The new RCPA Position Statement on the "Use and Interpretation of Vitamin D testing” Dr Michael Harrison RCPA VP , CEO SNP
Nov 12, 2014
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