The experience of Dr Lambert in her Hounslow practice is not surprising, and adds weight to the argument for clarity on the identification and management of such patients. Personal communications with primary care and public health colleagues in East London, Cardiff, Birmingham, Liverpool, Stoke, and Bradford have all yielded similar stories of population groups with unmet needs. No doubt there are many more.
The treatment of identified deficiency and the prevention of recurrence is complicated by the range of preparations currently available on prescription. Our local policy for the treatment of adults (300 000 IU repeated at 1 month assuming no evidence of hypercalcaemia) is frequently offered as an intramuscular injection, and appears to be very acceptable. Oral calciferol tablets (either 10 000 IU or 50 000 IU) can be taken as a short course to achieve an equivalent dose, but have been more difficult for local pharmacies to obtain, and delay in providing these tablets has led to reduced compliance with treatment.
Any patient with ongoing risk factors for deficiency should commence daily supplements after completion of treatment. Prescribable oral preparations of vitamin D that are suitable for adult supplementation (that is, containing 400 IU) are only available combined with calcium. Like Dr Lambert, we have found that compliance with such preparations is very poor, and believe this is largely due to gastrointestinal side effects secondary to the calcium component. We also aim to assess other family members whenever a mother or child is found to be affected, as family history of vitamin D deficiency appears to be a very significant risk factor.
The recent position statement on vitamin D by the Scientific Advisory Committee on Nutrition1 illustrates the extensive gaps in current knowledge on the epidemiology, diagnosis, and consequences of vitamin D deficiency. Their confirmation that all pregnant and breastfeeding women should be taking Healthy Start vitamins is welcomed, and it is hoped that their call for further research and guidance will be taken up urgently.
- © British Journal of General Practice, 2007.
