Clinical Management of Low Vitamin D: A Scoping Review of Physicians’ Practices

Abstract

The role of vitamin D in the prevention and treatment of non-skeletal health issues has received significant media and research attention in recent years. Costs associated with clinical management of low vitamin D (LVD) have increased exponentially. However, no clear evidence supports vitamin D screening to improve health outcomes. Authoritative bodies and professional societies do not recommend population-wide vitamin D screening in community-dwelling adults who are asymptomatic or at low risk of LVD. To assess patterns of physicians’ management of LVD in this conflicting environment, we conducted a scoping review of three electronic databases and the gray literature. Thirty-eight records met inclusion criteria and were summarized in an evidence table. Thirteen studies published between 2006 and 2015 across seven countries showed a consistent increase in vitamin D lab tests and related costs. Many vitamin D testing patterns reflected screening rather than targeted testing for individuals at high risk of vitamin D deficiency or insufficiency. Interventions aimed at managing inappropriate clinical practices related to LVD were effective in the short term. Variability and controversy were pervasive in many aspects of vitamin D management, shining a light on physicians’ practices in the face of uncertainty. Future research is needed to inform better clinical guidelines and to assess implementation practices that encourage evidence-based management of LVD in adult populations.

Assessment of knowledge, attitudes and practice towards Vitamin D among university students in Pakistan

“…Although there is a need to timely identify and treat severe vitamin D deficiency, such medicalised view towards vitamin D may highlight the existing culture of testing and treating with tablets among South Asians [12]. This approach may only help in short-term and can be ineffective for addressing this concerning problem for the long term [15,29,31,42,43].…”

Why Do They Do It? A Grounded Theory Study of the Use of Low-value Care Among Primary Health Care Physicians

“…We chose primary care physicians based on extensive discussions with managers within different parts of health care to nd examples of LVC. Then, we used three lab tests de ned by experts on LVC lab tests as a basis for the recruitment of centers: erythrocyte sedimentation rate (ESR), vitamin-D test, and aspartate transaminase (AST) (30)(31)(32). The criteria for selection speci ed that the tests were well de ned, all experts agreed that it was LVC, and statistics were available that show a difference in use between settings.…”

Is the Climb Worth the View? The Savings/Alert Ratio for Reducing Vitamin D Testing

“…However, looking at the actual laboratory costs of running the assay, the savings were $0.34 per alert. Testing vitamin D levels has increased worldwide, 18 with one study reporting a 94-fold increase in testing over a 4-year period in one location. 19 The costs associated with such testing are substantial, 18 with recent efforts made to develop a methodology for assessing the degree of inappropriate vitamin D testing.…”

“…Testing vitamin D levels has increased worldwide, 18 with one study reporting a 94-fold increase in testing over a 4-year period in one location. 19 The costs associated with such testing are substantial, 18 with recent efforts made to develop a methodology for assessing the degree of inappropriate vitamin D testing. 20 In the United Kingdom, approximately 70% of vitamin D testing in one instance was inappropriate based on indication, 21 with another such study in Canada identifying a similar frequency of approximately 65%.…”