Treatment of vitamin D deficiency: divergence between clinical practice and expert advice Postgraduate Medical Journal, 04/26/2012

Findlay M et al. - The authors have shown a divergence between clinical practice and even the most conservative expert advice for vitamin D replacement therapy. Possible explanations are conflicting advice on treatment and difficulty obtaining suitable vitamin D preparations, particularly high dose vitamin D and vitamin D without calcium, in the UK.

• The authors examined all requests for serum 25OHD over a 12-month period, from September 2009 to 2010 in southwest Scotland.
• The authors wrote to all 33 general practices asking whether they usually started replacement therapy with a loading dose and/or recommended over-the-counter maintenance preparations.
• The authors accessed the Emergency Care Summary for all patients with serum 25OHD <25 nmol/l to determine whether they had been prescribed maintenance therapy.

• Serum 25OHD was requested in 1162 patients.
• Levels were <25 nmol/l in 282 (24%) patients, only 173 (61%) of whom were receiving vitamin D replacement therapy 3–15 months after diagnosis.
• Only four (1.4%) were prescribed a loading dose.
• One hundred and fifty-three (54%) were treated with cholecalciferol or ergocalciferol and 19 (7%) with alfacalcidol or calcitriol.
• The median dose of chole/ergocalciferol was 800 IU per day, usually in combination with 1200 mg calcium per day.