Vitamin D: too much testing and treating?
Clin Med (Lond). 2018 Jun;18(3):196-200. doi: 10.7861/clinmedicine.18-3-196.
- Who needs a vitamin D test -Those with symptoms or those in high risk groups - March 2018
- UK appears to ignore the concept of high-risk groups
- which includes dark skin, obese, smokers, cancer, shut-ins, get little sun access, wear concealing clothing, pregnant,
Some places disagree with the UK
- Japanese need at least 30 ng of Vitamin D, test costs are now reimbursed – Nov 2016
- Mandatory Vitamin D screening for all patients’ – vitamin D conference in Middle East – March 2017
- No vitamin D test needed before supplementing (typically) – April 2014
Many places want to lower the costs by reducing Vitamin D testing
(which will raise long-term total medical costs)
- How Alberta Canada restricts Vitamin D testing – May 2016
- France restricts payments for Vitamin D tests – Dec 2015
- Medicare now pays for just one vitamin D test in lifetime
- Vitamin D testing in Australia before they shut it down – 42 percent retested – 2013
Tests for Vitamin D category listing has
- Fact: Many countries no longer pay for more than 1 (some not pay for even a single Vit D test)
They feel that Vit D testing is not needed except for a few conditions (Rickets, etc) Japan is an exception - Fact: Vit D tests are not very accurate
The best lab tests have accuracies and repeatabilities of +-5 ng
Low cost vitamin D Blood Tests - both in lab and at home
Many lab tests have accuracies and repeatabilities of +- 10 ng - or worse
Vitamin D deficiency of a group - 15% to 48% - Fact: Low-cost office/home Vit D tests are available around the world (not US as of 2018)
Low-cost 35 ng Y/N test by Nanospeed
Low-cost Vitamin D testers (two yes-no tests for 42 dollars) - 2023 Nanospeed
Quick, free, self test for deficiency - Fact: 3 major Vit D gene problems are not noticed by Vit D tests
~ 20% of people have poor Vit D genes
Hint that Vit D not getting to cells: Vit D related diseases run in your family
Another hint - you have one of the 40 diseases which are 2X more likely if have poor genes - Fact: A Vit D test will rarely (<1 in 1000) indicate that you are getting too much
- Opinion: If only getting a single test, wait till after supplementing with Vit D
3 months after starting a maintenance dose or 4 weeks after a loading dose
PDF is available free at Sci-Hub
Woodford HJ1, Barrett S2, Pattman S3.
1 North Tyneside General Hospital, Northumbria Healthcare NHS Foundation Trust, North Shields, UK henry.woodford@nhct.nhs.uk.
2 North Tyneside General Hospital, Northumbria Healthcare NHS Foundation Trust, North Shields, UK.
3 North Tyneside General Hospital Northumbria Healthcare NHS Foundation Trust, North Shields, UK.
There is clinical uncertainty as to the testing of serum 25 Hydroxy vitamin D (25OHD) concentrations and when to use high-dose supplementation. Data show that there has been a rapid increase in the number of tests performed within the Northumbria Healthcare NHS Foundation Trust over the past 8 years and an increase in high-dose supplementation over the past 5 years. We performed a retrospective analysis of the 25(OH)D test requests over the period from January to -October 2017. A total of 17,405 tests were performed in this time period. The overall average concentration was 57.5 nmol/L and this figure was similar across age groups, although a larger proportion of patients aged over 75 had a concentration <25 nmol/L.
Test requests were classified into 'appropriate', 'inappropriate' and 'uncertain' categories based on current expert opinion.
We found that between 70.4% and 77.5% of tests could be inappropriate, depending on whether the 'uncertain' categories of falls and osteoporosis are considered to be justified. Tiredness, fatigue or exhaustion was the reason for testing in 22.4% of requests. We suggest that a more rational approach to testing, and subsequent treating, could lead to reductions in costs to the healthcare system and patients.
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