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Independents' Day

Vitamin D treatment 'out of control' as prescriptions increase 40% in four years

Exclusive Prescriptions for vitamin D have risen 40% over the past four years in England, leading some experts to warn that testing and treatment is ‘out of control’, a Pulse investigation has revealed.

The rise has happened since the Government’s chief advisor sent out a warning that one in four people are deficient in vitamin D and that GPs should advise certain at-risk groups to take a daily supplement.

This is despite experts questioning the effectiveness of putting people on vitamin D, warning that it is risks overmedicalising the population.

A Pulse analysis of official figures show that GP prescriptions for vitamin D have risen steadily year on year from 14 million items in 2012, to 20 million items in 2015.

The cost to the NHS has shot up accordingly, from a stable cost of around £4.8m a month before 2012 to £7.1m in the latest figures from last November.

The total NHS spend on vitamin D last year was around £85m.

GP experts said the publicity around vitamin D has driven some of the rise in GP prescribing and warned that in some cases it was uncertain whether it would be better to simply advise people to get out more in the sun and eat a better diet.

Dr Andrew Green, chair of the GPC’s clinical and prescribing subcommittee, said: ‘There has to be some concern that patients are being medicated when lifestyle changes may be more appropriate.’

However leading GP critics also warned a sharp rise in testing for vitamin D levels for non-specific symptoms was leading to pressure on GPs to prescribe more and more vitamin D even though there was no evidence it would offer any benefit.

In line with this, data obtained by Pulse through Freedom of Information requests showed that requests for vitamin D testing – which can cost as much as £20 each time – have increased by up to 115% in some trusts over the four-year period.

Dr Alun Cooper, a GPSI in osteoporosis in Sussex and a member of the National Osteoporosis Society Scientific Committee and the National Osteoporosis Guideline Group, said: ‘The prescribing of vitamin D seems to have gone out of control.

‘We need to prescribe when clinically indicated, for example in osteomalacia, and not just treat a blood test result.’

But Dr Sally Hope, a recently retired GP from Oxford who works as an associate specialist for Oxford University Hospitals’ osteoporosis service at the Nuffield orthopaedic centre, said she believes that despite the rise in prescriptions there are still not enough people receiving vitamin D supplements – particularly the elderly and those diagnosed with osteoporosis.

She said: ‘I actually don’t think it’s anywhere nearly enough prescribing in older people. Virtually every person that comes in with a fractured hip to hospital is vitamin D deficient.’

Government experts recently indicated they want more blanket advice on boosting vitamin D, raising the potential for even more use of vitamin D pills.

However, it remains unclear what their final recommendation will be and whether a strategy to expand supplementation would include offering advice and prescriptions via GPs, or focus on food fortification schemes.

Vitamin d box

Vitamin D investigation figures

Read the full investigation here 

Readers' comments (40)

  • We live in a society where working age adults work such long hours that they never get outside in the daylight and the elderly are stuck at home.
    Yes, lifestyle advice is needed, but we need to tackle our society and culture to make change possible.

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  • Do we actually think it will reduce osteoporotic fractures in the future? It is surely way too expensive and long term to do a longitudinal study - so we are left guessing.

    I guess this is one of the limits of truly evidence based medicine.

    If it does reduce fractures, then the costs now are likely to be considered an excellent investment.

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  • Huzzah!
    My riposte to enquiries about Vitamin D from patients (and colleagues) is "yes, its a very fashionable test".
    Just another example of how clinical care is manipulated.
    Paul C

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  • Nanny state health meddling writ large;yet more tens of millions of tax payers' money squandered.
    When,oh when are we going to start making people take responsiblity for their own lifestyle or cultural choices.

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  • It's a complete and utter mess and the writing was on the wall 10 years ago. It's very easy to dismiss a depressed Somali woman with a vitamin D script than to try and identify the origins of her somatic pain which are likely to stem from PTSD.

    There are no robust RCTS in this area, GPs are screening rather than case finding when they request a vitamin D blood test for depression or TATT.

    And as always with this pathetic government, no one has the guts to tell people to self care as they are running scared of the racism card because it predominantly affects the BME community.

    The truth of the matter is that the majority in the Indian sub continent community do not want any sun exposure because white is considered beautiful.

    These needs to be managed by public health and self care.

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  • I just cant understand how the human race has existed for 200,000 years without Vitamin D pills? Perhaps we don't need them......

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  • "Virtually every person that comes in with a fractured hip to hospital is vitamin D deficient."

    But what proportion of matched controls without a fractured hip are vitamin D deficient?

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  • Well, if it has no clinical consequences and doesn't need treatment, how can it be called a deficiency? Until there are some good, reputable quality clinical trials and some meaningful data and advice all this talk is just wasted air. Can you prove that they are not right to test and treat? And as for it being mainly in the BME population how do you know unless you are testing? Can you guarantee that someone's lethargy and low mood is due to lifestyle choices, and not their Vitamin D deficiency? When you can state that, then pipe up and publish. Until then, pipe down.

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  • I hardly ever check it here as it is always low. I consider that as normal for my community. Rheumatologists locally are always checking it and we have a cohort of fibro. patients who feel that their symptoms are caused by it with all of the anxiety/further testing that goes along with it. I today have an anaesthetist checking it and wanting it sorted before he will do a knee replacement op???.

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  • What did they expect?
    We have NOGG and NICE PH56 and various other official recommendations stating that this is the service we are expected to provide. The fact that these are based upon papers by Michael Holick which have questionable statements and sets a high plasma target level with no evidence base is half the problem. That, and the expectation that medicine can provide a magic pill to promote better health which is compromised by lifestyle choice...
    Sadly, I can't really blame the pharma industry from trying to make a quick buck here.
    Can we go back to treating the patient, rather than treating test results? (Alas! Probably not.)

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