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Vitamin D Deficiency

Vitamin D Deficiency. Zoe Oliver GPST2 Patch Tutorial. Contents. Aims and Objectives Definitions Rickets/Osteomalacia Risk Factors Natural sources Testing Prescribing AKT questions. Aims and Objectives. Be able to define vitamin D deficiency. Be able to identify those at risk.

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Vitamin D Deficiency

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  1. Vitamin D Deficiency Zoe Oliver GPST2 Patch Tutorial

  2. Contents • Aims and Objectives • Definitions • Rickets/Osteomalacia • Risk Factors • Natural sources • Testing • Prescribing • AKT questions

  3. Aims and Objectives • Be able to define vitamin D deficiency. • Be able to identify those at risk. • Have a greater knowledge of the treatment options available. • Be able to advise patients on the appropriate treatment option according to local prescribing guidelines.

  4. Definitions

  5. Rickets/Osteomalacia • Bone has low mineral content – excess uncalcified osteoid and cartilage. • If occurs during period of bone growth ie childhood – Rickets. • If after fusion of epiphyses - Osteomalacia

  6. Rickets Knocked knees Bow legged Thickened wrists/ankles Signs of hypocalcaemia: Tetany Depression Perioral Paraesthesia Carpo-pedal spasm

  7. Osteomalacia Bone Pain Partial Fractures Looser’s Zones Proximal Myopathy Waddling gait

  8. Risk Factors • Pregnant • Breastfeeding • Babies and young children <5 • Older people aged > 65 • Institutions • Dark Skin • Poor sunlight exposure – night shift workers

  9. Vitamin D Requirements Note – I got this table from CKS on vitamin D but the CMO letter says 6 months to 5 years need 7-8.5mcg

  10. Sunlight • During the summer the skin can produce 100 micrograms/day • Possible to build up a store of vitamin D for winter months. • With age, skin becomes thinner and less Vitamin D can be produced.

  11. Vitamin D in Food

  12. Investigation • Vitamin D – RUH £20.50 • Bone Profile • Calcium ↓ • Phosphate ↓ • ALP ↑ • PTH ↑ • X- rays if fractures suspected • Looser's zones are characteristic but not always present • Other Radiological Signs: • crush fractures of the vertebrae • trefoil pelvis • spontaneous fractures of the ribs, pubic rami, femoral neck or the metaphyses above and below the knee • bowing of the long bones • in children - increased depth and width of the epiphyseal growth plate, and a 'cupped' appearance of the adjacent metaphyses

  13. Financial Implications • Expensive test • Testing in RUH up 600% in last 2 years • Vitamin D prescriptions up 16% from 2011 • CMO wrote to GP’s in Jan 2012 urging them to prescribe vitamin D to all at risk groups • Healthy Start vits – see separate talk

  14. AKT Questions

  15. Questions/Discussion

  16. References • BCAP Prescribing • BNF • Passmedicine.com • http://www.cks.nhs.uk/print_preview?pageid=321048000&pagepath=/patient_information_leaflet/osteomalacia_soft_bones_arc/view_as_a_leaflet&rootcontainerelement=nhsd_topicroot&viewtype=full • Pulsetoday.co.uk 22.08.2012 Surge in vitamin D prescribing, Sofia Lind.

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