title: Hypovitaminosis D among rheumatology outpatients in clinical practice.
abstract: OBJECTIVE
  A role for vitamin D in the pathogenesis of autoimmune and inflammatory diseases is emerging. We undertook an audit of 25-hydroxyvitamin D (25OHD) investigation and treatment in rheumatology outpatients.
  
  
  METHODS
  Serum 25OHD requests were matched to electronic medical records from rheumatology and metabolic bone clinics (April 2006-March 2007). Data were analysed separately for two groups, 'Documented osteoporosis/osteopaenia' (Group 1) and 'General rheumatology outpatients' (Group 2, sub-divided by diagnosis). Hypovitaminosis D was defined by 25OHD levels <50 nmol/l. Values were compared with healthy adults to calculate geometric z-scores.
  
  
  RESULTS
  A total of 263 patients were included (Group 1, n = 122; Group 2, n = 141) with an overall median 25OHD of 44 nmol/l. The 25OHD level among general rheumatology patients (median 39 nmol/l, mean z score -1.2, was statistically significantly lower than among osteoporotic/osteopaenic patients (median 49 nmol/l, mean z score of -0.9, p < 0.05 for the difference). 25OHD was lower in inflammatory arthritis and chronic pain/fibromyalgia than in other groups. Prescribing was recorded in 100 in Group 1 (of whom 95% were prescribed calcium/800 IU cholecalciferol) and 83 in Group 2 (91% calcium/800 IU). Only 31% of the patients with 25OHD <50 nmol/l would have been identified using general guidelines for screening patients at 'high risk' of hypovitaminosis D.
  
  
  CONCLUSIONS
  Improved guidelines for managing hypovitaminosis D in rheumatology patients are needed. We found a high prevalence of hypovitaminosis D among secondary care patients in rheumatology and widespread supplementation with 800 IU cholecalciferol. Substantially reduced levels of serum 25OHD were identified among patients with inflammatory arthritis and chronic pain.
authors.affiliation: Box 157, Department of Medicine, Division of Bone Research, University of Cambridge, Addenbrooke's Hospital, Cambridge, CB2 2QQ, UK.
authors.forename: M
authors.initials: M
authors.lastname: Mouyis
authors.forename: A J K
authors.initials: AJ
authors.lastname: Ostor
authors.forename: A J
authors.initials: AJ
authors.lastname: Crisp
authors.forename: A
authors.initials: A
authors.lastname: Ginawi
authors.forename: D J
authors.initials: DJ
authors.lastname: Halsall
authors.forename: N
authors.initials: N
authors.lastname: Shenker
authors.forename: K E S
authors.initials: KE
authors.lastname: Poole
mesh_terms: D000328:Adult; D000368:Aged; D001327:Autoimmune Diseases / Q000150:complications; D002118:Calcium / Q000627:therapeutic use; D002762:Cholecalciferol / Q000627:therapeutic use; D005356:Fibromyalgia / Q000150:complications; D006801:Humans; D008875:Middle Aged; D010024:Osteoporosis / Q000150:complications / Q000188:drug therapy; D012189:Retrospective Studies; D012216:Rheumatic Diseases / Q000150:complications*; D014807:Vitamin D / Q000031:analogs & derivatives / Q000097:blood; D014808:Vitamin D Deficiency / Q000097:blood / Q000150:complications* / Q000188:drug therapy
chemical_list: D014807:Vitamin D; D002762:Cholecalciferol; C104450:25-hydroxyvitamin D; D002118:Calcium