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Who needs a vitamin D test -Those with symptoms or those in high risk groups - March 2018

Clinical Management of Low Vitamin D: A Scoping Review of Physician Practices

J. Clinical Management of Low Vitamin D: (doi: 10.20944/preprints201803.0131.v1).
Michelle Rockwell * , Vivica Kraak , Matthew Hulver , John Epling


A variety of Vitamin D Testing Opinions

  1. Many countries have decided that testing everyone for Vitamin D costs too much and have restricted testing
    • Which is a mistake because the resulting Vitamin D deficiency problems are far more costly
    • Some allow testing, but the patient has to pay for it
    • US Medicare (incorrectly) only pays for 1 vitamin D test per lifetime
  2. Some groups suggest limiting testing to those with a few narrowly defined symptoms
  3. Some groups are testing only individuals in groups at high risk for being deficient (dark skin, obese, pregnant, etc)
  4. Some groups have decided to suggest Vitamin D to all members of high risk groups
  5. Some groups have decided to suggest Vitamin D for everyone
  6. Turkey decided to give free vitamin D to all children

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From the study

Population-wide 25-OH-D screening recommended? 25-OH-D testing for individuals at high risk of deficiency recommended?Definition of "high risk"
Public Health England
National Osteoporosis Society, 2017
NoYesSymptoms indicative of rickets, osteomalacia or symptomatic hypocalcaemia
U.S. Preventive Services Task Force, 2015 Current evidence is insufficient to assess The balance of benefits and harms of screening in asymptomatic adults (I statement) n/an/a
American Academy of Family Physicians, 2014 Current evidence is insufficient to assess the balance of benefits and harms of screening for vitamin D deficiency (I)Non/a
Canadian Medical Association, 2012 NoYes Significant renal or liver disease
Osteomalacia, osteopenia or osteoporosis
Hypo or hypercalcemia/ hyperphosphatemia
Hypo or Hyperparathyroidism
Patients on medications that affect vitamin D metabolism or absorption
Unexplained increased levels of serum alkaline phosphatase
Patients taking high doses of vitamin D (> 2000 IU daily) for extended periods of time (> 6 months), and who are exhibiting
symptoms suggestive of vitamin D toxicosis (hypervitaminosis D)
U.S. Endocrine Society, 2011NoYesRickets, osteomalacia, osteoporosis
Chronic kidney disease
Hepatic failure
Malabsorption syndromes Certain medications
African-American and Hispanic children and adults
Pregnant and lactating women
Older adults with history of falls or non-traumatic fracturesObese children and adults
Granuloma-forming disorders
Some lymphomas
Kidney Disease Outcomes 
Quality Initiative (KDOQI), 2009
NoYes• Stage 3 or 4 kidney disease

Studies of increased Vitamin D Testing


The role of vitamin D in the prevention and treatment of non-skeletal health issues has received significant media and research attention in recent years. Costs associated with clinical management of low vitamin D (LVD) have increased exponentially. However, no clear evidence supports vitamin D screening to improve health outcomes. Authoritative bodies and professional societies recommend against population-wide vitamin D screening in community-dwelling adults who are asymptomatic or at low risk of LVD. In order to assess patterns of physician management of LVD in this conflicting environment, we conducted a scoping review of three electronic databases and gray literature.
Thirty-eight records met inclusion criteria and were summarized in an evidence table.
Results from seven countries showed a consistent increase in vitamin D lab tests and related costs.
Many vitamin D testing patterns reflected screening rather than targeted testing for individuals at high risk of vitamin D deficiency or insufficiency. Interventions aimed at managing inappropriate clinical practices related to LVD were effective in the short term.
Variability and controversy were pervasive in many aspects of vitamin D management, shining light on physician practices in the face of uncertainty.
Future research is needed is needed to inform better clinical guidelines and to assess implementation practices that encourage evidence-based management of LVD in adult populations.
 Download the PDF from VitaminDWiki

Created by admin. Last Modification: Saturday March 17, 2018 12:41:07 GMT-0000 by admin. (Version 16)

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