Vets Lack Vitamin D, Follow-up Testing – MedPage Today
ORLANDO — Even after being found to lack sufficient levels of Vitamin D, most veterans who need supplementation do not reach therapeutic goals, researchers reported here.
Treatment with 25-hydroxyvitamin D supplementation did increase Vitamin D blood levels, but Tanzila Razzaki, MD, a resident in internal medicine at Rutgers New Jersey Medical School, in East Orange, said that the improvement among those taking supplements still failed to reach treatment goals.
After 23 weeks, the average level of vitamin D was 25.9 ng/mL in the patients who underwent repeated testing compared with an average level of 14.1 ng/mL in patients who delayed undergoing regular Vitamin D testing. In the study, Razzaki used a cutoff of 30 ng/mL as the level for Vitamin D sufficiency; levels below 21 ng/mL were considered Vitamin D-deficient.
“Current guidelines recommend replacing Vitamin D with high-dose Vitamin D2 therapy to the goal of 30-50 ng/mL,” she told MedPage Today at her poster presentation during the annual meeting of the American Association of Clinical Endocrinologists. “Subsequent maintenance therapy with Vitamin D2 or Vitamin D3 is recommended in order to prevent recurrent Vitamin D insufficiency/deficiency.”
More than 90% of the 281 veterans with less than optimal Vitamin D levels who were seen by the endocrinology service at the East Orange Veterans Affairs Hospital were initially prescribed Vitamin D therapy, but about 30% of them were not prescribed maintenance therapy. “That resulted in further reduced therapeutic response,” Razzaki said.
In the retrospective study, she and her colleagues identified veterans — 91% of whom were men — and examined their initial and post-replacement levels of Vitamin D by accessing the VA Computerized Patient Record System.
“There was no difference in the initial 25-hydroxyvitamin D levels in patients who received maintenance therapy compared with those who did not,” Razzaki reported. The group who got Vitamin D maintenance and the group who did not get Vitamin D maintenance did not differ significantly in terms of their age — about 61 years, — or their race — about 55% Caucasian and about 29% African-American. There were also no significant differences in body mass index or smoking history — 38% had never smoked — and about one-third in each group had substance abuse histories.
The majority of patients — 63.3% — were prescribed high-dose replacement therapy of 50,000 units of Vitamin D2 three times a week for 6 weeks; 24.9% were prescribed 50,000 units 2 times a week; and 7.1% were prescribed 50,000 units once a week. Most patients were prescribed maintenance therapy with vitamin D3, most frequently 2000 units/day (55.9%), followed by 1000 units/day (11.4%). She said 29.2% of patients were not prescribed any maintenance therapy.
Razzaki noted that Vitamin D insufficiency/deficiency causes inefficient intestinal absorption of dietary calcium and phosphorus, resulting in abnormalities in calcium, phosphorus, and bone metabolism.
“Better compliance with treatment guidelines and closer follow up of veterans with vitamin D insufficiency/deficiency in outpatient practice is needed to prevent adverse effects of low vitamin D levels on veterans’ skeletal and extraskeletal health,” she said.
“Compliance with Vitamin D supplementation is always a problem,” said Len Horovitz, MD, attending physician in internal medicine at Lenox Hill Hospital in New York City. “Everyone needs to have their Vitamin D levels checked because even if you are working outside a lot it can depend on the amount of sunscreen you are using or [on the use of] sun-protective clothing.”
“Get tested. Find a dose that can be tolerated and then, hopefully, stay on the medication,” he told MedPage Today. He said most physicians would prescribe 35,000 to 50,000 International Units of Vitamin D a week. “It is hard to get to a toxic level of Vitamin D in most people,” he said.
In his urban patient population, Horovitz said that most of his patients have to be on supplements. “Not many of my patients sunbathe in New York City so they need supplements. Vitamin D deficiency affects the immune system, wound healing and other conditions. Vitamin D is very important,” he said.
Repeat blood work is also required because even patients taking supplement might still have inadequate blood levels of Vitamin D and will need a higher dose, Horovitz added.
Mazzaki and Horovitz disclosed no relevant relationships with insdustry.