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Clinical Management of Low Vitamin D: A Scoping Review of Physicians’ Practices

1
Department of Human Nutrition, Foods, and Exercise, Virginia Polytechnic Institute & State University, Blacksburg, VA 24061, USA
2
Department of Family and Community Medicine, Virginia Tech Carilion School of Medicine and Research Institute, Roanoke, VA 24016, USA
*
Author to whom correspondence should be addressed.
Nutrients 2018, 10(4), 493; https://doi.org/10.3390/nu10040493
Received: 15 March 2018 / Revised: 7 April 2018 / Accepted: 12 April 2018 / Published: 16 April 2018
(This article belongs to the Special Issue Changing Times for Vitamin D and Health)
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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 do not recommend population-wide vitamin D screening in community-dwelling adults who are asymptomatic or at low risk of LVD. To assess patterns of physicians’ management of LVD in this conflicting environment, we conducted a scoping review of three electronic databases and the gray literature. Thirty-eight records met inclusion criteria and were summarized in an evidence table. Thirteen studies published between 2006 and 2015 across 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 a light on physicians’ practices in the face of uncertainty. Future research is needed to inform better clinical guidelines and to assess implementation practices that encourage evidence-based management of LVD in adult populations. View Full-Text
Keywords: vitamin D; 25-hydroxyvitamin-D; 25-OH-D; low vitamin D; screening; physician practices; low value care; test overutilization vitamin D; 25-hydroxyvitamin-D; 25-OH-D; low vitamin D; screening; physician practices; low value care; test overutilization
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Rockwell, M.; Kraak, V.; Hulver, M.; Epling, J. Clinical Management of Low Vitamin D: A Scoping Review of Physicians’ Practices. Nutrients 2018, 10, 493.

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