Scenario: Vitamin D supplements
Customer Nusrat Begum is talking to pharmacist Parveen about how the vitamin D supplement she is taking doesn’t seem to be working...
“My hands and feet are really stiff and achy. I thought it was vitamin D deficiency like last time,” says Nusrat, “but I’ve taken a supplement and it’s made no difference.”
“Did you get another prescription?” asks Parveen.
“Oh no, paying for my prescriptions works out quite expensive,” Nusrat says, “ so I got one of those multivitamins from your 99p range. It’s got vitamin D in it so it must basically be the same thing...” How should Parveen respond?
The most sensible first step is to check how much vitamin D is in the supplement Nusrat has been taking. Chances are it is around 400iU per tablet, which is fine as a preventative measure but will not correct a deficiency.
A trip to the GP is in order for Nusrat – perhaps for a blood test to check her vitamin D level, although the doctor may decide against it if convinced that her symptoms are the same as when she was found to have a deficiency on a previous occasion – in order for her to be prescribed a high dose supplement. This is usually around 280,000- 300,000iU over the course of six to 10 weeks.
Once her deficiency has been corrected, Nusrat should take a daily vitamin D supplement throughout the year. Her doctor will be able to advise her, but it may be the case that she needs a higher amount of 800iU per day as maintenance treatment compared to the more usual 400iU. There isn’t usually a need to monitor serum vitamin D levels, but it is a good idea for Nusrat to consider her calcium intake. If it is less than 700mg per day, dietary measures should be taken to address this or a supplement added if this is not appropriate.
The bigger picture
The National Diet and Nutrition Survey, conducted by Public Health England and the Food Standards Agency, revealed that just under a quarter of people in the UK had low vitamin D levels, although this figure increased to 30 per cent of over-65s and 40 per cent of 19-64s in the months of January to March. This is thought to be because the amount of UVB radiation in the UK is not enough to synthesize vitamin D in the skin during the winter months.
Vitamin D is essential for the regulation of calcium and phosphate levels in the body, and therefore core to good musculoskeletal health. Symptoms of low vitamin D levels can include bone loss, muscle weakness, falls and fragility fractures, hypocalcaemia and secondary hyperparathyroidism, with the main complication osteomalacia, which in turn can lead to osteopenia and osteoporosis.
Extend your learning
• Find out which groups of people are at higher risk of developing vitamin D deficiency. See NICE’s Clinical Knowledge Summary
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