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Purpose: The purpose of this study was to determine the rates of vitamin D sufficiency, insufficiency, and deficiency among patients with measured 25(OH)D levels at a VA Medical Center, to assess the treatment and follow-up that occurred after patients were identified as vitamin D insufficient or deficient, and to assess the effectiveness of vitamin D regimens recommended for the treatment of vitamin D insufficiency or deficiency.
Methods: The medical records of 300 patients who had an initial vitamin D level measured at between March 1, 2009 and June 30, 2009 were reviewed. The following information was recorded: race, BMI, medical history, VA medication use within previous six months of initial 25(OH)D, laboratory values within previous six months of initial 25(OH)D, type of clinic and provider ordering or treating 25(OH)D level, recommended vitamin D and calcium therapy, and information regarding first follow-up within one year of initial recommendation.
Results: Vitamin D deficiency and insufficiency was identified in 49% and 26% of evaluated patients respectively. An initial vitamin D recommendation was documented for 62% of patients with vitamin D deficiency and 73% of patients with vitamin D insufficiency. Among the deficient and insufficient patients who received an initial vitamin D recommendation, 62% and 51%, respectively, were followed-up at least once within 12 months of the initial recommendation. A serum 25(OH)D level ≥30 ng/ml was achieved in 34% of the deficient patients who received follow-up and 69% of the insufficient patients who received follow-up. Prescribers recommended more than 30 different ergocalciferol regimens.
Conclusion: The treatment of suboptimal vitamin D levels at an academic VA Medical Center varies considerably among providers. The wide variety of recommended vitamin D regimens and inconsistent follow-up suggest that an institution specific protocol would be beneficial for optimal patient care.