Insignificant medium-term vitamin D status change after 25-hydroxyvitamin D testing in a large managed care population.

Meng Wei,Run Yu,Stephen C Deutsch,Andrzej T Slominski

doi:10.1371/journal.pone.0105571

Meng Wei, Run Yu + Show 2 more

Open Access

https://doi.org/10.1371/journal.pone.0105571

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Abstract

ObjectivesTo examine the clinical utility of 25-hydroxyvitamin D (25(OH)D) testing in achieving medium-term vitamin D (VD) sufficiency in a managed care population.MethodsRetrospective study of a continuously-enrolled patient population in a 3-year period between 2011 and 2013. Primary outcome was VD status at ∼1 year after 25(OH)D testing. Patient demographics, comorbidities, medications, and 25(OH)D test results were gathered from relevant databases and multivariate logistic regression analysis used to study the risk factors of persistent VD deficiency or insufficiency.ResultsOf 22,784 patients, 7533 (females 69.3%) did 14,563 25(OH)D tests, with an estimated cost of $582,520. Of the 7533 patients, 1126 had another 25(OH)D test at 300–400 days after the first one. Based on the two test results, 234 patients (20.8%) maintained sufficient 25(OH)D levels; 132 (11.7%) turned from VD-sufficient into VD-insufficient or -deficient; 538 (47.8%) remained VD-insufficient or -deficient, and only 222 (19.7%) improved to be VD-sufficient. Overall, only 8.0% more patients were VD-sufficient at ∼1 year after 25(OH)D testing. Only younger age and higher BMI were independent risk factors for persistent low 25(OH)D levels and high-dose VD use was not associated with achieving VD sufficiency.Conclusions25(OH)D testing only benefits a small portion of patients thus lacks clinical utility in achieving VD sufficiency in the medium term but incurs a significant cost. A practical strategy to treat VD deficiency or insufficiency is needed; without it, 25(OH)D testing adds little value to most patients’ health and should be used with discretion.

Highlights

Low levels of vitamin D (VD), measured by serum 25hydroxyvitamin D (25(OH)D) levels, are detrimental to bone health and VD supplementation in patients with very low 25(OH)D levels is beneficial in correcting osteomalacia or osteoporosis [1,2]
There is no consensus on who should undergo 25(OH)D testing and routine screening for VD status is not recommended due to lack of evidence on feasibility, costeffectiveness, or benefits of such screening [1,2], some physicians may be convinced that it is worthwhile to screen for VD deficiency and to treat patients with VD if they do have it
The results of our study demonstrate that 25(OH)D testing lacks clinical utility in achieving VD sufficiency and should not be routinely performed in managed care populations or in other contemporary clinical practice

Summary

Introduction

Low levels of vitamin D (VD), measured by serum 25hydroxyvitamin D (25(OH)D) levels, are detrimental to bone health and VD supplementation in patients with very low 25(OH)D levels is beneficial in correcting osteomalacia or osteoporosis [1,2]. There is no consensus on who should undergo 25(OH)D testing and routine screening for VD status is not recommended due to lack of evidence on feasibility, costeffectiveness, or benefits of such screening [1,2], some physicians may be convinced that it is worthwhile to screen for VD deficiency and to treat patients with VD if they do have it. 25(OH)D testing and the associated cost, mostly for screening purpose, have been dramatically increased over the last decade [5,6].

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