In August 2018 I wrote my first blog on Vitamin D and wondered how long it would take for clinical practice to change. Much more has been documented since then to move prescribers to rethink and change what they recommend.
On August 27, 2019 JAMA published an original investigation, “Effect of High-Dose Vitamin D Supplementation on Volumetric Bone Density and Bone Strength: A Randomized Clinical Trial.” The September 3, 2019 NEJM Journal Watch comments on the study were succinct, “In any case, the findings point to no benefit for bone integrity — and even potential harm — with high-dose vitamin D supplementation in patients whose vitamin D levels are adequate.”
Even with critically ill patients the benefits were not evident. The December 26, 2019 NEJM original article “Early High-Dose Vitamin D3 for Critically Ill, Vitamin D–Deficient Patients” from The National Heart, Lung, and Blood Institute PETAL Clinical Trials Network concluded “Early administration of high-dose enteral vitamin D3 did not provide an advantage over placebo with respect to 90-day mortality or other, nonfatal outcomes among critically ill, vitamin D–deficient patients."
When it comes to recommending Vitamin D the willingness to change current prescribing behavior is still missing. The lag between the bench and clinical practice is not just a matter of communication; prescribers also have to be willing to change.