Author: Michael Holick PhD, MD
In a recent review of Medicare Benefits Schedule (MBS) vitamin D testing, the Medical Services Advisory Committee (MSAC) made a decision to restrict testing to high risk populations.
‘At risk’ groups include those with osteoporosis or chronic kidney disease being treated pharmaceutically.
While there has been a jump of 4,600% over the last 10 years in claims and benefits paid for MBS items relating to vitamin D testing, world-leading researchers and healthcare practitioners maintain that the MSAC must acknowledge the prevalence of vitamin D deficiency in the population, and not just those at high risk.
In the following column, world-renowned vitamin D expert and endocrinologist Dr Michael F. Holick advises practitioners to recommend his three-step solution to maintain optimal vitamin D levels: sensible sun exposure, foods fortified with vitamin D, and supplementation with a high quality vitamin D.
“It is now generally accepted that vitamin D deficiency [25-hydroxyvitamin D; 25(OH)D
In the United States the Centers for Disease Control reported that 32% of children and adults are at risk for vitamin D deficiency. This is similar to the 31% vitamin D deficiency observed in Australian adults aged 25 years and older from a national population-based study. The same study reported that 73% of these otherwise healthy Australian adults had evidence of vitamin D insufficiency i.e. 25(OH)D
It is well documented that vitamin D is not only critically important for maximising bone health in both children and adults but also has also been implicated in reducing risk of many chronic and acute diseases including the autoimmune diseases multiple sclerosis, type 1 diabetes, rheumatoid arthritis and Crohn's disease, cardiovascular disease and stroke, type 2 diabetes, deadly cancers including among others breast and colon cancer, neurocognitive decline and Alzheimer's disease, asthma and wheezing disorders, dental caries, periodontitis as well as acute and chronic infectious diseases including tuberculosis and influenza. With all of the publicity surrounding the health benefits of vitamin D health care professionals have begun to routinely measure vitamin D status [serum 25(OH)D levels] in their patients. In the United States this assay is now the most ordered assay by physicians. In Australia from 2000-2010 there was a 94 fold increased in the number of 25(OH)D tests costing over $148 million in 2012. In 2010 The Institute of Medicine and in 2011 the Endocrine Society's Practice Guidelines both concluded that there was no need to be screening the population for their vitamin D status except for those who are at risk for vitamin D deficiency. In 2014 a systematic review of the Australian government’s Medicare Benefits Schedule services revealed in the past 10 years a 4600% jump in the number of patients having their vitamin D status being evaluated. As a result The Medical Services Advisory Committee recommended limiting the testing of vitamin D status to high risk populations that include those with osteoporosis or kidney disease. The Endocrine Society has recommended that to treat and prevent vitamin D deficiency neonates need 400-1000 IUs daily, children 1 year and older 600-1000 IUs daily and all adults 1500-2000 IUs of vitamin D. They also recognised that obese children and adults require 2-3 times more vitamin D to achieve vitamin D sufficiency with a targeted serum 25(OH)D level of at least 75 nmol/L. Only those who are at risk for vitamin D deficiency has recommended by the Medical Services Advisory Committee as well as patients with fat malabsorption syndromes or who have a hypersensitivity to vitamin D including patients with sarcoidosis require routine testing.
My advice to physicians at my hospital is that they should be giving all of their patients vitamin D supplementation at the doses recommended by the Endocrine Society to prevent vitamin D deficiency and when appropriate to recommend sensible sun exposure that can be monitored with the free app dminder.info.”
To track your vitamin D intake, download the dminder app here.
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