The rise and rise of vitamin D testing

  • Bilinski K
  • Boyages S
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Moynihan and colleagues' report highlights the increasing trend for overdiagnosis, particularly of endocrine disorders. 1 Similar concerns exist for overdiagnosis and overtreatment of vitamin D deficiency. 2 3 Currently, the appropriate timing and frequency of testing for the diagnosis of vitamin D deficiency is unclear. The cost of testing in Australia increased from $A1m (£0.66m; €0.83m; $1m) in 2000 to $95.6m in 2010, on average 59% each year. 2 Similarly, in Ontario, Canada, testing increased 25-fold from 2004 to 2010. Projections suggest that $C150m (£95m; €120m; $147m) will be spent on vitamin D testing in 2012, up from $38m in 2009. 4 Similarly, the UK has seen a sixfold increase in such tests between 2007 and 2010. 5 Our data show that the past 11 years have seen an unsustainable growth in vitamin D testing in Australia (figure⇓). These findings have widespread consequences in terms of quality of care, unnecessary cost, and potential overdiagnosis. Further studies are needed to determine whether this increased testing translates into improved vitamin D status in the population and subsequent health outcomes. Worryingly, however, this large increase in vitamin D testing did not translate into increased testing for osteoporosis, as shown by the flat trend in bone density measurements (figure⇓). Guidelines are urgently needed to limit overtesting, overdiagnosis, and as a consequence overtreatment for vitamin D deficiency. Competing interests: None declared. 1 Moynihan R, Doust J, Henry D. Preventing overdiagnosis: how to stop harming the healthy. BMJ 2012;344:e3502. (29 May.) 2 Bilinski KB, Boyages SC. The rising cost of vitamin D testing in Australia: time to establish guidelines for testing. Med J Aust 2012; published online 17 July. 3 Boyages SC, Bilinski K. Seasonal reduction in vitamin D level persists into spring in NSW Australia: implications for monitoring and replacement therapy. Clin Endocrinol 2012; published online 3 April. 4 Mittelstaedt M. Ontario considers curbing vitamin D testing. The Globe and Mail 2010. 5 Sattar N, Welsh P, Panarelli M, Forouhi NG. Increasing requests for vitamin D measurement: costly, confusing, and without credibility. Lancet 2012;379:95-6. Cite this as: BMJ 2012;345:e4743

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