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Vitamin D testing in primary care

Introduction BNP | Haemochromatosis | Vitamin D PDF
Pathophysiology
Who is at risk of low vitamin D levels?
For people at risk, supplementation may be given without testing
Testing is expensive and likely to be positive in people at high risk
When is vitamin D testing appropriate?
References
From the same publication
BNP testing in primary care
Haemochromatosis testing in primary care
Full colour PDF of the “BNP | Haemochromatosis | Vitanin D testing in primary care” POEM.
 Printer friendly PDF.
Download a powerpoint presentation of the key points.

Introduction

Although rickets and osteomalacia are now rare in New Zealand there is concern that low vitamin D levels in older adults are contributing to bone loss and consequent fractures. Low levels of vitamin D are common in older adults but measurement of vitamin D is expensive. As an alternative to widespread testing, there is international interest in vitamin D supplementation for older people. However, there is no international consensus on how to deal with this issue1. In this article, we discuss a reasonable approach to vitamin D supplementation and testing.

Our key recommendations are:
  1. Increased sun exposure is advisable for people at high risk of vitamin D insufficiency due to inadequate exposure.
  2. Vitamin D and calcium supplementation is appropriate for people at high risk who cannot increase their sun exposure.
  3. Routine testing of vitamin D levels is not usually necessary prior to or after starting vitamin D supplementation.
  4. Vitamin D testing is appropriate for people with:
    1. Unexplained raised serum alkaline phosphatase or low calcium or phosphate.
    2. Atypical osteoporosis.
    3. Unexplained proximal limb pain in older people.
    4. Unexplained bone pain, unusual fractures or other evidence suggesting metabolic bone disease. Consider specialist advice for people in this category.

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