RESEARCH - Hypovitaminosis D among rheumatology outpatients in clinical practice

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Rheumatology Advance Access published online on May 22, 2008

Rheumatology, doi:10.1093/rheumatology/ken203

Hypovitaminosis D among rheumatology outpatients in clinical practice

M. Mouyis1, A. J. K. Ostor1, A. J. Crisp1, A. wi1, D. J. Halsall2,

N. Shenker1 and K. E. S. Poole1,3

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.

Abstract

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

http://rheumatology.oxfordjournals.org/cgi/content/abstract/ken203v1?papetoc

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