Vitamin D deficiency

doi:10.1136/bmj.318.7193.1284a

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Time for a tablet containing high doses of vitamin D alone

C H Cheetham (lesley.martyn@wyclib.demon.co.uk), Consultant paediatrician

Wycombe General Hospital, High Wycombe, Buckinghamshire HP11 2TT
Metabolism Laboratory, St Vincents Hospital, Dublin 4, Republic of Ireland
Kent and Canterbury Hospital, Canterbury CT1 3NG
Department of Medicine, Addenbrooke's Hospital, Cambridge CB2 2QQ

EDITOR—I was heartened to read Compston's editorial calling for action on vitamin D deficiency.1 Another point should be made to encourage a more active role by the health service.

The British National Formulary does not include a tablet containing vitamin D alone in reasonable dose. Prescribers can give a calcium and vitamin D mixture, which may be unpalatable and therefore impair compliance. Alternatively, a vitamin capsule can be prescribed containing many other vitamins. If a dose greater than minimal daily requirements is needed higher doses of unnecessary vitamins must also be given. Surely it should be easy to prescribe 500-1000 units of vitamin D daily without any other addition?

References

↵
1. Compston JE
. Vitamin D deficiency: time for action. BMJ 1998; 317: 1466–1467. (28 November.)
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Groups at risk need supplementation, and milk could be fortified

Rosemarie Freaney, Principal biochemist,
Malachi J McKenna, Consultant endocrinologist

Wycombe General Hospital, High Wycombe, Buckinghamshire HP11 2TT
Metabolism Laboratory, St Vincents Hospital, Dublin 4, Republic of Ireland
Kent and Canterbury Hospital, Canterbury CT1 3NG
Department of Medicine, Addenbrooke's Hospital, Cambridge CB2 2QQ

EDITOR—We agree with Compston that the time has come for reappraisal of measures aimed at preventing vitamin D deficiency with consequent bone loss predisposing to osteoporotic fracture.1 The high prevalence of vitamin D deficiency and secondary hyperparathyroidism with high bone turnover emphasises this urgent need.

The adequacy of current vitamin D intake recommendations is being questioned. The most sensitive yardstick for ascertaining the degree of hypovitaminosis D that predisposes to bone disease is secondary hyperparathyroidism. Vitamin D deficiency is known to occur even at a serum 25-hydroxyvitamin D concentration previously considered adequate—namely, 37.5 nmol/l. Over the past two years the threshold has …