The UK’s first clinical guideline for health professionals identifying and treating vitamin D deficiency has been published by the National Osteoporosis Society to address widespread uncertainty over how vitamin D deficiency should be detected and how deficiency should be treated.
Vitamin D and Bone Health: A Practical Clinical Guideline for Patient Management has been developed by the National Osteoporosis Society in response to increased enquiries from healthcare professionals, who have been inundated with requests for vitamin D tests. Uncertainty and diversity in opinion has led to calls from clinicians for guidance that addresses a growing concern, both for patients and healthcare professionals.
The Guideline, developed by a group of clinicians and scientists with expertise in vitamin D and osteoporosis, addresses three key areas:
Who to test for vitamin D deficiency
How to interpret vitamin D measurements
How to treat vitamin D deficiency
It recommends:
1. Measuring levels of serum 25 hydroxyvitamin D (25OHD) is the best way of assessing vitamin D status.
2. Adopting the following vitamin D thresholds in respect to bone health:
Serum 25OHD of less than 30 nanomoles per litre – deficient
Serum 25OHD of 30 – 50 nanomoles per litre – may be inadequate in some people
Serum 25OHD of more than 50 nanomoles per litre – sufficient for almost the whole population
3. Oral vitamin D3 is the treatment of choice in vitamin D deficiency.
4. Testing only those patients with symptoms of vitamin D deficiency OR where low vitamin D levels could affect treatment for osteoporosis.
5. Patients who need rapid correction of vitamin D deficiency should be treated with fixed loading doses, followed by regular maintenance therapy – the Guideline offers advice on the best way to do this.
The new Vitamin D Guideline provides balanced, expert advice to Doctors and other Health Care Professionals on the management of patients with vitamin D deficiency, which has previously been relatively neglected and inconsistent around the UK.
People worried about their vitamin D levels will be able to talk to their doctor about whether they actually need a test; for those who do, this Guideline provides clarity about when vitamin D measurements should be performed, how the results should be interpreted and how vitamin D deficiency should be treated. It provides a uniform approach to what should be considered as deficiency. This should improve bone health in patients with vitamin D deficiency and reduce the risk of falls and fractures.
Professor Roger Francis, Chair of the Guideline’s Authoring Group and Honorary Medical Director of the National Osteoporosis Society explains:
“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.
The National Osteoporosis Society is the only UK-wide charity dedicated to improving the diagnosis, prevention and treatment of osteoporosis and fragility fractures, so it was appropriate that this guideline concentrates on bone health, falls and fractures.
The Guideline provides balanced, expert advice to Doctors and other Health Care Professionals on the management of patients with vitamin D deficiency, which has previously been relatively neglected and inconsistent around the UK. This should improve bone health in patients with vitamin D deficiency and reduce the risk of falls and fractures.”
Vitamin D deficiency is common in the UK, particularly in older people. Vitamin D deficiency may contribute to the development of osteoporosis and to falls and fractures.
The Guideline has been endorsed by a wide range of other health organisations including Arthritis Research UK, Bone Research Society, British Dietetic Association, British Geriatrics Society, British Orthopaedic Association, International Osteoporosis Foundation, Paget’s Association, Primary Care Rheumatology Society, Royal College of Nursing, Royal Pharmaceutical Society, Royal Society of Medicine, Society for Endocrinology and the UK Clinical Pharmacy Association.
Opinder Sahota the British Geriatric Society said:
“The BGS Falls and Bone Health Section welcomes the guidance, which provides a very practical management to the assessment, diagnosis, treatment and monitoring of vitamin D deficiency. The loading doses and treatment intervals are particularly welcomed.”
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”
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 Royal Pharmaceutical Society:
“This Guideline addresses an issue of growing importance, including who needs to be on Vitamin D and what the assessment and monitoring requirements are for those taking Vitamin D.”
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 in June 2014.
NICE are currently developing public health guidance: Vitamin D: implementation of existing guidance to prevent deficiency.
The Vitamin D Guideline also supports the Department of Health recommendations that 400IU of vitamin D should be advised to all pregnant and breastfeeding women, infants and young children under 5 years of age, older people aged 65 years and over, people who have low or no exposure to the sun and people who have darker skin.
When they launched their first Sunlight Campaign in 2007, the National Osteoporosis Society were the first UK organisation to recommend that most people should spend a short time outdoors in summer sun, without protection, to boost their vitamin D levels. Now, they are the first UK organisation to publish guidance for health professionals who, until now, have faced a confusing dilemma with patients who are likely to be deficient in Vitamin D.
— ENDS —
Notes for editor:
Vitamin D and Bone Health: A Practical Clinical Guideline for Patient Management was developed by a group of clinicians and scientists with expertise in vitamin D and osteoporosis. Where clear-cut evidence was unavailable to inform the National Osteoporosis Society guideline, the authoring group have offered pragmatic advice, based on a consensus of their own views and experience.
The Guideline is a clinical guideline intended to inform patient management but not to influence public health policy. The latter is the remit of the Department of Health Scientific Advisory Committee on Nutrition (SACN), which is currently reviewing the dietary reference values for vitamin D.
The development of the Guideline was funded by the National Osteoporosis Society.
The National Osteoporosis Society is the only UK-wide charity dedicated to improving the diagnosis, prevention and treatment of osteoporosis and fragility fractures.
In the UK, 1 in 2 women and 1 in 5 men over the age of 50 will break a bone mainly because of poor bone health.
3 million people are estimated to have osteoporosis in the UK.
The National Osteoporosis Society will launch the 2013 Sunlight Campaign in May.
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