Endocrine Abstracts

The high prevalence of vitamin D deficiency has increasingly become recognised as a problem for patients living in temperate regions. There has been considerable controversy regarding the optimal level of vitamin D nutrition and the means by which vitamin D should be replaced. The National Osteoporosis Society with the support of several other national groups including the Society for Endocrinology prepared guidelines on the diagnosis and management of vitamin D deficiency which were published in 2013. They are available for download at http://www.nos.org.uk/document.doc?id=1352.

The guidelines recommend that vitamin D status be assessed by measurement of serum 25 hydroxyvitamin D (25OHD) and that the following thresholds be applied:

• 25OHD <30 nmol/l=deficiency

• 30 < 25OHD <50 nmol/l=insufficiency, may be inadequate

• 50 nmol/l <25OHD=sufficient for almost all people

It is recommended that vitamin D status should be checked in the following groups of patients:

Patients with diseases that may be improved by vitamin D treatment.

Patients with musculoskeletal symptoms that could be attributed to vitamin D deficiency.

In asymptomatic individuals at high risk of vitamin D deficiency the current guidance from the Department of Health is commended but routine vitamin D screening in asymptomatic healthy individuals is not recommended.

The clinical consequences of these recommendations together with their practical application in the management of patients in clinic will be illustrated together with appropriate strategies for vitamin D replacement.