analyzed. A total of 94,505 patients (aged 69.4 years) were included.
Following the introduction of Note 96, a 2-fold (OR 1.98, 95% CI: 1.92–2.04) increased risk of VD discontinuation was observed. These findings were independent of seasonal variation, osteoporosis treatment patterns, as well as other confounding variables. However, a higher rate of interruption was observed in patients without vertebral/femur fracture (37.8%) vs. those with fracture (32.9%). Rheumatoid arthritis, dyslipidemia and previous fracture were associated with a lower risk of VD interruption, while stroke increased the risk of VD interruption. Our results highlight that a possible misinterpretation of newly introduced criteria for reimbursement restrictions in VD outside of osteoporosis have resulted in an inadequate level of VD supplementation in patients with osteoporosis. This undertreatment could reduce the effect of osteoporosis therapies leading to increased risk of negative outcome.
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VitaminDWiki - Overview Osteoporosis and vitamin D contains

  • 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 205 items
  • Category Bone Health has 296 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

VitaminDWiki - Osteoporosis category contains

Various groups have tried to reduce costs of Vitamin D tests by restricting testing

VA found less testing for vitamin D resulted in increased health costs – Jan 2012

Created by admin. Last Modification: Thursday October 6, 2022 22:03:14 GMT-0000 by admin. (Version 10)

Attached files

ID Name Comment Uploaded Size Downloads
17528 Osteo repay Vitamin D.jpg admin 29 Apr, 2022 16:06 52.79 Kb 114
17527 Restrict paying for vit D with osteo.pdf PDF 2022 admin 29 Apr, 2022 16:06 336.92 Kb 96