Treatment of vitamin d deficiency within a large integrated health care delivery system.
J Manag Care Pharm. 2012 Sep;18(7):497-505.
Stratton-Loeffler MJ, Lo JC, Hui RL, Coates A, Minkoff JR, Budayr A.
Kaiser Permanente Division of Research, 2000 Broadway, Oakland, CA, 94612. USA. Joan.C.Lo at kp.org.
BACKGROUND: In the past decade, increasing attention has focused on identification and treatment of vitamin D deficiency although repletion ?outcomes of pharmacologic vitamin D therapy have not been examined at ?a population level.
OBJECTIVE: To investigate population trends and outcomes of pharmacologic treatment of vitamin D deficiency.
METHODS: We conducted a retrospective cohort study using data from an integrated health system with approximately 3.2 million members. Automated laboratory and pharmacy databases were used to identify patients aged 18 years or older with hypovitaminosis D (defined as a 25-hydroxy-vitamin D [25(OH)D] serum level less than ?20 nanograms [ng] per mL) who newly initiated pharmacologic ergocalciferol (50,000 international units [IU] per week) during 2007-2010 and did not have a prescription for ergocalciferol in the prior 12 months. Patients were required to be continuously enrolled for 12 months before and 6 months after ergocalciferol initiation. Age, gender, race/ethnicity, body mass index, and 25(OH)D levels were obtained from health plan electronic medical records and administrative, laboratory, and pharmacy databases. Outcome and predictors of repletion among the subset who received 12 weekly doses of 50,000 IU ergocalciferol (total dose 600,000 IU) were examined using multivariable logistic regression.
RESULTS: There were 72,093 vitamin D-deficient patients who newly initiated pharmacologic ergocalciferol. During the study period, the use of ergocalciferol increased nearly 8-fold from 161 per 100,000 adult members in 2007 to 1,241 per 100,000 adult members in 2010.
One-fifth (n?=?14,727) had severe vitamin D deficiency (25[OH]D level less than ?10 ng per mL).
Among 23,322 patients receiving 50,000 IU ergocalciferol for 12 weeks in whom subsequent 25(OH)D levels were measured between 90 and 365 days after the index ergocalciferol prescription date,
- 74.0% achieved 25(OH)D of ?at least 20 ng per mL, and
- 35.8% achieved 25(OH)D of at least 30 ng per mL.
Increasing age (adjusted odds ratio [OR] 1.02, 95% CI 1.02-1.02) and higher baseline 25(OH)D level (OR 1.11, 95% CI 1.10-1.12) were associated with greater odds of successful repletion. Asian race (OR 0.80, 95% CI 0.73-0.88), Hispanic ethnicity (OR 0.71, 95% CI 0.65-0.77), and increasing overweight/obesity (OR 0.78, 95% CI 0.72-0.85 for body mass index [BMI], 25.0-29.9 kg/m2; OR 0.66, 95% CI 0.60-0.71 for BMI 30.0-39.9 kg/m2; OR 0.53, 95% CI 0.48-0.60 for BMI ??40 kg/m2) were associated with lower odds of repletion compared with BMI 18.5-24.9 kg/m2.
CONCLUSIONS:
There is increasing recognition and treatment of vitamin D deficiency within the health care setting.
Patients of
- younger age,
- Asian and Hispanic race/ethnicity, and those who are
- obese
or with more severe vitamin D deficiency may be at greater risk for incomplete repletion using standard regimens and may require additional treatment to achieve optimal levels.
PMID: 22971203
Histogram of deficiency before treatment
PDF is attached at the bottom of this page
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Comments by VitaminDWiki
Weekly Vitamin D2 is not very effective
As of 2012 doctors can prescribe vitamin D3 capsules– which are far more effective
Also, weekly D3 is much more effective than weekly D2
Previous studies achieved > 80% getting > 30 ng when using 40,000 IU Vitamin D3 weekly (see below)
Whereas Kaiser achieved 36% getting >30 ng using 50,000 vitamin D2 weekly
Should have followed up with additional vitamin D after 12 week loading dose - no indication in the abstract
Unfortunately at the time the doctors had no ability to prescribe other than 50,000 IU of vitamin D2
Should have increased the dose with weight, dark skin, etc.
Disclosure by Henry Lahore: Sept 2012
I have been taking 50,000 IU of vitamin D3 every 5 days for about 18 months
This is not a loading dose, but my on-going dose.
See also VitaminDWiki
- Overview Vitamin D3 not D2
Note: several studies have shown that vitamin D2 actually DECREASE vitamin D3 levels in the body - How often should I take 50000 IU of vitamin D3
- Doctors able to prescribe vitamin D3 - March 2012
- Huge gap between vitamin D advice and actual prescriptions – April 2012
only 1.4% got a loading dose - Kaiser appears to be doing much better - Vitamin D2 half-life about 3 days – April 2012 note: chart time line is HOURS, not days
- Half-life of vitamin D varies and D2 has the shortest half-life
- Many ways to increase the response to a dose of vitamin D
Probably increase the response to a vitamin D dose by > 2X - Overview Loading of vitamin D which has the following chart
Notice: Loading dose (D3) should be a function of patient weight – not a fixed amount
Equation: 30ng (in ng and pounds) = 35 x (30-serum 25-OHD(3)) x body weight.
Short url = http://is.gd/3ZdlXu