AB0903 VITAMIN D LEVELS IN PRIMARY CARE AND RHEUMATOLOGY PATIENTS
Authors: H. D. Marta, A. García Dorta, C. Luis Zárate, S. Bustabad, F. Diaz-Gonzalez
Journal: Annals of the Rheumatic Diseases (2020)

Background: Although many studies are calling into question the benefits commonly attributed to the vitamin D out of the bone sphere, in the recent years its determination and supplementation has been generalized in the population. Causes of this trend are not clear, but generalist media pressure or even specialized over patients and doctors, along with overrated normality levels could be contributing to this fact. Actual literature 123 indicates that 25-OH vitamin D levels of 30ng/ml or higher are not necessary, and most of the authors agree that 20ng/ml levels are enough for the general population, and only levels below 12.5ng/ml must be considered deficient and subsidiaries of supplementation. Objectives: Obtain the vitamin D levels distribution from a sample of individuals with no bone pathology, or supplementation prescription in Tenerife’s North Area. Methods: Retrospective descriptive study of the 25-OH vitamin D levels requests from the Tenerife’s North Area, made for any reason by the Primary Care Doctor or the rheumatologist, both in the Primary Care Centers and the Hospital Universitario de Canarias (HUC). 25-OH vitamin D values were gathered from 2662 blood samples from a total of 2635 patients, from September to November of 2018 (2241 from Primary Care and 421 from rheumatology). In order to determine the use of calcium and vitamin D supplements, and the presence of bone pathology, either renal or from a malabortive process, 400 individuals were randomized (250 from primary care and 150 from rheumatology. Demographic data (age and gender), calcium serum, phosphor and 25-OH vitamin D levels were gathered for the individual records. With regards to the treatment, data about vitamin D supplements, calcium with vitamin D, or the sum of both, that the patient may have in electronic prescriptions at that time; as well as osteoporosis treatment (biphosphonates, denosumab or teriparatide) were gathered. Results: Using the age, gender, male/female relation, the levels of vitamin D, calcium and phosphor, as comparison factors; the characteristics of the random population were statistically indistinguishable from the global population. Regarding the random sample characteristics, from the 150 rheumatology patients, 11 were men (7.3%) and 139 women (92.7%). While from the 250 primary care patients, 66 were men (26.4%) and 184 were women (73.6%). The average age of the primary care sample was 55.76±19.72 years and 65.16±13.84 years in the rheumatology sample. In the total random healthy population: without bone pathology, renal or malabortive and without calcium, vitamin D or antiresorptive drug (n=181) treatment, the levels of vitamin D were 31±14ng/ml with a normal distribution and without clear differences between the primary care and rheumatology patients. When the healthy population distribution was studied by vitamin D levels, the 55% presented values below 30ng/ml, 12% below 20ng/ml and 4% showed levels under 12.5ng/ml: levels agreed as deficient (see graph). Conclusion: The 55% of the patients studied in primary care and rheumatology, without renal, digestive or bone disease and without vitamin D supplement, presented vitamin levels below the actual limits of 30ng/ml. These limits, used by most of the laboratories, tend to overestimate the vitamin D deficiency. References: [1]Manson, JE. N Engl J Med 2018, DOI: 10.1056/NEJMoa1809944. [2]Spector, TD. BMJ 2016: 355: i6183 [3]Wu, F. Osteoporosis International 2017; 28: 505-515. Disclosure of Interests: None declared