Southern Derbyshire Shared Care Pathology Guidelines. Vitamin D

Save this PDF as:
 WORD  PNG  TXT  JPG

Size: px
Start display at page:

Download "Southern Derbyshire Shared Care Pathology Guidelines. Vitamin D"

Transcription

1 Southern Derbyshire Shared Care Pathology Guidelines Vitamin D Purpose of guideline Provide clear advice on when to measure vitamin D and identify patients with insufficiency and deficiency. To provide information on treatment and monitoring. When to measure vitamin D levels? Vitamin D deficiency is very common in the UK with an estimated % of the population being insufficient.. Population screening by measuring Vitamin D levels is unnecessary, even in high risk populations High risk populations (see table 1) without symptoms should not have Vitamin D levels measured, but should be offered lifestyle advice in order to avoid vitamin D deficiency. Over the counter (OTC) supplements may also be suggested. Measure Vitamin D levels only in patients with symptoms of rickets or osteomalacia (see table 2). Who is most at risk of Vitamin D deficiency? Table 1: Age/Groups Poor exposure to UVB light Dietary intake/ absorption Metabolic risk 75years <5 years Pregnancy Breastfeeding Pigmented skin Occlusive garments Housebound Use of sun blocking creams Vegetarian/ fish-free diet Malabsorption (including bariatric surgery) Cholestatic liver disease Breast fed infants Elderly (reduced synthesis) Liver disease (reduced stores) Renal disease (reduced activation) Obese people (excess storage in fat) Drugs: Rifampicin, Antiretroviral drugs, anticonvulsants, cholestyramine, glucocorticoids. Authorised by Julia Forsyth Page 1 of 5

2 Symptoms of deficiency n specific aches and pains are the commonest features. As such, vitamin D deficiency can be easily overlooked. Consider a diagnosis of Vitamin D deficiency in patients with risk factors presenting with musculoskelatal pain. The symptoms outlined in the table below are more commonly observed in patients with severe deficiency leading to Rickets in children or Osteomalacia in adults. Table 2: Clinical features of Vitamin D deficiency Children Poor growth, delayed fontanelle closure Delayed walking or waddling gait Bone pain or tenderness Tender or swollen joints Muscle spasms, seizures or irritability due to hypocalcaemia requiring urgent treatment Breathing difficulties Late teething Adults Proximal muscle weakness Gradual onset and persistent musculoskeletal pain (often in back or lower limbs) Waddling gait Fragility fracture Carpopedal spasm, tetany, seizures or irritability due to hypocalcaemia Laboratory Investigations Serum 25-hydroxy vitamin D (25-OH Vit D) levels are the most reliable marker of overall Vitamin D status. Measurement of other vitamin D metabolites or subfractions is not recommended. 1. In patients with symptoms, measure U&E, LFT, calcium, phosphate and 25-OH Vit D. 2. Severe vitamin D deficiency can result in hypocalcaemia. Measure 25-OH Vit D in any hypocalcaemic patient. If deficient, treatment with vitamin D alone should correct the hypocalcaemia. 3. PTH is commonly raised in vitamin D deficiency (secondary hyperparathyroidism). Measure 25-OH Vit D in any patient with unexplained raised PTH. A high PTH is common in renal disease - there is no indication for measuring vitamin D levels in CKD patients, unless the patient is at risk of deficiency. Authorised by Julia Forsyth Page 2 of 5

3 Diagnosis and Management of Vitamin D Deficiency in Primary Care Symptoms of rickets or osteomalacia? (see table 2) Investigations U&E, LFT, Calcium, Phosphate 25-OH Vitamin D Risk factors for Vitamin D deficiency? Vit D <30 nmol/l Prescription 1 Referral to Specialist Indicated? 2 Refer GP to Prescribe Vit D nmol/l Lifestyle advice & OTC supplements 1 Further Action investigation required Offer lifestyle advice Suggest OTC supplements te 1 Cut off for high dose vitamin D prescription Symptomatic deficiency is unlikely when 25-OH VitD is >30 nmol/l but there is no clear threshold. If symptoms are strongly suspected to be vitamin D related it is reasonable to offer high dose treatment when levels are between 30 and 35 nmol/l. te 2 Reasons for Secondary Care Referral Referral should be to Osteoporosis & Metabolic Bone Clinic unless otherwise stated CKD 4&5 Renal Referral Malabsorption Gastro Referral Atypical biochemistry (includes hypercalcaemia) Failure to respond to treatment after 3 months Short stature / skeletal deformity Focal bone pain Unexplained severe deficiency Authorised by Julia Forsyth Page 3 of 5

4 Management of Vitamin D deficiency < 30 nmol/l Deficiency High dose treatment, long term maintenance nmol/l Insufficiency Lifestyle advice and OTC supplements > 50 nmol/l Adequate rmal no indication for supplementation Please refer to the Derbyshire Joint Area Prescribing Committee (JAPC) guidance on the management of Vitamin D deficiency in primary care. Follow the link y_by_bnf_chapter_prescribing_guidelines/bnf_chapter_9/vitamin%20d%20deficiency %20in%20primary%20care%20(review%20Oct%202015).pdf Monitoring Vitamin D Insufficiency Over-the-counter supplementation should be continued long term in most patients unless there is reason to believe that a change in lifestyle has altered requirements. The majority of these patients do not need biochemical monitoring. Vitamin D Deficiency 2 months following the commencement of the high dose phase, re-check calcium, phosphate and ALP. Routine repeat of vitamin D levels is not needed if symptoms of vitamin D deficiency resolve. If symptoms do not resolve despite adequate vitamin D repletion then the symptoms are not due to vitamin D deficiency Sun exposure: Sun exposure is the main source of vitamin D and should be exploited! However, this should be balanced with the risks of excessive exposure. Diet: Dietary sources of Vitamin D include: Oily fish, cod liver oil/ fish oils, red meat, egg yolks Fortified breakfast cereals, soya products, fortified margarines, low fat spreads The average daily intake from a normal diet is just 2-4 µg/day, and it is difficult to obtain enough vitamin D from usual diet alone. Where supplementation is indicated a dose of units is advised. Authorised by Julia Forsyth Page 4 of 5

5 Contacts Duty Biochemist (8am to 7pm, Mon - Fri) On Call Consultant Biochemist Via RDH switchboard, (24/7) Renal Registrar 9am to 9pm, via RDH switchboard bleep 8121 Osteoporosis and Metabolic Bone Clinic References Vitamin D and Bone Health: A practical Clinical Guideline for Patient Management. National Osteoporosis Society. April 2013 Diagnosis and Management of vitamin D deficiency. Pearce SHS & Cheetham TD. BMJ 2010; 340: b5664 Primary Vitamin D deficiency in adults. Drug & Therapeutics Bulletin. 2006; 44(4): Authors: Dr Vicky Thurston, Dr Penny Blackwell, Dr Roger Stanworth, Dr Rustam Rea; Dr Greg Summers, February 2012 Reviewed by: Date: Expiry date: Dr P Blackwell, Dr R Stanworth, Dr G Summers, Mrs H Seddon June th Jun 2016 Authorised by Julia Forsyth Page 5 of 5

GUIDANCE ON THE PREVENTION, DIAGNOSIS AND MANAGEMENT OF VITAMIN D DEFICIENCY IN PRIMARY CARE

GUIDANCE ON THE PREVENTION, DIAGNOSIS AND MANAGEMENT OF VITAMIN D DEFICIENCY IN PRIMARY CARE GUIDANCE ON THE PREVENTION, DIAGNOSIS AND MANAGEMENT OF VITAMIN D DEFICIENCY IN PRIMARY CARE This guidance is based on national recommendations from NICE (PH56) and the National Osteoporosis Society. Summary

More information

Guidance on the Treatment of Vitamin D Deficiency & Insufficiency in Adult Patients

Guidance on the Treatment of Vitamin D Deficiency & Insufficiency in Adult Patients Guidance on the Treatment of Vitamin D Deficiency & Insufficiency in Adult Patients In line with the recommendations of The Greater Manchester Medicines Management Group (GMMMG). (1) NHS Trafford recommends

More information

ELHT Guideline for Vitamin D in Children

ELHT Guideline for Vitamin D in Children ELHT Guideline for Vitamin D in Children This guideline is based on Guideline issued by Royal College of Paediatrics & Child Health UK in October 2013. The aim of this guideline is to give advice on how

More information

Guideline on Diagnosis & Management of Vitamin D Deficiency in Adults for Non-Specialists

Guideline on Diagnosis & Management of Vitamin D Deficiency in Adults for Non-Specialists Guideline on Diagnosis & Management of Vitamin D Deficiency in Adults for Non-Specialists January 2014 (Review date: Jan 2016) Contents Summary Flowchart... 2 Introduction... 3 Structure and mechanism

More information

GUIDELINES FOR THE MANAGEMENT OF VITAMIN D DEFICIENCY

GUIDELINES FOR THE MANAGEMENT OF VITAMIN D DEFICIENCY GUIDELINES FOR THE MANAGEMENT OF VITAMIN D DEFICIENCY This document provides management guidelines for clinicians involved in the management of patients with or at risk of Vitamin D deficiency. Authors:

More information

PAN-DORSET GUIDELINE FOR THE MANAGEMENT OF VITAMIN D DEFICIENCY & INSUFFICIENCY IN ADULTS

PAN-DORSET GUIDELINE FOR THE MANAGEMENT OF VITAMIN D DEFICIENCY & INSUFFICIENCY IN ADULTS PAN-DORSET GUIDELINE FOR THE MANAGEMENT OF VITAMIN D DEFICIENCY & INSUFFICIENCY IN ADULTS Introduction Over 90% of the body s vitamin D is produced from skin photosynthesis following ultraviolet B sunlight

More information

GUIDE FOR VITAMIN D IN CHILDHOOD

GUIDE FOR VITAMIN D IN CHILDHOOD GUIDE FOR VITAMIN D IN CHILDHOOD October 2013 Introduction There are many different recommendations for the prevention, detection and treatment of Vitamin D deficiency in the UK. The following is a practical

More information

Guideline on Diagnosis & Management of Vitamin D Deficiency for Non-Specialists in Primary Care

Guideline on Diagnosis & Management of Vitamin D Deficiency for Non-Specialists in Primary Care Guideline on Diagnosis & Management of Vitamin D Deficiency for Non-Specialists in Primary Care Hillary Smith with acknowledgment to East Lancashire Health Economy Staffordshire and Lancashire CSU September

More information

Guidance on Vitamin D Deficiency/Insufficiency November 2011 (updated February 2012)

Guidance on Vitamin D Deficiency/Insufficiency November 2011 (updated February 2012) Guidance on Vitamin D Deficiency/Insufficiency vember 2011 (updated February 2012) This guidance aims to provide general advice for clinicians in a community setting including areas where clinical uncertainty

More information

Vitamin D Deficiency in Adults: Primary Care Guideline

Vitamin D Deficiency in Adults: Primary Care Guideline Vitamin D Deficiency in Adults: Primary Care Guideline The prevalence of vitamin D deficiency in the UK is 16% and around 50% of the UK adult population have vitamin D insufficiency in winter and spring.

More information

National. min. for early infancy. on Vitamin D. to get converted to action being. here. to treat an. will be insufficient

National. min. for early infancy. on Vitamin D. to get converted to action being. here. to treat an. will be insufficient ABUHB Prescribing Guideline Diagnosis and Management of Vitamin D Deficiency In ADULTS (including guidance for Non Specialists) This document aims to provide comprehensive guidance on the cost effective

More information

D. Vitamin D. 1. Two main forms; vitamin D2 and D3

D. Vitamin D. 1. Two main forms; vitamin D2 and D3 D. Vitamin D. Two main forms; vitamin D2 and D3 H H D3 - Cholecalciferol D2 - Ergocalciferol Technically, vitamin D is not a vitamin. It is the name given to a group of fat-soluble prohormones (substances

More information

Guidelines on the Diagnosis and Management of Vitamin D Deficiency in Children and Adults

Guidelines on the Diagnosis and Management of Vitamin D Deficiency in Children and Adults Reference Number: UHB 205 Date of Next Review: 21 st January 2019 Previous Trust/LHB Reference Number: N/A Guidelines on the Diagnosis and Management of Vitamin D Deficiency in Policy Statement To ensure

More information

Protecting and improving the nation s health. Vitamin D. Information for healthcare professionals

Protecting and improving the nation s health. Vitamin D. Information for healthcare professionals Protecting and improving the nation s health Vitamin D Information for healthcare professionals 1 Vitamin D: Information for healthcare professionals Why is vitamin D important? Some of the UK population

More information

Low vitamin D in Victoria

Low vitamin D in Victoria Low vitamin D in Victoria Key health messages for doctors, nurses and allied health August 2012 Vitamin D is essential for musculoskeletal health in all age groups and is likely to be important for other

More information

Potential Health Benefits of Vitamin D and Omega-3 Fatty Acids

Potential Health Benefits of Vitamin D and Omega-3 Fatty Acids Potential Health Benefits of Vitamin D and Omega-3 Fatty Acids Nimal Ratnayake, Ph.D. Senior Research Scientist Nutrition Research Division Health Canada Hindu Temple of Ottawa-Carleton April 8, 2012 What

More information

Vitamin D An Overview

Vitamin D An Overview Vitamin D An Overview Dr. Raja Padidela Consultant in Paediatric Endocrinology Department of Paediatric Endocrinology Royal Manchester Children's Hospital Overview What is Vitamin D? Vitamin D production

More information

Dr Chelsea McMahon Bone and Calcium Registrar St Vincent s Hospital

Dr Chelsea McMahon Bone and Calcium Registrar St Vincent s Hospital Dr Chelsea McMahon Bone and Calcium Registrar St Vincent s Hospital Outline Vitamin D sources and metabolism Benefits of Vitamin D Vitamin D deficiency and toxicity Optimal levels Available preparations

More information

Vitamin D Deficiency in Adults

Vitamin D Deficiency in Adults Vitamin D Deficiency in Adults Around 50% of the UK adult population have vitamin D insufficiency in winter and spring, whilst the prevalence of vitamin D deficiency is 16%. 1 This means that in Wandsworth

More information

Vitamin D. an essential nutrient for all but who is at risk of vitamin D deficiency? Important information for healthcare professionals

Vitamin D. an essential nutrient for all but who is at risk of vitamin D deficiency? Important information for healthcare professionals Vitamin D an essential nutrient for all but who is at risk of vitamin D deficiency? Important information for healthcare professionals Why is vitamin D important? A significant proportion of the UK population

More information

Southern Derbyshire Shared Care Pathology Guidelines. Hypothyroidism

Southern Derbyshire Shared Care Pathology Guidelines. Hypothyroidism Southern Derbyshire Shared Care Pathology Guidelines Hypothyroidism Purpose of Guideline The management and referral criteria of patients with newly diagnosed hypothyroidism in adults. Background Hypothyroidism

More information

Model guidance. This document includes the following: Model pathway for treating vitamin D deficiency and insufficiency in adults

Model guidance. This document includes the following: Model pathway for treating vitamin D deficiency and insufficiency in adults Model guidance Prevention, investigation and treatment of vitamin D deficiency and insufficiency This document includes the following: Model pathway for treating vitamin D deficiency and insufficiency

More information

NHS GGC Vitamin D Supplementation Frequently asked Questions

NHS GGC Vitamin D Supplementation Frequently asked Questions Pharmacy & Prescribing Support Unit NHS GGC Vitamin D Supplementation Frequently asked Questions In February 2012 the Scottish Government issued advice on supplements for groups at risk of vitamin D deficiency.

More information

Vitamin D. an essential nutrient for all... but who is at risk of vitamin D deficiency? Important information for healthcare professionals

Vitamin D. an essential nutrient for all... but who is at risk of vitamin D deficiency? Important information for healthcare professionals Vitamin D an essential nutrient for all... but who is at risk of vitamin D deficiency? Important information for healthcare professionals Why is vitamin D important? Vitamin D plays an important role in

More information

Vitamin D. Why Vitamin D is important and how to get enough

Vitamin D. Why Vitamin D is important and how to get enough Vitamin D Why Vitamin D is important and how to get enough Why is vitamin D vital for health? Vitamin D is needed by the body for both physical and mental health, but is best known for making sure bones

More information

Vitamin D: How much, how often and what formulation to prevent and treat vitamin D deficiency? Conflicts of Interest. Objectives. None.

Vitamin D: How much, how often and what formulation to prevent and treat vitamin D deficiency? Conflicts of Interest. Objectives. None. Vitamin D: How much, how often and what formulation to prevent and treat vitamin D deficiency? Eileen Pyra, RN,MN Clinical Nurse Specialist, Endocrine Alberta Children s Hospital Calgary, Alberta, Canada

More information

Southern Derbyshire Shared Care Pathology Guidelines. Hyperkalaemia

Southern Derbyshire Shared Care Pathology Guidelines. Hyperkalaemia Southern Derbyshire Shared Care Pathology Guidelines Hyperkalaemia Purpose of Guideline Dealing with adult patients with Hyperkalaemia in the community Definition Serum potassium normal range is 3.5 5.3

More information

Clinical Guideline on Replacement with High-potency Vitamin D in patients with vitamin D insufficiency or deficiency

Clinical Guideline on Replacement with High-potency Vitamin D in patients with vitamin D insufficiency or deficiency Hull and East Riding Prescribing Committee Clinical Guideline on Replacement with High-potency Vitamin D in patients with vitamin D insufficiency or deficiency When should vitamin D level be checked? Test

More information

Corporate Medical Policy

Corporate Medical Policy Corporate Medical Policy File Name: Origination: Last CAP Review: Next CAP Review: Last Review: testing_serum_vitamin_d_levels 9/2015 2/2016 2/2017 2/2016 Description of Procedure or Service Vitamin D,

More information

Diagnosis and Management of Vitamin D Deficiency

Diagnosis and Management of Vitamin D Deficiency Diagnosis and Management of Vitamin D Deficiency Sujata Edate, SpR Paediatrics Shailini Bahl, Consultant Paediatrician Ashford and St Peters Hospitals 14/5/12 Introduction Vitamin D deficiency is increasing

More information

Frontier AIDS Education and Training Center

Frontier AIDS Education and Training Center Frontier AIDS Education and Training Center Vitamin D and HIV Subbulaxmi Trikudanathan, MD, MRCP, MMSc Division of Endocrinology, Metabolism and Nutrition University of Washington Medical Center Presentation

More information

Our main source of vitamin D is that made by our own bodies. 90% of our vitamin D is made in the skin with the help of sunlight.

Our main source of vitamin D is that made by our own bodies. 90% of our vitamin D is made in the skin with the help of sunlight. Vitamin D Deficiency Vitamin D deficiency is a very common problem - more than half of the UK population has insufficient levels of vitamin D Vitamin D is mostly made in the skin by exposure to sunlight

More information

Nottingham Children s Hospital

Nottingham Children s Hospital Vitamin D Deficiency Title of Guideline (must include the word Guideline Contact Name and Job Title (author) Directorate & Speciality Date of submission October 2016 Date when guideline reviewed October

More information

Guidance for the Prevention, Investigation and Treatment of Vitamin D Deficiency and Insufficiency

Guidance for the Prevention, Investigation and Treatment of Vitamin D Deficiency and Insufficiency Guidance for the Prevention, Investigation and Treatment of Vitamin D Deficiency and Insufficiency This document includes the following: Key points and Pathway for treating Vitamin D deficiency and insufficiency

More information

Vitamin D deficiency from BMJ January 16 th 2010

Vitamin D deficiency from BMJ January 16 th 2010 Vitamin D deficiency from BMJ January 16 th 2010 Vitamin D insufficiency is common in the UK population Vitamin D deficiency typically presents with bony deformity (rickets) or hypocalcaemia in infancy

More information

RECOMMENDATIONS VITAMIN D TESTING 1,2. VITAMIN D TESTING AND SUPPLEMENTATION Clinical Practice Guideline August 2014

RECOMMENDATIONS VITAMIN D TESTING 1,2. VITAMIN D TESTING AND SUPPLEMENTATION Clinical Practice Guideline August 2014 VITAMIN D TESTING AND SUPPLEMENTATION Clinical Practice Guideline August 2014 OBJECTIVE Appropriate vitamin D testing and supplementation is understood and practiced in Alberta. Specifically that: There

More information

Vitamin D Deficiency and Thyroid Disease. Theodore C. Friedman, M.D., Ph.D.

Vitamin D Deficiency and Thyroid Disease. Theodore C. Friedman, M.D., Ph.D. Vitamin D Deficiency and Thyroid Disease Theodore C. Friedman, M.D., Ph.D. Vitamin D deficiency and thyroid diseases Vitamin D is an important vitamin that not only regulates calcium, but also has many

More information

Vitamin D. betterhealth.vic.gov.au. Health effects of low vitamin D. Summary

Vitamin D. betterhealth.vic.gov.au. Health effects of low vitamin D. Summary Vitamin D Summary Vitamin D is essential for strong bones, muscles and overall health. The sun is the best natural source of vitamin D, but you need to balance sun exposure with cancer risk. Solariums

More information

Vitamin D. Sources of vitamin D

Vitamin D. Sources of vitamin D 1 has been in the news frequently this past year, including an article in The New York Times on November 16, 2009. So what is this vitamin? Why is it important? Most people have heard that vitamin D is

More information

Vitamin D Deficiency and Thyroid Disease. Theodore C. Friedman, M.D., Ph.D.

Vitamin D Deficiency and Thyroid Disease. Theodore C. Friedman, M.D., Ph.D. Vitamin D Deficiency and Thyroid Disease Theodore C. Friedman, M.D., Ph.D. Vitamin D deficiency and thyroid diseases Vitamin D is an important vitamin that not only regulates calcium, but also has many

More information

Vitamin D deficiency in adults

Vitamin D deficiency in adults Background information Patient information Key messages for this pathway Management of vitamin D status Healthy Start and other options for vitamin supplements General advice for asymptomatic but concerned

More information

Protecting and improving the nation s health. Vitamin D. All you need to know

Protecting and improving the nation s health. Vitamin D. All you need to know Protecting and improving the nation s health Vitamin D All you need to know 1 Vitamin D: All you need to know Why is vitamin D important? Throughout our lives, we need vitamin D to keep our bones and teeth

More information

Calcium and Vitamin D Nutrition in the Elderly. Functions of Calcium. OCW: Geriatric Dentistry (E. Krall)

Calcium and Vitamin D Nutrition in the Elderly. Functions of Calcium. OCW: Geriatric Dentistry (E. Krall) 1. 2. Functions of Calcium Page - 1 3. Regulation of calcium: Hypocalcemia 4. Regulation of calcium: Hypercalcemia Page - 2 5. Calcium Homeostasis 6. Calcium absorption Page - 3 7. Some factors influencing

More information

Key words: Vitamin D Production, Vitamin D Deficiency, and Vitamin D Treatment

Key words: Vitamin D Production, Vitamin D Deficiency, and Vitamin D Treatment Title: Vitamin D Author: Kerry Lynn Kuffenkam Date: 4-29-09 Key words: Vitamin D Production, Vitamin D Deficiency, and Vitamin D Treatment Abstract: Since the term Vitamin D contains the word vitamin most

More information

Press Information. Vitamin D deficiency

Press Information. Vitamin D deficiency DSM, Corporate Communications P.O. Box 6500, 6401 HJ Heerlen The Netherlands phone +31 (0) 45 578 2421 www.dsm.com Vitamin D is one of the essential nutrients for human health. Unlike other types of vitamins

More information

Guidelines for the Treatment and Prophylaxis of vitamin D deficiency in children and adolescents

Guidelines for the Treatment and Prophylaxis of vitamin D deficiency in children and adolescents Corby Clinical Commissioning Group Kettering General Hospital NHS Trust Nene Clinical Commissioning Group Northampton General Hospital NHS Trust Northamptonshire Healthcare Foundation Trust Guidelines

More information

Department of Health. Rheynn Slaynt. Clinical Recommendations Committee

Department of Health. Rheynn Slaynt. Clinical Recommendations Committee Department of Health Rheynn Slaynt Clinical Recommendations Committee Recommendation 03/12 The Department of Health recommends as a High Priority, high dose vitamin D supplementation in those patients

More information

Southern Derbyshire Shared Care Pathology Guidelines. Diagnosis and Management of Myeloma

Southern Derbyshire Shared Care Pathology Guidelines. Diagnosis and Management of Myeloma Southern Derbyshire Shared Care Pathology Guidelines Diagnosis and Management of Myeloma When to screen for Myeloma and related disorders Not recommended to screen the normal population Clinical Symptoms,

More information

Vitamin D Deficiency and Thyroid Disease. Theodore C. Friedman, M.D., Ph.D.

Vitamin D Deficiency and Thyroid Disease. Theodore C. Friedman, M.D., Ph.D. Vitamin D Deficiency and Thyroid Disease Theodore C. Friedman, M.D., Ph.D. Vitamin D deficiency and thyroid diseases Vitamin D is an important vitamin that not only regulates calcium, but also has many

More information

Policy on the Diagnosis and Management of Vitamin D Deficiency / Insufficiency

Policy on the Diagnosis and Management of Vitamin D Deficiency / Insufficiency Policy on the Diagnosis and Management of Vitamin D Deficiency / Insufficiency Version no: 2.1 Issue Status: Approved Ratified by: Drugs & Therapeutics Committee Date of Ratification: 20 th May 2013 Policy

More information

Southern Derbyshire Shared Care Pathology Guidelines. Hyponatraemia in Adults

Southern Derbyshire Shared Care Pathology Guidelines. Hyponatraemia in Adults Southern Derbyshire Shared Care Pathology Guidelines Hyponatraemia in Adults Purpose of Guideline The investigation and management of adult patients with newly diagnosed hyponatraemia. Hyponatraemia can

More information

Selected Questions and Answers on Vitamin D

Selected Questions and Answers on Vitamin D Selected Questions and Answers on Vitamin D Joint FAQs to the BfR, German Nutrition Society (DGE) und Max Rubner-Institute (MRI) of 03 December 2014 1 Vitamin D promotes the intake of calcium from the

More information

Mersey Cluster - Guidance for Vitamin D Deficiency and Treatment Options

Mersey Cluster - Guidance for Vitamin D Deficiency and Treatment Options Mersey Cluster - Guidance for Vitamin D Deficiency and Treatment Options Recent BMJ articles 1,2 highlighted the problem of vitamin D deficiency in the UK population. There is an increasing body of evidence

More information

Endocrinology. Vitamin D and bone health National Osteoporosis Society Guideline 2013. What is the GP s role? Vitamin D physiology

Endocrinology. Vitamin D and bone health National Osteoporosis Society Guideline 2013. What is the GP s role? Vitamin D physiology Endocrinology Vitamin D and bone health... 182 - What is the GP s role?...182 - Vitamin D physiology...182 - Why do people become vitamin D deficient?...183 - Which foods contain vitamin D?...183 - What

More information

Volume 9; Number 13 September 2015 TREATMENT OF VITAMIN D DEFICIENCY IN AT-RISK ADULTS (SECOND EDITION)

Volume 9; Number 13 September 2015 TREATMENT OF VITAMIN D DEFICIENCY IN AT-RISK ADULTS (SECOND EDITION) Arden and Greater East Midlands Commissioning Support Unit in association with Lincolnshire Clinical Commissioning Groups, Lincolnshire Community Health Services, United Lincolnshire Hospitals Trust and

More information

Hypocalcaemia. Shaila Sukthankar

Hypocalcaemia. Shaila Sukthankar Hypocalcaemia Shaila Sukthankar Ca Daily Requirements Age/ sex Ca (mg) 1-3 350 4-6 450 7-10 550 11-18 M 1000 11-18 F 800 19 + 700 Ca Dietary Sources (NDC) Milk 100 ml =120mg Cheese 15gm = 110mg Yoghurt

More information

Question I. A vitamin D deficient mother will give birth. A. True B. False. Answer A

Question I. A vitamin D deficient mother will give birth. A. True B. False. Answer A Vitamin D Jatinder Bhatia, MD, FAAP Question I A vitamin D deficient mother will give birth to an infant with Vit D deficiency A. True B. False Answer A Question II Human breast milk has adequate amounts

More information

Vitamin D deficiency: the cause of everything?

Vitamin D deficiency: the cause of everything? Health problems linked to vitamin D deficiency: Vitamin D deficiency: the cause of everything? Louise Gagné M.D. Family Physician Saskatoon Community Clinic Clinical Assistant Professor Department of Community

More information

Prevalence of Vitamin D Deficiency In Secure Mental Health Setting: is routine screening required?

Prevalence of Vitamin D Deficiency In Secure Mental Health Setting: is routine screening required? Prevalence of Vitamin D Deficiency In Secure Mental Health Setting: is routine screening required? Dr Neel Halder, Consultant Psychiatrist and Senior Honorary Lecturer, Manchester University Dhana Govindaraj,

More information

Vitamin D Deficiency: What s the Big Deal?

Vitamin D Deficiency: What s the Big Deal? Page 1 Ranti Akiyode, PharmD, BCPS, BC-ADM, CDE Howard University, College of Pharmacy Accreditation Faculty Pharmacists: 0798-0000-12-035-L01-P Pharmacy Technicians: 0798-0000-12-035-L01-T Nurses: N-759

More information

Osteoporosis. Dr Gordon MacDonald BSc MB BChir MRCP Consultant Rheumatologist. Rheumatology and Arthritis Seminar Tuesday 5 th February 2013

Osteoporosis. Dr Gordon MacDonald BSc MB BChir MRCP Consultant Rheumatologist. Rheumatology and Arthritis Seminar Tuesday 5 th February 2013 Osteoporosis Dr Gordon MacDonald BSc MB BChir MRCP Consultant Rheumatologist Rheumatology and Arthritis Seminar Tuesday 5 th February 2013 Plan What is osteoporosis? Consequences of osteoporosis Risk factors

More information

GUIDELINES FOR THE PRESCRIBING OF VITAMIN D IN ADULTS

GUIDELINES FOR THE PRESCRIBING OF VITAMIN D IN ADULTS GUIDELINES FOR THE PRESCRIBING OF VITAMIN D IN ADULTS This guidance has been adapted from the North of Tyne Guideline Group guidelines, published in 2011. The treatment of children has been removed, as

More information

Vitamin D Deficiency in Clinical Practice

Vitamin D Deficiency in Clinical Practice Vitamin D Deficiency in Clinical Practice Robert Banner, MD With thanks for some slides to: Linda M. Rapson MD, CAFCI President, Ontario Society of Physicians for Complementary Medicine Chair, Complementary

More information

DERBYSHIRE JOINT AREA PRESCRIBING COMMITTEE (JAPC) OSTEOPOROSIS GUIDELINE

DERBYSHIRE JOINT AREA PRESCRIBING COMMITTEE (JAPC) OSTEOPOROSIS GUIDELINE DERBYSHIRE JOINT AREA PRESCRIBING COMMITTEE (JAPC) OSTEOPOROSIS GUIDELINE This is an updated guideline It incorporates the latest NICE guidance There are strong recommendations for calcium + vitamin D

More information

Role of Vitamin D in the Prevention of Falls

Role of Vitamin D in the Prevention of Falls Role of Vitamin D in the Prevention of Falls Anthony J. Caprio, MD Assistant Professor of Medicine Division of Geriatric Medicine Center for Aging and Health University of North Carolina at Chapel Hill

More information

Calcium (serum, plasma, blood)

Calcium (serum, plasma, blood) Calcium (serum, plasma, blood) 1 Name and description of analyte 1.1 Name of analyte Calcium (total in serum, plasma, ionised in blood (see 2.1 (2)). 1.2 Alternative names None 1.3 NMLC code 1.4 Description

More information

Earth at Night View from the Space Shuttle. Vitamin D: All You Need to Know

Earth at Night View from the Space Shuttle. Vitamin D: All You Need to Know Earth at Night View from the Space Shuttle Vitamin D: All You Need to Know Sunil Wimalawansa, MD, PhD, MBA 11/12/2011 Vitamin D: All You Need to Know Sunil J. Wimalawansa, MD, PhD, MBA, FACE, FACP Professor

More information

Calcium & Vitamin D. Calcium Requirements

Calcium & Vitamin D. Calcium Requirements ROBERT M. SELIG, M.D., FAAP JOANN C. COZZA, D.O., FAAP DANIEL S. SELIG, M.D., FAAP ANDORRA PEDIATRICS 8945 RIDGE AVENUE SUITE 3-4-5 PHILADELPHIA, PA 19128 215-483-8558 Calcium & Vitamin D Calcium is necessary

More information

VITAMIN D UPDATE Vitamin D as a nutrient

VITAMIN D UPDATE Vitamin D as a nutrient VITAMIN D UPDATE Vitamin D as a nutrient Professor Susan J Whiting College of Pharmacy and Nutrition University of Saskatchewan CANADA Vitamin D as a Nutrient Why sun exposure is not adequate for UK or

More information

Skeletal and Non-Skeletal Effects of Vitamin D

Skeletal and Non-Skeletal Effects of Vitamin D Skeletal and Non-Skeletal Effects of Vitamin D Sunil J. Wimalawansa, MD, PhD, MBA, DSc - University Professor - Professor of Medicine Endocrinology, Metabolism & Nutrition Professor of Physiology & Integrative

More information

Vitamin D and calcium supplementation in primary care: an update

Vitamin D and calcium supplementation in primary care: an update Vitamin D and calcium supplementation in primary care: an update key practice points Most people can achieve adequate levels of vitamin D through exposure to sunlight Vitamin D supplementation should be

More information

Vitamin supplements and you

Vitamin supplements and you Vitamin supplements and you Guidance for pregnant or breastfeeding women, babies and young children Health Improvement About this leaflet Vitamins are really important they are essential nutrients that

More information

VITAMIN D PRODUCTS -WHAT AND WHEN TO PRESCRIBE. Claudette Allerdyce Principal Pharmacist Croydon CCG Pharmacy Team

VITAMIN D PRODUCTS -WHAT AND WHEN TO PRESCRIBE. Claudette Allerdyce Principal Pharmacist Croydon CCG Pharmacy Team VITAMIN D PRODUCTS -WHAT AND WHEN TO PRESCRIBE Claudette Allerdyce Principal Pharmacist Croydon CCG Pharmacy Team WHAT ARE THE ISSUES? A lack of suitable licensed vitamin D products in the UK for treating

More information

University College Hospital

University College Hospital University College Hospital Vitamin and mineral supplements for children Information for parents and guardians Department of Nutrition & Dietetics If you would like this document in another language or

More information

SUMMARY OF THE RISK MANAGEMENT PLAN (by medicinal product)

SUMMARY OF THE RISK MANAGEMENT PLAN (by medicinal product) PART VI SUMMARY OF THE RISK MANAGEMENT PLAN (by medicinal product) Format and content of the summary of the RMP The summary of the RMP part VI contains information based on RMP modules SI, SVIII and RMP

More information

Vitamin D Deficiency: Family Medicine Review 2012

Vitamin D Deficiency: Family Medicine Review 2012 Vitamin D Deficiency: Family Medicine Review 2012 Don Chaffer, MD Program Director Nephrology Fellowship Division of Nephrology and Hypertension Scott and White Clinic Texas A&M University Health Science

More information

Vitamin supplements and you

Vitamin supplements and you Vitamin supplements and you Vitamin supplements and you For pregnant or breastfeeding women, and babies and young children about this leaflet Vitamins are really important they are essential nutrients

More information

Vitamin D in Children: FAQs

Vitamin D in Children: FAQs PL Detail-Document #311231 This PL Detail-Document gives subscribers additional insight related to the Recommendations published in PHARMACIST S LETTER / PRESCRIBER S LETTER December 2015 Vitamin D in

More information

Fourth Year Medical Students Required Written Patient Care Assignments Reflecting Awareness of Use of Vitamin D in Older Patients at Risk for Falling

Fourth Year Medical Students Required Written Patient Care Assignments Reflecting Awareness of Use of Vitamin D in Older Patients at Risk for Falling Fourth Year Medical Students Required Written Patient Care Assignments Reflecting Awareness of Use of Vitamin D in Older Patients at Risk for Falling John Agens, M.D. Associate Professor in Geriatrics

More information

Vitamin supplements and you

Vitamin supplements and you Vitamin supplements and you For pregnant or breastfeeding women, and babies and young children About this leaflet Vitamins are really important they are essential nutrients that your body needs, in small

More information

Doctors and pharmacists. Document. Reference No: Reference: Issued by: Pharmacy Effective Date: September 2012. Information Pharmacist

Doctors and pharmacists. Document. Reference No: Reference: Issued by: Pharmacy Effective Date: September 2012. Information Pharmacist Document Title: Document Purpose: Document Statement: Document Application: Responsible for Implementation: Vitamin D deficiency and insufficiency guidelines To improve the management of patients with

More information

Nutrition MANAGING VITILIGO

Nutrition MANAGING VITILIGO MANAGING VITILIGO Nutrition A common question that people with vitiligo ask is whether their diet makes any difference to their skin condition. Choosing the food we eat is something we can manage, so having

More information

Shining a light on the Sunshine Vitamin Lin A. Brown,MD Dartmouth and DHMC

Shining a light on the Sunshine Vitamin Lin A. Brown,MD Dartmouth and DHMC Shining a light on the Sunshine Vitamin Lin A. Brown,MD Dartmouth and DHMC Vitamin D What do surfers have in abundance and maybe most of the rest of us lack? Vit D - a vitamin primarily obtained by man

More information

Vitamin D (serum, plasma)

Vitamin D (serum, plasma) Vitamin D (serum, plasma) 1 Name and description of analyte 1.1 Name of analyte Vitamin D 1.2 Alternative names The term vitamin D covers a group of closely related naturally occurring lipid soluble compounds

More information

7/18/2013. None. Micol S. Rothman, MD Associate Professor of Medicine Clinical Director Metabolic Bone Program University of CO-Denver July 2013

7/18/2013. None. Micol S. Rothman, MD Associate Professor of Medicine Clinical Director Metabolic Bone Program University of CO-Denver July 2013 Micol S. Rothman, MD Associate Professor of Medicine Clinical Director Metabolic Bone Program University of CO-Denver July 2013 None Understand the pathophysiology of Vitamin D metabolism, when to suspect

More information

CALCIUM AND VITAMIN D PREPARATIONS. Calcium and vitamin D are two essential nutrients long known for their role in bone health.

CALCIUM AND VITAMIN D PREPARATIONS. Calcium and vitamin D are two essential nutrients long known for their role in bone health. CALCIUM AND VITAMIN D PREPARATIONS. Calcium and vitamin D are two essential nutrients long known for their role in bone health. Estimated Average Requirement (EAR): Reflects the estimated median requirement

More information

Vitamin D & Iron Dosing Guidelines

Vitamin D & Iron Dosing Guidelines Vitamin D & Iron Dosing Guidelines Ayman Khmour, MD I have no actual or potential conflict of interest in relation to this program. Objectives Review Ca metabolism Review Recent AAP Guidelines Review CMH

More information

Update on Calcium, Vitamin D and Hip Protectors in ACFs. John Ward, Clinical Leader in Aged Care, November, 2007

Update on Calcium, Vitamin D and Hip Protectors in ACFs. John Ward, Clinical Leader in Aged Care, November, 2007 Update on Calcium, Vitamin D and Hip Protectors in ACFs John Ward, Clinical Leader in Aged Care, November, 2007 Calcium metabolism Postmenopausal obligatory losses Approx 320 mg/day (140 mg in urine; 140

More information

Fortunately, there are many things we can do at every age to keep our bones strong and healthy.

Fortunately, there are many things we can do at every age to keep our bones strong and healthy. Healthy Bones at Every Age Page ( 1 ) Bone health is important at every age and stage of life. The skeleton is our body s storage bank for calcium a mineral that is necessary for our bodies to function.

More information

Calcium Metabolism physiology of hormone 2007

Calcium Metabolism physiology of hormone 2007 Calcium Metabolism physiology of hormone 2007 Calcium metabolism What is the recommended daily intake? 1000mg What is the plasma concentration? 2.2-2.6mmol/L 2.6mmol/L How is calcium excreted? Kidneys

More information

The evidencebehindthe increased NordicNutritionRecommendations for vitamind. Christel Lamberg-Allardt University of Helsinki

The evidencebehindthe increased NordicNutritionRecommendations for vitamind. Christel Lamberg-Allardt University of Helsinki The evidencebehindthe increased NordicNutritionRecommendations for vitamind Christel Lamberg-Allardt University of Helsinki Aimsfor NutritionRecommendations Aimsfor vitamind The overall aim was to review

More information

Vitamin D Deficiency: Information for Cancer Patients. A Publication of The Bone and Cancer Foundation

Vitamin D Deficiency: Information for Cancer Patients. A Publication of The Bone and Cancer Foundation Vitamin D Deficiency: Information for Cancer Patients A Publication of The Bone and Cancer Foundation Contents Introduction (page 2). Vitamin D deficiency - a worldwide problem (page 2). Sources and types

More information

FOR HEALTH. Huldschinsky 1919. Rickets THE D-LIGHTFUL VITAMIN. Solar UV Radiation. Treated VITAMIN D TOXIC OH FROM SUN EXPOSURE. with Mercury Arc Lamp

FOR HEALTH. Huldschinsky 1919. Rickets THE D-LIGHTFUL VITAMIN. Solar UV Radiation. Treated VITAMIN D TOXIC OH FROM SUN EXPOSURE. with Mercury Arc Lamp THE D-LIGHTFUL VITAMIN W DO YOU MAKE VITAMIN D???? FOR HEALTH Michael F. Holick Boston University Medical Center Solar UV Radiation 7-DHC UV PreD 3 UV UV Tachysterol 3 7-DHC CH2 Vitamin D 3 ΔH PreD 3 Vitamin

More information

Calcium. 1995-2013, The Patient Education Institute, Inc. www.x-plain.com nuf40101 Last reviewed: 02/19/2013 1

Calcium. 1995-2013, The Patient Education Institute, Inc. www.x-plain.com nuf40101 Last reviewed: 02/19/2013 1 Calcium Introduction Calcium is a mineral found in many foods. The body needs calcium to maintain strong bones and to carry out many important functions. Not having enough calcium can cause many health

More information

SPOTLIGHT ON CALCIUM AND VITAMIN D. Presenter Name. Presenter Title Presenter Organization

SPOTLIGHT ON CALCIUM AND VITAMIN D. Presenter Name. Presenter Title Presenter Organization SPOTLIGHT ON CALCIUM AND VITAMIN D Presenter Name Presenter Title Presenter Organization OUTLINE Calcium Recommendations - How are we doing? Calcium and Bones More Than Strong Bones Sources, Absorption,

More information

Improvement of Chronic Back Pain or Failed Back Surgery with Vitamin D Repletion: A Case Series

Improvement of Chronic Back Pain or Failed Back Surgery with Vitamin D Repletion: A Case Series BRIEF REPORT Improvement of Chronic Back Pain or Failed Back Surgery with Vitamin D Repletion: A Case Series Gerry Schwalfenberg, MD This article reviews 6 selected cases of improvement/resolution of chronic

More information

NATIONAL OSTEOPOROSIS FOUNDATION OSTEOPOROSIS CLINICAL UPDATES Vitamin D and Bone Health CE APPLICATION FORM

NATIONAL OSTEOPOROSIS FOUNDATION OSTEOPOROSIS CLINICAL UPDATES Vitamin D and Bone Health CE APPLICATION FORM NATIONAL OSTEOPOROSIS FOUNDATION OSTEOPOROSIS CLINICAL UPDATES Vitamin D and Bone Health CE APPLICATION FORM First Name: Last Name: Mailing Address: City: State: Zip/Postal Code: Country: Phone Number:

More information

Ideas for improving your calcium intake

Ideas for improving your calcium intake Ideas for improving your calcium intake This booklet is designed to help you increase dietary calcium intake using foods high in calcium to maintain healthy bones and teeth This booklet was given to you

More information

Press Information. Interactive Maps on Vitamin D Level Worldwide. Objectives. Key findings. Conclusions

Press Information. Interactive Maps on Vitamin D Level Worldwide. Objectives. Key findings. Conclusions DSM Corporate Communications P.O. Box 2676 4002 Basel Switzerland Press Information phone +41 (0)61 815 88 88 fax +41 (0)61 815 88 80 www.dsm.com Interactive Maps on Vitamin D Level Worldwide International

More information