Intended for healthcare professionals

Practice Change

Do not routinely test for vitamin D

BMJ 2022; 378 doi: (Published 18 July 2022) Cite this as: BMJ 2022;378:e070270

Linked Editorial

Sustainable practice: what can I do?

  1. Christopher McChesney, medical student1,
  2. Alexander Singer, associate professor2,
  3. D’Arcy Duquette, patient adviser,
  4. Nita G Forouhi, professor3,
  5. Wendy Levinson, professor1
  1. 1Temetry Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
  2. 2Max Rady College of Medicine, Department of Family Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
  3. 3Medical Research Council Epidemiology Unit, University of Cambridge School of Clinical Medicine, Cambridge, UK
  4. Correspondence to A Singer

What you need to know

  • Routinely testing vitamin D levels in asymptomatic individuals is not recommended, based on a lack of evidence for benefit

  • Shared decision making and conversations with patients can help explore the risks and benefits of unnecessary testing

  • Physician education, audit, feedback of physicians’ ordering practices, and system-wide changes in ordering and remuneration are effective strategies to reduce unnecessary vitamin D testing

Routine vitamin D testing has been increasing owing to patient demand, attention in mass media, correlational studies connecting vitamin D to various health concerns, and physicians promoting its use.12345678910 Recently, possible associations between vitamin D deficiency and severe covid-19 received scientific attention, fuelling renewed media attention and a rapid guideline from the National Institute for Health and Care Excellence (NICE) on appropriate indications for supplementation.111213141516

Box 1 presents a list of clinical conditions where testing vitamin D may be appropriate, but vitamin D tests are frequently requested without any of these clinical indications. Studies from the UK, US, Canada, and Australia suggest that 25% to 75% of vitamin D testing may be unnecessary.92223242526 This can be potentially harmful to patients by leading to additional testing, and wastes valuable healthcare resources.27 In this article we offer an overview of evidence and guideline recommendations on routine vitamin D testing, (also known as vitamin D screening) and offer practical suggestions for reducing unnecessary testing.

Box 1

Commonly cited indications where vitamin D testing is appropriate1718192021

  • Rickets

  • Osteomalacia

  • Osteoporosis

  • Hyperparathyroidism

  • Malabsorption syndromes

  • Medications affecting absorption or metabolism of vitamin D (antifungals, HIV antiretroviral therapy, anticonvulsants, etc)

  • Chronic kidney disease

  • Hypophosphatemia and hypo/hypercalcemia

  • Deeply pigmented skin

  • Isolated elevation of alkaline phosphatase


Evidence for change

Several international guidelines recommend against routinely testing or screening for vitamin D in people with no clinical symptoms or risk of deficiency …

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