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In episode 73, we try to put Vitamin D levels into context and Tina Korownyk once again is here to help us decipher the evidence for Vitamin D supplementation when it comes to fractures, falls and overall mortality. At the end of the podcast Mike, James and Tina don their swim gear and go outside without sunscreen on to make some Vitamin D, although Mike and Tina quickly realise they live in Edmonton and it’s wintertime.
Show notes
1) CRP paper by Mike and James
2) Meta-analyses of Vitamin D and impact on fractures, falls and mortality
Arch Intern Med 2009;169:551-6
Arch Intern Med 2007;167:1730-7
3) Toxicity of Vitamin D
4) Sun and Vitamin D3
{ 7 comments… read them below or add one }
As a family doc in the UK and currently in New Zealand I find it interesting how certain medical “fashions ” seem restricted to certain parts of the world. Vitamin D as well as the previously mentioned CRP seem a case in point. It is possible that these issues are discussed in the more rarefied atmosphere of academia in the UK as well, but here on the grassroots-level I have not ordered a Vitamin D level – ever. Nor have I ever been asked to. And where I work CRP is a helpful tool to diagnose and monitor chronic diseases like RA or Crohns or diagnose acute infections but that is pretty much it. Nothing to do with CHD
While some problems you guys discuss are comletely identical to my daily experiences at work others seem to get lost in translation from North America to the rest of the world
Thanks for listening – an interesting comment – cultural differences obviously invade the medical field as well. Given that you have never ordered a Vitamin D level or a CRP level you seem to be “following the evidence” appropriately. It would be intriguing to look at why there are these differences – I imagine much of it is due to “marketing” and i don’t mean just the drug industry.
I live in BC and work as a nurse practitioner in the US and it is like two different planets sometimes. Every person admitted to the nursing home where I work gets a vit D level and then there are so many different dosage routines it makes my head spin. I am advocating for a standing order of 1000 IU daily on all admits after discussion with resident and family. Thanks for your information. I have yet to see a vit D level ordered in BC.
Mike and James …. Welcome back from from the only Island in the world with an economy that can match Greece !!
There are not many things that are good about the nanny state BUT it would appear that sending our practice nurses to all the nursing and residential homes so that all the people are happily chewing on Calcichew D3 Forte ( Vit D 800iu) actually is a good idea.
I sometimes wonder about whether the Calcium comes risk free if they are eating well. I think there was a small trial in the BMJ a couple of years ago where Calcium Supplements were associated with an increased risk of MI but I am not sure if it has been repeated.
By the way with NNT it still seems a slightly cooky figure. Sometimes its NNT in 1 year , or NNT in 3 years etc. If that is so would it not be better if this figure was always given as an ‘as if’ number. In other words if the trial showed a NNT of 225 in 3 years there was an NNT1 which would be NNT as if it was one year. The answer would then by NNT1 775. Just a thought
Great to have you boys back. I even spelt your names correctly ( I think)
Many happy returns
Tom
Catching up on my reading and saw a letter to the editor about vit D supplementation–the authors did an observational study of vit D3 supplementation on blood levels. They tried single dose 100,000 IU followed by 800 IU daily and didn’t get an increase in blood levels, so they tried loading dose of 200,000 IU followed by 800IU daily and rechecked levels. They supplemented everyone less than 50mnol/L. The ave starting level was 19 and they got it up to 62.4 by Day 28 in those they treated at the higher loading dose. They say 85% were deficient and they conclude that everyone should be monitored. JAGS 2009 57: 2155-2156. Nice data, odd conclusion.
In all our nursing homes we now precribe Vit D as 10,000 units a week. This is jsut as effective in boosting levels. We do not measure, we base this strategy on others reseach in geriatrics. In some places they give an even larger dose once amonth. Again effectve. Helps in less pills per day for nurses & patients
Hi. Great comment – this certainly seems like a very reasonable approach. Easy to do, inexpensive. Thanks.
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