7175 Vitamin D Restoration with a Treat-To-Goal Clinical Strategy: A Retrospective, Quality of Care, Controlled Study of 3,871 Cases in a Real-World Setting
Authors: Bantouna Dimitra , Angelopoulos Nicholas G , Livadas Sarantis , Carlos Jaume Juan , Karvounis Evangelos , Papadimitriou Dimitrios T , Karras Spyridon , Paparodis Rodis D 
Published: October 2024

Abstract
Disclosure: D. Bantouna: None. N.G. Angelopoulos: None. S. Livadas: None. J.C. Jaume: None. E. Karvounis: None. D.T. Papadimitriou: None. S. Karras: None. R.D. Paparodis: None.
Introduction: Vitamin D deficiency (VDD) (&lt; 30ng/ml) is a global epidemic. Vitamin D adequacy (VDA) (≥30 ng/ml) is rarely achieved, despite a rise in the use of vitamin D supplements (VDS).[1] We designed the present study to assess the effectiveness of a treatment strategy used in our practice. Methods: We reviewed the outcomes of a patient tailored strategy in our Endocrine practice in Patras, Greece for 10 years. Patients with VDD enrolled in a two-step strategy using a loading dose (LD) for 2 months and half that dose for maintenance (MD) thereafter, using cholecalciferol 25.000 IU amps. LD: subjects with 25-D &lt;10 ng/ml: 3 amps weekly; 25-D 10-19.9 ng/ml: 2 amps weekly; 25-D 20-29.9: 1 amp weekly. We retested 25-D after 2 months and yearly thereafter. We halved the dose when 25-D reached &gt;50 ng/ml and doubled it when 25-D dropped &lt;30 ng/ml. We followed our subjects for up to 5 years. Subjects who did not take VDS, served as controls. We excluded those who admitted to use &lt;50% of the VDS prescribed. All subjects signed informed consent for release of their clinical data. Results: A total of n=3,871 subjects were included, with a mean follow up of 1.95 years: n=1,554 cases and n=2,317 controls. In an intention-to-treat analysis, 25-D rose from 20.3 ± 6.5 at baseline, to 41.0 ± 10.3 at 2 months (VDA 1461/1554, 94.0%), 39.5 ± 8.8 at 1 year (VDA 792/876, 90.4%), 39.0 ± 8.5 at 2 years (n=596, VDA 530/596, 88.9%), 39.5 ± 8.8 at 3 years (VDA 375/417, 89.9%), 40.5 ± 8.6 at 4 years (VDA 258/280, 92.1%) and 39.4 ± 8.0 ng/ml at 5 years (VDA 174/189, 92.1%). Controls had a baseline 25-D of 19.7 ± 6.1, at 2 months 20.2 ± 7.3 (VDA 209/2317, 9.0%), at 1 year 19.8 ± 5.9 (VDA 146/1643, 8.9%), at 2 years 19.2 ± 7.0 (VDA 105/1107, 9.5%), at 3 years 20.0 ± 6.5 (VDA 98/821, 11.9%), at 4 years 19.9 ± 6.3 (n=71/633, 11.2%) and at 5 years 20.2 ± 6.1 ng/ml (VDA 50/401, 12.5%). All time point means were lower in the control group compared to the treatment arm, p&lt;0.001. Overall, 324/3912 (8.3%) time point measures were &lt; 30 ng/ml on treatment and no measurements &gt;100 ng/ml were observed; 1 new case and 3 recurrent cases of kidney stones occurred in the treatment arm; 2 new cases and 7 recurrent cases occurred in the control group, p&gt;0.05. Conclusions Despite its simplicity, our treatment strategy appears extremely effective in producing vitamin D adequacy, as seen in this large, real-world population of patients with vitamin D deficiency. Our strategy is one of the most effective one’s ever reported in day-to-day clinical practice. Similar protocols should be implemented globally, if we are to solve this major health issue. Reference: [1] Paparodis, R.D.; Bantouna, D.; Karvounis, E.; Zoupas, I.; Livadas, S.; Angelopoulos, N.; Imam, S.; Papadimitriou, D.T.; Jaume, J.C. Intense Testing and Use of Vitamin D Supplements Leads to Slow Improvement in Vitamin D Adequacy Rates: A Cross-Sectional Analysis of Real-World Data. Nutrients 2024, 16, 111. https://doi.org/10.3390/nu16010111
Presentation: 6/2/2024