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First UK clinical guideline for treating vitamin D deficiency published

Aims to address widespread uncertainties among clinicians about best approach

Caroline White

Friday, 26 April 2013

The UK’s first clinical guideline for spotting and treating vitamin D deficiency has been published in a bid to address widespread uncertainties among healthcare professionals about how the deficiency should be managed.

One in two women and 1 in 5 men over the age of 50 in the UK will break a bone mainly because of poor bone health, while an estimated 3 million people have osteoporosis.

The guideline was developed by the National Osteoporosis Society in response to a rising tide of enquiries from healthcare professionals, inundated with requests for vitamin D tests, but confused by widely differing opinions on the best way to tackle vitamin D deficiency.

It aims to improve bone health in patients with vitamin D deficiency and reduce the risk of falls and fractures, by tackling three key areas: who to test for vitamin D deficiency, how to interpret vitamin D measurements and how to treat the deficiency.

Measuring levels of serum 25 hydroxyvitamin D (25OHD) is the best way of assessing vitamin D status, it says, and recommends adopting a level of less than 30 nmol/litre as the threshold for deficiency.

A level of 30-50 nmol/litre may be inadequate in some people, it says, while a level of 50 nmol or more per litre will be enough for almost the whole population.

It recommends oral vitamin D3 as the corrective treatment of choice, and says that only those patients with symptoms of vitamin D deficiency or in whom low vitamin D could affect treatment for osteoporosis, should be tested.

Patients who need rapid correction of vitamin D deficiency should be treated with fixed loading doses, followed by regular maintenance therapy, it recommends.

“Pressure was mounting from clinicians to have guidance that covers the investigation, diagnosis and treatment of vitamin D deficiency. This, coupled with growing public awareness and interest in vitamin D, encouraged us to provide guidance for healthcare professionals across the UK,” explains Professor Roger Francis, Chair of the guideline’s authoring group and Honorary Medical Director of the National Osteoporosis Society.

“The management of patients with vitamin D deficiency has previously been relatively neglected and inconsistent around the UK,” he added.

The guideline has been endorsed by a wide range of other health organisations including the British Geriatrics Society, British Orthopaedic Association, Primary Care Rheumatology Society, Royal College of Nursing, and the British Dietetic Association.  

Alison Nelson, Food and Health Policy Officer, at The British Dietetic Association said: “The BDA welcomes these guidelines; they raise awareness and the importance of treatment for what has often been a forgotten or unrecognised deficiency”

And President of the Primary Care Rheumatology Society, Dr Alan Nye said: "These guidelines give some excellent advice on the importance of Vitamin D in maintaining good bone health for all members of society. They also give some very timely advice on measurement and replacing for front line clinicians."

The Scientific Advisory Committee on Nutrition (SACN) is currently reviewing the dietary requirements for vitamin D, by considering the role that vitamin D has not only on bone health, but also the potential effects on non-skeletal conditions such as cancer, cardiovascular disease, diabetes, multiple sclerosis and autoimmune diseases. The SACN Report is due to be published next June. NICE is also developing public health guidance to prevent vitamin D deficiency.

Vitamin D and Bone Health: A Practical Clinical Guideline for Patient Management

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