Vitamin D: too much testing and treating?

Area of Science:

• Endocrinology
• Clinical Chemistry
• Public Health

Background:

• Clinical uncertainty exists regarding the appropriate testing of serum 25-Hydroxy vitamin D (25[OH]D) and the use of high-dose supplementation.
• A notable increase in 25[OH]D testing and high-dose supplementation has been observed in recent years.

Purpose of the Study:

• To analyze the appropriateness of serum 25[OH]D test requests.
• To evaluate the patterns of 25[OH]D testing and identify areas for improved clinical practice.

Main Methods:

• Retrospective analysis of 17,405 serum 25[OH]D test requests from January to October 2017.
• Classification of test requests into 'appropriate', 'inappropriate', and 'uncertain' categories based on expert opinion.
• Analysis of average 25[OH]D concentrations across different age groups.

Main Results:

• The overall average 25[OH]D concentration was 57.5 nmol/L, with higher rates of <25 nmol/L in patients over 75.
• Between 70.4% and 77.5% of tests were deemed potentially inappropriate, with tiredness/fatigue cited in 22.4% of requests.
• Significant variation in test appropriateness was noted, particularly concerning 'uncertain' categories like falls and osteoporosis.

Conclusions:

• A substantial proportion of serum 25[OH]D testing may be inappropriate, indicating a need for revised testing guidelines.
• Implementing a more rational approach to 25[OH]D testing and treatment could lead to significant cost savings for healthcare systems and patients.
• Further research into optimizing vitamin D testing protocols is warranted to ensure efficient and effective patient care.