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Original article

Vol. 141 No. 2122 (2011)

High prevalence of hypovitaminosis D in a Swiss rheumatology outpatient population

  • D Hans
  • A So
  • MA Krieg
  • B Aubry-Rozier
DOI
https://doi.org/10.4414/smw.2011.13196
Cite this as:
Swiss Med Wkly. 2011;141:w13196
Published
23.05.2011

Summary

Vitamin D is important for bone metabolism and neuromuscular function. While a routine dosage is often proposed in osteoporotic patients, it is not so evident in rheumatology outpatients where it has been shown that the prevalence of hypovitaminosis D is high. The aim of the current study was to systematically evaluate the vitamin D status in our outpatient rheumatology population to define the severity of the problem according to rheumatologic diseases. During November 2009, all patients were offered a screening test for 25-OH vitamin D levels and categorised as deficient (<10 µg/l [ng/ml] [25 nmol/l]), insufficient (10 µg/l to 30 µg/l [25 to 75 nmol/l]) or normal (>30 µg/l [75 nmol/l]). A total of 272 patients were included. The mean 25-OH vitamin D level was 21 µg/l (range 1.5 to 45.9). A total of 20 patients had vitamin D deficiency, 215 patients had an insufficiency and 37 patients had normal results. In the group of patients with osteoporosis mean level of 25-OH vitamin D was 25 µg/l and 31% had normal results. In patients with inflammatory rheumatic diseases (N = 219), the mean level of 25-OH vitamin D was 20.5 µg/l, and only 12% had normal 25-OH vitamin D levels.In the small group of patients with degenerative disease (N = 33), the mean level of 25-OH vitamin D was 21.8 µg/l, and 21% had normal results. Insufficiency and deficiency were even seen in 38% of the patients who were taking supplements. These results confirm that hypovitaminosis D is highly prevalent in an outpatient population of rheumatology patients, affecting 86% of subjects.Despite oral supplementation (taken in 38% of our population), only a quarter of those on oral supplementation attained normal values of 25-OH vitamin D.

References

  1. Holick MF. Vitamin D deficiency. N Engl J Med. 2007;357(3):266–81.
  2. DeLuca HF. Overview of general physiologic features and functions of vitamin D. Am J Clin Nutr. 2004;80(6 Suppl):1689S–96S.
  3. de Torrente de la Jara G, Pecoud A, Favrat B. Female asylum seekers with musculoskeletal pain: the importance of diagnosis and treatment of hypovitaminosis D. BMC Fam Pract. 2006;7:4.
  4. Plotnikoff GA, Quigley JM. Prevalence of severe hypovitaminosis D in patients with persistent, nonspecific musculoskeletal pain. Mayo Clin Proc. 2003;78(12):1463–70.
  5. Bischoff-Ferrari HA, et al. Higher 25-hydroxyvitamin D concentrations are associated with better lower-extremity function in both active and inactive persons aged > or = 60 y. Am J Clin Nutr. 2004;80(3):752–8.
  6. Bischoff-Ferrari HA, et al. Effect of Vitamin D on falls: a meta-analysis. JAMA. 2004;291(16):1999–2006.
  7. Trivedi DP, Doll R, Khaw KT. Effect of four monthly oral vitamin D3 (cholecalciferol) supplementation on fractures and mortality in men and women living in the community: randomised double blind controlled trial. BMJ. 2003;326(7387):469.
  8. Chapuy MC, et al. Vitamin D3 and calcium to prevent hip fractures in the elderly women. N Engl J Med. 1992;327(23):1637–42.
  9. Janssen HC, Samson MM, Verhaar HJ. Vitamin D deficiency, muscle function, and falls in elderly people. Am J Clin Nutr. 2002;75(4):611–5.
  10. Hypponen E, et al. Intake of vitamin D and risk of type 1 diabetes: a birth-cohort study. Lancet. 2001;358(9292):1500–3.
  11. Penckofer S, et al. Vitamin D and diabetes: let the sunshine in. Diabetes Educ. 2008;34(6):939–40, 942, 944 passim.
  12. Giovannucci E, et al. 25-hydroxyvitamin D and risk of myocardial infarction in men: a prospective study. Arch Intern Med. 2008;168(11):1174–80.
  13. Holick MF. Vitamin D: importance in the prevention of cancers, type 1 diabetes, heart disease, and osteoporosis. Am J Clin Nutr. 2004;79(3):362–71.
  14. Stene LC, Joner G. Use of cod liver oil during the first year of life is associated with lower risk of childhood-onset type 1 diabetes: a large, population-based, case-control study. Am J Clin Nutr. 2003;78(6):1128–34.
  15. Sanders KM, et al. Annual high-dose oral vitamin D and falls and fractures in older women: a randomized controlled trial. JAMA. 2010;303(18):1815–22.
  16. Chapuy MC, et al. Prevalence of vitamin D insufficiency in an adult normal population. Osteoporos Int. 1997;7(5):439–43.
  17. Holick MF, Matsuoka LY, Wortsman J. Age, vitamin D, and solar ultraviolet. Lancet. 1989;2(8671):1104–5.
  18. Boulat O, et al. Clinical chemistry variables in normal elderly and healthy ambulatory populations: comparison with reference values. Clin Chim Acta. 1998;272(2):127–35.
  19. Holick MF. Environmental factors that influence the cutaneous production of vitamin D. Am J Clin Nutr. 1995;61(3 Suppl):638S–645S.
  20. Mouyis M, et al. Hypovitaminosis D among rheumatology outpatients in clinical practice. Rheumatology (Oxford), 2008;47(9):1348–51.
  21. Chiu G. Vitamin D deficiency among patients attending a central New Zealand rheumatology outpatient clinic. N Z Med J. 2005;118(1225):U1727.
  22. Cutolo M, et al. Circannual vitamin d serum levels and disease activity in rheumatoid arthritis: Northern versus Southern Europe. Clin Exp Rheumatol. 2006;24(6):702–4.
  23. Cutolo M, et al. Vitamin D in rheumatoid arthritis. Autoimmun Rev. 2007;7(1):59–64.
  24. Cutolo M, Otsa K. Review: vitamin D, immunity and lupus. Lupus. 2008;17(1):6–10.
  25. Merlino LA, et al. Vitamin D intake is inversely associated with rheumatoid arthritis: results from the Iowa Women’s Health Study. Arthritis Rheum. 2004;50(1):72–7.
  26. Mithal A, et al. Global vitamin D status and determinants of hypovitaminosis D. Osteoporosis international: a journal established as result of cooperation between the European Foundation for Osteoporosis and the National Osteoporosis Foundation of the USA. 2009;20(11):1807–20.
  27. Rosen CJ. Clinical practice. Vitamin D insufficiency. N Engl J Med. 2011;364(3):248–54.
  28. Bhattoa HP, et al. Prevalence and seasonal variation of hypovitaminosis D and its relationship to bone metabolism in community dwelling postmenopausal Hungarian women. Osteoporos Int. 2004;15(6):447–51.
  29. Kull M Jr, et al. Seasonal variance of 25-(OH) vitamin D in the general population of Estonia, a Northern European country. BMC Public Health. 2009;9:22.
  30. Rizzoli R, et al. Risk factors for vitamin D inadequacy among women with osteoporosis: an international epidemiological study. Int J Clin Pract. 2006;60(8):1013–9.
  31. Tang BM, et al. Use of calcium or calcium in combination with vitamin D supplementation to prevent fractures and bone loss in people aged 50 years and older: a meta-analysis. Lancet. 2007;370(9588):657–66.
  32. Lips P, et al. The prevalence of vitamin D inadequacy amongst women with osteoporosis: an international epidemiological investigation. J Intern Med. 2006;260(3):245–54.
  33. Patel S, et al. Association between serum vitamin D metabolite levels and disease activity in patients with early inflammatory polyarthritis. Arthritis and rheumatism. 2007;56(7):2143–9.
  34. Cantorna MT, Mahon BD. Mounting evidence for vitamin D as an environmental factor affecting autoimmune disease prevalence. Experimental biology and medicine. 2004;229(11):1136–42.
  35. Kanis JA, et al. Assessment of fracture risk. Osteoporos Int. 2005;16(6):581–9.
  36. Dawson-Hughes B, Harris SS, Dallal GE. Plasma calcidiol, season, and serum parathyroid hormone concentrations in healthy elderly men and women. Am J Clin Nutr. 1997;65(1):67–71.
  37. Pearce SH, Cheetham TD. Diagnosis and management of vitamin D deficiency. BMJ. 2010;340:b5664.
  38. Audran M, Briot K. Critical reappraisal of vitamin D deficiency. Joint Bone Spine. 2010:77(2):115–9.
  39. Ryan PJ. Vitamin D therapy in clinical practice. One dose does not fit all. Int J Clin Pract. 2007;61(11):1894–9.