Rheumatology Advance Access published online on May 22, 2008
Rheumatology, doi:10.1093/rheumatology/ken203
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Hypovitaminosis D among rheumatology outpatients in clinical practice
1Department of Medicine, Division of Rheumatology, 2Department of Clinical Biochemistry and 3Department of Medicine, Division of Bone Research, University of Cambridge, Addenbrooke's Hospital, Cambridge, UK.
Correspondence to:
K. E. S. Poole, Box 157, Department of Medicine, Division of Bone Research, University of Cambridge, Addenbrooke's Hospital, Cambridge, CB2 2QQ, UK. E-mail: kenpoole{at}doctors.org.uk
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Abstract |
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Objectives. A role for vitamin D in the pathogenesis of autoimmune and inflammatory diseases is emerging. We undertook an audit of 25-hydroxyvitamin D (25OHD) investigation and treatment in rheumatology outpatients.
Methods. Serum 25OHD requests were matched to electronic medical records from rheumatology and metabolic bone clinics (April 2006–March 2007). Data were analysed separately for two groups, ‘Documented osteoporosis/osteopaenia’ (Group 1) and ‘General rheumatology outpatients’ (Group 2, sub-divided by diagnosis). Hypovitaminosis D was defined by 25OHD levels <50 nmol/l. Values were compared with healthy adults to calculate geometric z-scores.
Results. A total of 263 patients were included (Group 1, n = 122; Group 2, n = 141) with an overall median 25OHD of 44 nmol/l.The 25OHD level among general rheumatology patients (median 39 nmol/l, mean z score –1.2, was statistically significantly lower than among osteoporotic/osteopaenic patients (median 49 nmol/l, mean z score of –0.9, p < 0.05 for the difference). 25OHD was lower in inflammatory arthritis and chronic pain/fibromyalgia than in other groups. Prescribing was recorded in 100 in Group 1 (of whom 95% were prescribed calcium/800 IU cholecalciferol) and 83 in Group 2 (91% calcium/800 IU). Only 31% of the patients with 25OHD <50 nmol/l would have been identified using general guidelines for screening patients at ‘high risk’ of hypovitaminosis D.
Conclusions. Improved guidelines for managing hypovitaminosis D in rheumatology patients are needed. We found a high prevalence of hypovitaminosis D among secondary care patients in rheumatology and widespread supplementation with 800 IU cholecalciferol. Substantially reduced levels of serum 25OHD were identified among patients with inflammatory arthritis and chronic pain.
KEY WORDS: Vitamin D deficiency, Vitamin D, Osteoporosis, Immunopathology, Autoimmune disease, Biochemical analysis, Inflammatory arthritis, Fibromyalgia
Submitted 16 January 2008;
revised version accepted 17 April 2008.
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