Interesting, and something which has been taxing me for some time.
Classically it used to be taught that Rickets/Vitamin D deficiency resulted in low serum Calcium, raised Phosphate and Alkaline Phosphates.
Having reviewed several hundred Vitamin D requests, there appears to be no correlation between Vitamin D levels and these other "markers". The only good indicator appears to be PTH done at same time, which will be high, showing increased bone resorption, and falls with adequate replacement, although it appears to take quite some time to do so, and for the calcium level to increase.
So should we abandon the old cheaper tests, and move across to Vitamin D and PTH instead?

Looking at another parameter in pregancy, I frequently see very low Ferritin levels, usually with normal serum iron status. So for both, are we saying that irrespective of what the blood results are telling us, we should give both Vitamin D and Iron supplements to everyone throughout pregnancy?

Now there's a nice longterm project for someone to get ethical approval to carry out, but I think with the evidence it would be difficult to get consent for a placebo/no treatment group.

Gary Mascall
Consultant in Clinical Biochemistry
Head of Clinical Biochemistry Services
Worcestershire Acute Hospitals NHS Trust
Tel: 01562 823424 extn 56100


________________________________________
From: Clinical biochemistry discussion list [[log in to unmask]] On Behalf Of Jonathan Kay [[log in to unmask]]
Sent: 19 August 2011 08:10
To: [log in to unmask]
Subject: BBC News - Vitamin D mum test 'could protect babies from rickets'

http://www.bbc.co.uk/news/health-14576626
"The NHS should consider checking pregnant women's vitamin D levels to protect babies from the "Victorian" bone disease rickets, an expert says.
The Journal of Medical Screening piece suggests rickets is making a comeback, with many not getting enough vitamin D, which comes mainly from sunlight."

"Screening in selected populations is currently the way forward”
Dr Jonathan Berg, City Hospital, Birmingham"

Jonathan
------ACB discussion List Information--------
This is an open discussion list for the academic and clinical community working in clinical biochemistry.
Please note, archived messages are public and can be viewed via the internet. Views expressed are those of the individual and they are responsible for all message content.
ACB Web Site
http://www.acb.org.uk
Green Laboratories Work
http://www.laboratorymedicine.nhs.uk
List Archives
http://www.jiscmail.ac.uk/lists/ACB-CLIN-CHEM-GEN.html
List Instructions (How to leave etc.)
http://www.jiscmail.ac.uk/

Unless expressly stated otherwise, the information contained in this email is confidential and is intended only for the named recipients. You must not copy, distribute, or take any action or reliance upon it. If you have received this email in error, please notify the sender. Any unauthorised disclosure of the information contained in this email is strictly prohibited.

The information contained in this email may be subject to public disclosure under the Freedom of Information Act 2000. Unless the information is legally exempt from disclosure, the confidentiality of this email and your reply cannot be guaranteed.
------ACB discussion List Information--------
This is an open discussion list for the academic and clinical community working in clinical biochemistry.
Please note, archived messages are public and can be viewed via the internet. Views expressed are those of the individual and they are responsible for all message content.
ACB Web Site
http://www.acb.org.uk
Green Laboratories Work
http://www.laboratorymedicine.nhs.uk
List Archives
http://www.jiscmail.ac.uk/lists/ACB-CLIN-CHEM-GEN.html
List Instructions (How to leave etc.)
http://www.jiscmail.ac.uk/