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The confusion around vitamin D is concerning

As the only UK charity at the forefront of raising awareness about bone heath, osteoporosis and the often debilitating fractures the condition causes, the National Osteoporosis Society has long held a keen interest in the subject of vitamin D deficiency and treatment highlighted in your recent article.

It is concerning that a lack of national guidance on vitamin D measurement, interpretation and treatment of deficiency has led to confusion

While we welcome the growing levels of media coverage this issue has received, it is indeed concerning that a lack of national guidance on vitamin D measurement, interpretation and treatment of deficiency has led to confusion among health professionals and the public alike.

It was partly in response to this confusion that in 2013 the National Osteoporosis Society published guidance on this subject. ’Vitamin D and Bone Health: A practical clinical guideline for patient management’ provides a practical approach to decision-making around testing and treatment of vitamin D deficiency in people with, or at risk of developing, bone disease.

This guidance, developed by a leading group of clinicians and scientists with expertise in vitamin D and osteoporosis, advises that vitamin D testing is prioritised for patients with bone diseases that may be improved with vitamin D treatment, or where vitamin D deficiency prior to a specific treatment would be appropriate (e.g. osteomalacia, osteoporosis and Paget’s disease).

Vitamin D testing is not always necessary in people with osteoporosis as they are often prescribed vitamin D as part of their treatment plan. However, correction of vitamin D deficiency is essential where zoledronate or denosumab are being prescribed to avoid development of hypocalcaemia and testing is usually appropriate in these patients.

For most people, safe exposure to sunlight during the summer months is still an effective way of getting vitamin D and levels can be topped up through diet too. As your article notes, NICE recommends supplements for certain groups who are at greater risk of deficiency, where sunlight exposure is unlikely to maintain vitamin D levels needed for good health. These people do not need routine vitamin D testing. Nor do asymptomatic healthy individuals.

While we look forward to the publication of the Scientific Advisory Committee on Nutrition report on vitamin D, it’s important to point out that the proposed changes do raise some important issues which need to be addressed. These include the potential increase in prescribing costs, the over medicalisation of the general population through supplement use and the acceptability amongst the wider population of food fortification.

It will be interesting to see how Public Health England tackles these issues.