They warn of the excessive and unjustified prescription of vitamin D

• Boticaria García Vitamin D: a hormone disguised as a vitamin

Is vitamin D deficiency being overdiagnosed and supplementation being overprescribed?

One study concludes yes.

According to their data, the blood levels of this vitamin are analyzed in many cases without justification, the intake of supplements is prescribed even if it is not indicated, and their use is inadequately monitored.

Vitamin D is a fundamental nutrient for our body that is obtained through diet and sun exposure, although it can also be ingested through supplements.

However, in excess it can lead to important complications such as the appearance of hypercalcemia (excess calcium), cardiac arrhythmias or the development of kidney stones, among others.

The research, which is published in the latest issue of the journal of the Spanish Society of General and Family Physicians, has followed up 212 patients

a single health center in Castilla y León, but its conclusions coincide with those of other Previous international works.

"The number of vitamin D determinations has increased exponentially in recent years in many parts of the world" multiplying, for example, "by 80 in the US in just a decade (2000-2010), by eight in France between 2008 and 2013 or by 11 in Liverpool, United Kingdom, in six years," the text states.

"In recent years there has been an increase in interest in vitamin D due not only to its involvement in musculoskeletal health, but also to its supposed involvement in extra-osseous processes (cancer, cardiovascular disease, diabetes, depression, cognitive functioning , functional status, etc)

", explain by email María Jesús Hernández Arroyo and Alfonso Díaz Madero, members of the Spanish Society of Primary Care Pharmacists (SEFAP) and signatories of the research, who point out that "currently there is no consensus in the scientific community on

".

"According to the Institute of Medicine, the prevalence of vitamin D deficiency is overestimated because, frequently, the cut-off points are too high. This can lead to classifying actually healthy individuals as sick or at risk of getting sick," they stress.

For this reason, they continue, "it is necessary to reach a general consensus among clinical analysis laboratories that allows the establishment

, based on current recommendations, and that avoid unnecessarily medicalizing the population."

Patient follow-up

The 212 patients analyzed in the Spanish study were older than 14 and were being treated with one of the two main vitamin D supplements,

(104) and

(108).

According to the follow-up data, 83% of the patients had undergone a previous analysis to check the levels of vitamin D despite the fact that this determination was only justified in 52% of the cases.

The authors of the research emphasize that the measurement of this vitamin should not be carried out indiscriminately, but in the presence of certain factors, such as disorders related to the skeleton, chronic kidney disease, malabsorption or high risk of falls in the elderly, among others.

48% of the sample "did not have a justified request for vitamin D levels, which suggests that the existence of risk factors associated with vitamin D deficiency is not previously assessed," they point out in the text.

The work also showed that in 24.1% -almost one in four patients- the treatment was not justified as there were no risk factors with sufficient evidence of the beneficial effect of treatment with vitamin D.

"It is striking that

, which suggests that sometimes it is prescribed as a nutritional supplement without analytical control, which carries risks of overtreatment," the researchers point out. in the magazine.

In addition, inadequate treatment follow-up was also detected.

38.2% of the patients had not undergone new tests to determine vitamin D levels after one year of follow-up, despite the fact that it is indicated.

"Current recommendations advise requesting an analysis four months after the start of treatment and subsequently carrying out an annual control to avoid intoxication. Our study shows that 38.2% did not follow up the treatment, which implies a risk of overtreating ", indicate the authors.

In their conclusions, the authors emphasize that the data from their work show that "there is a high proportion of unjustified requests for vitamin D levels and prescriptions", which can lead to unintended consequences.

"The main side effect of overdose is

, which can cause anorexia, nausea, vomiting, muscle weakness, kidney stones, cardiac arrhythmias, depression, confusion, and coma," they explain.

"In 2019, a safety note was published by the Spanish Agency for Medicines and Health Products, which alerted to the existence of serious cases of hypercalcemia, both in adult and pediatric patients, which were attributed to the administration of doses daily or administration frequencies higher than those recommended", they add.

In any case, pharmacists recall that "adverse effects from supplementation are infrequent" and "

, since there is a greater risk of prescription errors or misinterpretation of the dosage by the patient" .

The data from the work, the researchers point out in the journal, also indicate that "

and insufficient follow-up of the levels after the start of treatment, which is why training is required for professionals on the adequacy of measurement and treatment".

into electronic medical records

that can help professionals in decision-making; communication between primary care and the hospital must also be improved, as well as reaching an agreement with the laboratory in clinical analysis of the area on the values benchmarks and base them on current recommendations," they conclude.

According to the criteria of The Trust Project

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