Vitamin D supplementation in a healthy, middle-aged population: actual practices based on data from a French comprehensive regional health-care database.

BACKGROUND/OBJECTIVES: The debate surrounding recommendations for vitamin D supplementation in middle-aged patients (that is, 20-60 years of age) with low serum concentrations of 25-hydroxyvitamin D (25(OH)D) is growing. Our aim was to describe practices regarding vitamin D supplementation in this age group, which are basically unknown. SUBJECTS/METHODS: We performed an analysis using exhaustive reimbursement data from the individuals in Rhône-Alpes area, a French region regrouping more than 6 million of inhabitants. The data were collected from the French Insurance Health-care System. Patients who were 20-60 years of age, had no severe comorbidities, had a 25(OH)D assay between 1 December 2008 and 31 January 2009 were identified. Those who received a subsequent prescription for vitamin D were included in this analysis. We described patterns of vitamin D supplementation by frequency and daily dose. RESULTS: The sample in this study included 1311 patients. The mean age was 47.7 years (s.d.: 9.5) and the median age was 50.2 years. Most of the participants (that is, 85.9%) were women. A total of 372 distinct prescription patterns for vitamin D supplementation were observed. The two most frequent (that is, 32.6% in total) involved a unique dispensation of a high dose of either 200,000 (17.5%) or 100,000 IU (15.1%). Most prescribed supplements were based on vitamin D3 (65%), and the most prescribed forms were high dose ampoules (81.6%). Only 48.9% of the participants were given a maintenance prescription after the initial loading phase. CONCLUSIONS: Our results reveal a significant variability in the prescriptions for vitamin D supplementation from physicians in the French population. Moreover, less than half of the patients receive maintenance therapy after the initial loading phase of supplementation.

MENOPOST--calcium and vitamin D supplementation in postmenopausal osteoporosis treatment: a descriptive cohort study.

SUMMARY: Adequate vitamin D/calcium supplementation during osteoporosis (OP) treatments seems insufficient. This cohort study within a national claims database evaluated calcium/vitamin D co-prescription in postmenopausal women initiating an OP treatment. A high co-prescription rate was observed with three quarters of women supplemented with calcium and/or vitamin D in agreement with current recommendations. INTRODUCTION: Adequate calcium/vitamin D supplementation should be taken in combination with antiresorptive drugs in OP treatment. Despite guidelines, supplementation appears to be insufficient. The objective of this study was to describe and estimate co-prescription rates of calcium/vitamin D among postmenopausal women initiating an OP treatment. METHODS: All women over 50 years with a first claim for a bisphosphonates, raloxifene, or strontium prescription filled between May and August 2010 were included in a retrospective cohort study. Data source was the health insurance claims database of the Rhône-Alpes area. RESULTS: Among 4,415 women, 77.0 % had co-prescription of calcium or vitamin D with initial OP treatment, of which 2,150 (49.7 %) had both calcium and vitamin D. The proportion of women with calcium and/or vitamin D (81.7 %) was significantly higher when OP treatment was a bisphosphonate compared to strontium (70.9 %) or raloxifene (67.0 %) (p < 0.05). Among women prescribed both calcium and vitamin D, 7.6 % received a bisphosphonate and vitamin D ± calcium fixed-combination pack. General practitioners prescribed two thirds of initial supplementation treatment (66.9 %). Patients were twice as likely to be prescribed supplementation when the prescriber was a rheumatologist (OR = 2; 95 % CI = 1.57-2.54). CONCLUSION: Three quarters of women initiating OP treatment were supplemented with calcium and/or vitamin D in agreement with current recommendations. This represents a high co-prescription rate.