The new RCPA Position Statement on the "Use and Interpretation of

Vitamin D testing”

Dr Michael Harrison RCPA VP , CEO SNP

Talk outline

Basic Vitamin D biology

Dynamics and demand of Vit D testing

The funding dilemma

Test demand interventions

The new RCPA guidelines

The path forward

Vitamin D biology

Vitamin D deficiency

Vitamin D tests - Australia

0

500,000

1,000,000

1,500,000

2,000,000

2,500,000

3,000,000

3,500,000

4,000,000

4,500,000

5,000,000

Series1

Vitamin D test utilization international comparison 2009

Vitamin D tests – state breakdown

0

200,000

400,000

600,000

800,000

1,000,000

1,200,000

1,400,000

1,600,000

1,800,000

State NSW Services

State VIC Services

State QLD Services

State SA Services

State WA Services

State TAS Services

State ACT Services

State NT Services

Vitamin D tests population utilization

Services per capita (per 100,000 popn. rolling 12m. average) - item 66608 VitaminD

0

200

400

600

800

1,000

1,200

1,400

Jul-02 Jan-03 Jul-03 Jan-04 Jul-04 Jan-05 Jul-05 Jan-06 Jul-06 Jan-07 Jul-07 Jan-08 Jul-08 Jan-09 Jul-09 Jan-10

NSW Vic Qld SA WA Tas ACT NT

Ed Wilson

EW Consulting

Ed Wilson

EW Consulting P/L

Vitamin D Medicare expenditure

Vitamin D publications

Google – Vitamin D 60 million

Google - Vitamin D deficiency 8.7million

Google - Vit D deficiency Aus 1.3 million

PubMed – Vitamin D 60,000

PubMed - Last 5 years 16,000

PubMed - Last 10 years 25,000

PubMed –Vitamin D deficiency 21,000

Articles VS Vitamin D tests 2002-12 Articles = Major national and international medical journals, General Practitioner (GP)

targeted journals and publications, Government funded bodies and associated

publications, Guidelines and position statements published by specialist and

authoritative medical societies

Old-World Primates Humans exposing

full skin surface to

Sunshine’s

UVB

Winter

43o N Latitude

“Normal” 0

40

120

160

A

Vitamin D Status in Primates

and Early Humans

Sources, include Cosman, Osteoporosis Int 2000; Fuleihan NEJM 1999; Scharla Osteoporosis Int 1998; Vieth AJCN 1999, 2000

80 80

Physiological adult intake

Blood Levels when

taking 1000 IU/day Northern People

Taking

4000 IU/day

Deviation (% bias) of methods from the

NIST

Mean inter-laboratory imprecision (CV%)

NPS : Program Objectives

1. Increase awareness of risk factors for vitamin D deficiency and appropriate management of high risk groups

2. Improve health professional awareness of the limitations of vitamin D tests

3. Increase the awareness and adoption of lifestyle measures to prevent vitamin D deficiency

4. Increase the appropriate use of vitamin D supplements

5. Increase appropriate use of vitamin D testing

RCPA Vitamin D working group

1.Assoc. Prof. James Davidson, Chemical Pathologist,

Labplus, Auckland

2.Dr. Zhong Lu, Chemical Pathologist | Melbourne

Pathology

3. Professor Howard Morris, Clinical Scientist,

Endocrine Bone Research Laboratory, SA Pathology

4. Dr Hans Schneider, Chemical Pathologist, Alfred

Health

RCPA Vitamin D working group

1. Types of Vitamin D Tests Currently on the Market,

Methods, Pitfalls etc. Zhong Lu

2. Who Should Be Tested -Adult and Paediatric James

Davidson and Howard Morris

3.How Often Should Retesting occur. Howard Morris

and Zhong Lu

4. Interpretation of Results. Paul Glendenning and

Hans Schneider

5. Possible Harms of Testing Paul Glendenning

RCPA Vitamin D Testing Guidelines 1

RCPA Vitamin D Testing Guidelines 2

The Vitamin D testing dilemma

Preventive medicine & the value of “screening”

for disease

Public interest & dealing with scientific

uncertainty

Evidence based guidelines vs “uncontrolled

experiments”

Individual vs population intervention measures

Cost vs everything else