JISCMail - ACB-CLIN-CHEM-GEN Archives

Dear Colleagues,

Regarding Vitamin D there has indeed been a position statement on Vitamin D from the Royal College of Pathologists in Australasia (RCPA) a couple of weeks ago. It relates specifically to testing and makes (almost no) reference to treatment. The point highlighted in the press statements is the reduced criteria where testing is recommended. For example the current Australasian recommendations (Med J Aust, 2012 (196) 18 June; not formally including pathology in the process) includes testing "office workers" who may not get much sun during winter, whereas the Pathology document says only those with "chronic and severe lack of sun exposure"should be tested. As Ian has said this recommendation is because there is no evidence that treating people in this group will receive a benefit. The RCPA guidelines do not recommend "treat rather than test". For a media release and link to the statement go to: www.rcpa.edu.au

My reading of the UK guidelines from the UK National Osteoporosis Society (widely endorsed but not by any lab medicine group that I can see) is that is it possibly more restrictive on testing recommendations than for Australia saying for high risk groups "Do not routinely test 25 OH vitamin D in these groups" and recommends vitamin D therapy for pregnant and breastfeeding women and older people without much sun exposure without testing.

The 2012 NZ consensus statement says the following:
- Vitamin D testing is considerably more expensive than vitamin D supplementation.
- In general, asymptomatic, at-risk people should be prescribed supplements without testing.
- Routine testing of vitamin D levels is not usually necessary before or after starting vitamin D supplementation.

I do note an important paper from our NZ colleagues (including Chris Florkowski from the labs) that in a randomised, controlled trial of vitamin D therapy there was absolutely no effect on frequency, severity or duration of the common cold (JAMA 2012;308:1333-9). While the common cold may not be the most important clinical endpoint, it shows that the work is needed to prove efficacy.

Regards,

Graham

>>> Ian Young <[log in to unmask]> 12/06/2013 1:45 am >>>
>.I was at a meeting 2 weeks ago in Australia. There, the Royal College had a media event and said that there is no point in measuring Vit D - you should just take the supplement [and stop wasting money]. opies of media clip links attached. Perhaps we need to do the same

The Australian College certainly don't recommend widespread supplement use either:

" The college position statement says that while there is good evidence that vitamin D supplements can help the elderly, there is little evidence they are helpful for the otherwise healthy people. The ''quality of the evidence for the health benefits of an adequate vitamin D status is highly variable,'' the statement says.

Read more: http://www.smh.com.au/national/health/unnecessary-vitamin-d-tests-cost-millions-20130528-2n9nj.html#ixzz2VvHVZTv2

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