Vitamin D prescribing and monitoring trends within the Durham VA medical center

Introduction: Vitamin D is essential in the body’s maintenance of normal levels of calcium to promote bone health and prevent fractures, falls, and cardiovascular events.  Appropriate screening, treatment, and monitoring of vitamin D deficiency are necessary to improve outcomes in high risk populations.

Objectives: The primary objective was to determine if patients with vitamin D deficiency at the Durham VA Medical Center were receiving repletion therapy and monitoring in accordance with guidelines and local expert opinion. The review also sought to determine the incidence of vitamin D repletion within one year, the appropriateness of screening, and the incidence of vitamin D toxicity. 

Study Design: Retrospective chart review  

Methods: Patients with a vitamin D level indicating vitamin D deficiency between July 1, 2013 and June 30, 2014 were identified for screening. Patients were excluded if they had a non-VA primary care provider or received the majority of medications from outside of the VA. Patients with past medical history that would contraindicate vitamin D therapy or significantly alter vitamin D absorption were also excluded.  

Results: A total of 301 patients were included, 91 (30.2%) had no identifiable risk factor to warrant screening.   The patients were majority male with mean age of 55.4 years. Overall, 186 (61.8%) patients received some form of vitamin D therapy. Only 26 (8.6%) patients received both guideline recommended repletion and maintenance therapy. Ultimately, 43 (14.3%) patients achieved at least one sufficient vitamin D level in the year after screening. The majority of patients (52.5%) did not have a follow-up level in the year after screening. Four patients had a vitamin D level considered to be toxic.

Conclusions: The majority of included patients did not receive guideline-directed vitamin D therapy nor monitoring. Efforts are needed to guarantee that patients are receiving guideline-directed therapy and monitoring to ensure achievement of sufficient vitamin D levels.