Melissa K. Thomas, M.D., Ph.D., Donald M. Lloyd-Jones, M.D., Ravi I. Thadhani, M.D., M.P.H., Albert C. Shaw, M.D., Ph.D., Donald J. Deraska, M.D., Barrett T. Kitch, M.D., Eleftherios C. Vamvakas, M.D., Ph.D., Ian M. Dick, M.Sc., Richard L. Prince, M.D., and Joel S. Finkelstein, M.D.
Background Vitamin D deficiency is a major risk factor for boneloss and fracture. Although hypovitaminosis D has been detectedfrequently in elderly and housebound people, the prevalenceof vitamin D deficiency among patients hospitalized on a generalmedical service is unknown.
Methods We assessed vitamin D intake, ultraviolet-light exposure,and risk factors for hypovitaminosis D and measured serum 25-hydroxyvitaminD, parathyroid hormone, and ionized calcium in 290 consecutivepatients on a general medical ward.
Results A total of 164 patients (57 percent) were consideredvitamin D–deficient (serum concentration of 25-hydroxyvitaminD, <15 ng per milliliter), of whom 65 (22 percent) were consideredseverely vitamin D–deficient (serum concentration of 25-hydroxyvitaminD, <8 ng per milliliter). Serum 25-hydroxyvitamin D concentrationswere related inversely to parathyroid hormone concentrations.Lower vitamin D intake, less exposure to ultraviolet light,anticonvulsant-drug therapy, renal dialysis, nephrotic syndrome,hypertension, diabetes mellitus, winter season, higher serumconcentrations of parathyroid hormone and alkaline phosphatase,and lower serum concentrations of ionized calcium and albuminwere significant univariate predictors of hypovitaminosis D.Sixty-six percent of the patients who consumed less than therecommended daily amount of vitamin D and 37 percent of thepatients with intakes above the recommended daily amount werevitamin D–deficient. Inadequate vitamin D intake, winterseason, and housebound status were independent predictors ofhypovitaminosis D in a multivariate model. In a subgroup of77 patients less than 65 years of age without known risk factorsfor hypovitaminosis D, the prevalence of vitamin D deficiencywas 42 percent.
Conclusions Hypovitaminosis D is common in general medical inpatients,including those with vitamin D intakes exceeding the recommendeddaily amount and those without apparent risk factors for vitaminD deficiency.
Source Information
From the Endocrine Unit (M.K.T., D.J.D., J.S.F.), Department of Medicine (D.M.L.-J., R.I.T., A.C.S., B.T.K.), and the Department of Pathology (E.C.V.), Massachusetts General Hospital and Harvard Medical School, Boston; and the Department of Medicine, University of Western Australia, Perth (I.M.D.), and the Department of Endocrinology and Diabetes, Sir Charles Gairdner Hospital, Nedlands (R.L.P.) — both in Australia.
Address reprint requests to Dr. Finkelstein at the Endocrine Unit, Bulfinch 327, Massachusetts General Hospital, 55 Fruit St., Boston, MA 02114.
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