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Only investigate high-risk patients for vitamin D deficiency, says new guidance

GPs should only order vitamin D blood tests in patients with confirmed or suspected bone conditions or who are at high risk of deficiency, says new guidance.

In updated clinical guidelines, the National Osteoporosis Society (NOS) recommends that only patients with confirmed osteoporosis or confirmed or suspected osteomalacia, musculoskeletal symptoms that could be due to vitamin D deficiency and patients at risk of deficiency due to age or lack of exposure to the sun are tested.

It also recommends blood testing for patients who are due to start antiresorptive treatment for osteoporosis.

Regarding subsequent treatment, the guideline recommends that:

  • Patients with plasma 25(OH)D <25nmol/L are treated for deficiency.
  • Patients with plasma 25(OH)D 25–50nmol/L are treated if they have a fragility fracture, documented osteoporosis, increased risk of developing deficiency or are being treated with antiresorptive medication for bone disease.
  • Patients with plasma 25(OH)D >50nmol/L are reassured and given lifestyle advice about maintaining adequate vitamin D levels.

NOS clinical director Ali Doyle said: ‘We want healthcare professionals to feel more confident about treating the right patients with the right amount of vitamin D at the right time

‘These updated guidelines give clear details about measuring plasma levels to clarify whether someone is deficient in vitamin D, giving healthcare professionals the guidance to know when, and importantly, if to test.’

It comes as research published in October suggested that there was ‘little justification’ for recommending vitamin D to improve musculoskeletal health in most patient groups. 


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