Only one fourth of patients who were prescribed vitamin D by mail achieved sufficient vitamin D levels 6 months later, according to research presented at the Endocrine Society Meeting in San Francisco.
Lead author Dr Vithika Sivabalasundarum and colleagues at the University of Toronto reviewed data from 338 patients included in a university osteoporosis program. After blood samples were taken at the clinic, 265 patients (78%) were mailed a letter telling them they were vitamin D insufficient (20-29 ng/ml). The letter instructed them to take 4000 IU vitamin D daily for 3 months, then 2000 IU/daily from then on. Furthermore, 73 (23%) participants received a letter telling them they were vitamin D deficient (<20 ng/ml) and to take 50,000 IU vitamin D every week in addition to 2000 IU/day for 3 months, followed by 2000 IU/day.
The researchers report that only half (169) of the patients returned for the repeat blood test after 6 months. Of those, 56% achieved a vitamin D blood level of at least 30 ng/ml. The other 74 patients’ vitamin D levels remained unchanged or even decreased.
“We were recommending fairly high doses of vitamin D, and that may have been intimidating. There was no chance really for them to discuss face-to-face with a clinician what their vitamin D status meant, and what treatment entailed,” Dr Sivabalasundaram explained.
Baseline vitamin D status and history of osteoporotic fractures didn’t predict compliance. “We thought that would motivate patients, but we didn’t see that,” Dr Sivabalasundaram said. The only predictor of achieving vitamin D sufficiency (30 ng/ml) was how soon after the 6 months study period patients returned for their blood test, which was most likely an indicator of how seriously they took the diagnosis and treatment.
The authors conclude that when addressing patients about vitamin D deficiency, it’s important to discuss the benefits of vitamin D for bone health, as well as the slim chance of any adverse effects with supplementation.
The researchers are currently taking steps to address this problem. When patients have their blood drawn they’re informed that, depending on their test results, they may be placed on a “vitamin D protocol,” so if they receive a letter they understand the diagnosis more clearly. Additionally, nurses are now calling patients to discuss their vitamin D status and answer any questions the patient may have. The doctors are also developing an information pamphlet to send to patients.