Preprint Review Version 1 This version is not peer-reviewed

Clinical Management of Low Vitamin D: A Scoping Review of Physician Practices

Version 1 : Received: 15 March 2018 / Approved: 16 March 2018 / Online: 16 March 2018 (07:14:14 CET)

A peer-reviewed article of this Preprint also exists.

Rockwell, M.; Kraak, V.; Hulver, M.; Epling, J. Clinical Management of Low Vitamin D: A Scoping Review of Physicians’ Practices. Nutrients 2018, 10, 493. Rockwell, M.; Kraak, V.; Hulver, M.; Epling, J. Clinical Management of Low Vitamin D: A Scoping Review of Physicians’ Practices. Nutrients 2018, 10, 493.

Journal reference: Nutrients 2018, 10, 493
DOI: 10.3390/nu10040493

Abstract

The role of vitamin D in the prevention and treatment of non-skeletal health issues has received significant media and research attention in recent years. Costs associated with clinical management of low vitamin D (LVD) have increased exponentially. However, no clear evidence supports vitamin D screening to improve health outcomes. Authoritative bodies and professional societies recommend against population-wide vitamin D screening in community-dwelling adults who are asymptomatic or at low risk of LVD. In order to assess patterns of physician management of LVD in this conflicting environment, we conducted a scoping review of three electronic databases and gray literature. Thirty-eight records met inclusion criteria and were summarized in an evidence table. Results from seven countries showed a consistent increase in vitamin D lab tests and related costs. Many vitamin D testing patterns reflected screening rather than targeted testing for individuals at high risk of vitamin D deficiency or insufficiency. Interventions aimed at managing inappropriate clinical practices related to LVD were effective in the short term. Variability and controversy were pervasive in many aspects of vitamin D management, shining light on physician practices in the face of uncertainty. Future research is needed is needed to inform better clinical guidelines and to assess implementation practices that encourage evidence-based management of LVD in adult populations.

Subject Areas

vitamin D; 25-hydroxyvitamin-D; 25-OH-D; screening; physician practices; low value care; test overutilization

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