25-OH Vitamin D Levels in a 25-OH Vitamin D Levels in a Community Based Primary Care Community Based Primary Care Office in Western New YorkOffice in Western New York

By By

Ryan Weber D.O.Ryan Weber D.O.

BackgroundBackground

Vitamin D has become widely studied Vitamin D has become widely studied and has been implicated in many and has been implicated in many diseases states. diseases states.

More specifically, 25-OH vitamin D More specifically, 25-OH vitamin D insufficiency and deficiency has been insufficiency and deficiency has been implicated in increased disease rates and implicated in increased disease rates and severity. severity.

BackgroundBackground

Disease states that have been linked to Disease states that have been linked to low 25 OH vitamin D levelslow 25 OH vitamin D levels Cancers – Hodgkin’s Lymphoma, prostate, Cancers – Hodgkin’s Lymphoma, prostate,

colon, ovarian, breast, pancreatic. colon, ovarian, breast, pancreatic. Multiple SclerosisMultiple Sclerosis OsteoporosisOsteoporosis Type I DMType I DM Crohn’s DiseaseCrohn’s Disease Schizophrenia/depressionSchizophrenia/depression

BackgroundBackground

Disease states that have been linked to low 25 Disease states that have been linked to low 25 OH vitamin D levelsOH vitamin D levels CVD – Melamed and colleagues in the August CVD – Melamed and colleagues in the August

11/25, 2008 issue of the 11/25, 2008 issue of the Archives of Internal Archives of Internal Medicine. Medicine.

when subgroups were analayzed, Melamed and when subgroups were analayzed, Melamed and colleagues found those with no history of CVD in the colleagues found those with no history of CVD in the lowest quartile of 25(OH)D level had a stronger risk lowest quartile of 25(OH)D level had a stronger risk association with mortality. association with mortality.

BackgroundBackground

WNY and some startling CVD statisticsWNY and some startling CVD statistics

CVA death in WNY is 23% higher than the CVA death in WNY is 23% higher than the national ratenational rate

CVD is the #1 cause of mortality in WNYCVD is the #1 cause of mortality in WNY Niagara county is 2x the NYS average for Niagara county is 2x the NYS average for

coronary artery disease hospital admissions. coronary artery disease hospital admissions.

BackgroundBackground

One would expect persons in WNY to One would expect persons in WNY to have low levels of 25-OH vitamin D have low levels of 25-OH vitamin D especially in winter monthsespecially in winter months

A previous study in Boston (which is at a A previous study in Boston (which is at a similar latitude to Buffalo) showed that winter similar latitude to Buffalo) showed that winter sunlight is not sufficient to produce adequate sunlight is not sufficient to produce adequate amounts of vitamin D precursors in the skin. amounts of vitamin D precursors in the skin.

BackgroundBackground

This initial research may have implication for This initial research may have implication for WNY WNY

WNY has very high rates of disease such as WNY has very high rates of disease such as CVD and cancer. CVD and cancer.

The WNY population is at risk for low vitamin D The WNY population is at risk for low vitamin D level due to the fact that it is at approximately level due to the fact that it is at approximately 4242° latitude. ° latitude.

This Study This Study

IntroductionIntroduction My study attempts to see if 25-OH vitamin D My study attempts to see if 25-OH vitamin D

insufficiency and deficiency is prevalent in a insufficiency and deficiency is prevalent in a community based practice in the Buffalo community based practice in the Buffalo New York area. New York area.

If the prevalence is high in this community If the prevalence is high in this community cohort, perhaps it would justify further studycohort, perhaps it would justify further study

MethodsMethods

from 10/12/07 – 10/30/08 serum 25-OH from 10/12/07 – 10/30/08 serum 25-OH vitamin D levels were ordered on patients vitamin D levels were ordered on patients having routine preventative physicalshaving routine preventative physicals

Ages 20-90 were eligible Ages 20-90 were eligible Both males and femalesBoth males and females All racial typesAll racial types

MethodsMethods

109 serum 25-OH vitamin D levels were 109 serum 25-OH vitamin D levels were orderedordered

75 patients were eligible for this study 75 patients were eligible for this study and had the blood work completed. and had the blood work completed.

MethodsMethods

Exclusion criteriaExclusion criteria Patients that had recently moved to western Patients that had recently moved to western

New YorkNew York Patients taking Bisphosphonates, Patients taking Bisphosphonates,

Multivitamins, or OTC vitamin D Multivitamins, or OTC vitamin D supplementssupplements

Patients without insurance. Patients without insurance.

MethodsMethods

Definition of 25-OH vitamin D levelsDefinition of 25-OH vitamin D levels ≥ ≥ 30 ng/ml = sufficient 30 ng/ml = sufficient

20-29 ng/ml = insufficient20-29 ng/ml = insufficient

< 20 = deficient< 20 = deficient

ResultsResults

It was found that out of the 75 participants 16 were It was found that out of the 75 participants 16 were classified as being 25-OH vitamin D deficient, while 29 classified as being 25-OH vitamin D deficient, while 29 participants were found to have insufficient 25-OH participants were found to have insufficient 25-OH vitamin D levels, and 30 persons had sufficient levels. vitamin D levels, and 30 persons had sufficient levels.

With breakdown of the data into 3 month intervals, it With breakdown of the data into 3 month intervals, it was found that the highest percentage of 25-OH was found that the highest percentage of 25-OH vitamin D insufficiency and deficiency was seen in the vitamin D insufficiency and deficiency was seen in the months October - June. months October - June.

The total percentages for 25-OH vitamin D levels were The total percentages for 25-OH vitamin D levels were also examinedalso examined

ResultsResults

Number of Patients and respective 25-OH Vitamin D levels

05

101520253035

< 20 20-29 30 or greater

Levels of 25-OH Vitamin D ng/ml

Nu

mb

er O

f P

atie

nts

ResultsResults

Total % of Serum 25 OH Vitamin D levels over a 12 Month Period

Less than 20

20-29

30 or Greater

40%

39%

21%

ResultsResults

% of Patients with Serum 25-OH Vitamin D levels < 30 ng/ml by months

0%

20%

40%

60%

80%

Jan - March April - June July-Sept Oct-Dec

Months

% o

f P

ati

en

ts

Conclusion and Conclusion and discussiondiscussion

Vitamin D insufficiency and Deficiency Vitamin D insufficiency and Deficiency were very prevalent in this population were very prevalent in this population with 60% of participants in these groups. with 60% of participants in these groups.

The months with lower amounts of The months with lower amounts of sunlight showed the highest levels of sunlight showed the highest levels of deficiency and insufficiencydeficiency and insufficiency

Conclusion and Conclusion and discussiondiscussion

Limitations of this studyLimitations of this study Small sample sizeSmall sample size Lack of consensus values for adequate 25-Lack of consensus values for adequate 25-

OH vitamin DOH vitamin D Comparing results of this study to others is Comparing results of this study to others is

difficult due to wide ranges of vitamin D difficult due to wide ranges of vitamin D levels being defined as adequate. levels being defined as adequate.

Conclusion and Conclusion and discussiondiscussion

It is clear that many causes for disease It is clear that many causes for disease are multifactorialare multifactorial

Current attention has been given to Current attention has been given to vitamin D as a possible link to a variety of vitamin D as a possible link to a variety of disease states. disease states.

Just attention has been given to Just attention has been given to preventative measures such as lipid preventative measures such as lipid levels, smoking cessation, blood levels, smoking cessation, blood pressure, in the primary care setting. pressure, in the primary care setting.

Conclusion and Conclusion and discussiondiscussion

As more data regarding vitamin D is As more data regarding vitamin D is gathered it may be seen as a marker to gathered it may be seen as a marker to be monitored for disease preventionbe monitored for disease prevention

With this study vitamin D levels were With this study vitamin D levels were shown to be insufficient or deficient in the shown to be insufficient or deficient in the majority of patients. majority of patients.

It would seem that in the WNY population It would seem that in the WNY population vitamin D monitoring could be valuable in vitamin D monitoring could be valuable in a primary care setting. a primary care setting.

Conclusion and Conclusion and discussiondiscussion

If in the future Vitamin D is definitively If in the future Vitamin D is definitively shown to be a factor in disease states, shown to be a factor in disease states, primary care providers may find benefit in primary care providers may find benefit in routine screening and treatment of low routine screening and treatment of low vitamin D states. vitamin D states.

Thank YouThank You

Dr. Andrew Harbison (mentor)Dr. Andrew Harbison (mentor) Dr. David MartinkeDr. David Martinke The staff at PCWNYThe staff at PCWNY

QuestionsQuestions

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