Choosing Wisely®: Vitamin D Testing
“There are many orders for Vitamin D testing where it is likely the patient would benefit from supplements regardless of the quantitation of the vitamin,” according to M. Qasim Ansari, MD.
“There are other cases where Vitamin D testing is an essential part of a diagnostic algorithm. The challenge to the caregiver is understanding the two kinds of Vitamin D testing and when to order them. Having guidelines like those proposed by the Choosing Wisely® campaign are very useful.”
Vitamin D testing guidelines for evaluation of Vitamin D deficiency:
- Do not perform routine 1,25 dihydroxy Vitamin D in evaluating suspected Vitamin D deficiency unless there is hypercalcemia or renal impairment; serum 25-hydroxyvitamin D is the correct test for assessing Vitamin D stores or to diagnose Vitamin D deficiency1.
- Do not use 25-hydroxyvitamin D for population based testing for Vitamin D deficiency; reserve for higher risk patients (e.g. osteoporosis, chronic kidney disease, malabsorption , some infections, or obesity)2. In low risk individuals suspected of having vitamin D deficiency, increasing the daily intake of Vitamin D is recommended over Vitamin D testing.
- The above recommendations refer specifically to Vitamin D testing in the setting of suspected Vitamin D deficiency. Testing for 1,25 dihydroxy Vitamin D and/or 25-hydroxyvitamin D may also be appropriate in the evaluation and or management of specific conditions such a s hypothyroidism, hyperphosphatemia, hypomagnesemia, rickets, granulomatous diseases, and growth retardation.
Choosing Wisely® Initiative of the American Board of Internal Medicine:
1 American Association of Clinical Endocrinologists and The Endocrine Society
2 American Society for Clinical Pathology
To read more Recommendations from the Choosing Wisely® Initiative, click here.
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