Vitamin D deficiency in outpatients:--a Scottish perspective

Vitamin D deficiency is common in older people and increases risk of falls, osteoporosis and fracture. This may be reduced with supplements. Recent Scottish guidelines recommend routine use of vitamin D and calcium for all older housebound, sunlight deprived or institutionalised people. Whilst many outpatients will undoubtedly meet these criteria, others who would benefit may not. We have determined the extent of vitamin D deficiency in older outpatients in our geographical area, to clarify further whether those found to be deficient, would receive supplementation under current guidelines.

102 new patient referrals to outpatient clinics and day hospital were questioned over their social circumstances and activity levels, and had serum 25-Hydroxy Vitamin D (25(OH)D) levels measured in wintertime.

Mean age was 79.6 (SD 7.3), 31.4% were housebound and 51.0% exposed their skin to sunlight. 72.6% had insufficient vitamin D levels [25(OH)D < 50 nmol/l], 27.5% of whom levels were frankly deficient [25(OH)D < 25 nmol/l]. Deficiency was significantly more common in females (p = 0.002), those attending the falls clinic or day hospital (p = 0.021), the housebound (p = 0.012) or patients who never exposed their skin to sunlight (p = 0.007). However, even in those patients who were outdoors frequently or who did expose their skin to the sun, the mean vitamin D levels remained insufficient [mean 25(OH)D = 45.6 (SD 26.2) nmol/l and 47.9 (SD 26.3) nmol/l respectively].

The prevalence of vitamin D deficiency is high in older outpatients in this geographical area. These patients may benefit from routine vitamin D and calcium, but currently many would not be targeted in recent Scottish Executive recommendations because they are not housebound and sunlight deprived.