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25-OH Vitamin D Levels in a Community Based Primary Care Office in Western New York

25-OH Vitamin D Levels in a Community Based Primary Care Office in Western New York. By Ryan Weber D.O. Background. Vitamin D has become widely studied and has been implicated in many diseases states.

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25-OH Vitamin D Levels in a Community Based Primary Care Office in Western New York

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  1. 25-OH Vitamin D Levels in a Community Based Primary Care Office in Western New York By Ryan Weber D.O.

  2. Background • Vitamin D has become widely studied and has been implicated in many diseases states. • More specifically, 25-OH vitamin D insufficiency and deficiency has been implicated in increased disease rates and severity.

  3. Background • Disease states that have been linked to low 25 OH vitamin D levels • Cancers – Hodgkin’s Lymphoma, prostate, colon, ovarian, breast, pancreatic. • Multiple Sclerosis • Osteoporosis • Type I DM • Crohn’s Disease • Schizophrenia/depression

  4. Background • Disease states that have been linked to low 25 OH vitamin D levels • CVD – Melamed and colleagues in the August 11/25, 2008 issue of the Archives of Internal Medicine. • when subgroups were analayzed, Melamed and colleagues found those with no history of CVD in the lowest quartile of 25(OH)D level had a stronger risk association with mortality.

  5. Background • WNY and some startling CVD statistics • CVA death in WNY is 23% higher than the national rate • CVD is the #1 cause of mortality in WNY • Niagara county is 2x the NYS average for coronary artery disease hospital admissions.

  6. Background • One would expect persons in WNY to have low levels of 25-OH vitamin D especially in winter months • A previous study in Boston (which is at a similar latitude to Buffalo) showed that winter sunlight is not sufficient to produce adequate amounts of vitamin D precursors in the skin.

  7. Background • This initial research may have implication for WNY • WNY has very high rates of disease such as CVD and cancer. • The WNY population is at risk for low vitamin D level due to the fact that it is at approximately 42° latitude.

  8. This Study • Introduction • My study attempts to see if 25-OH vitamin D insufficiency and deficiency is prevalent in a community based practice in the Buffalo New York area. • If the prevalence is high in this community cohort, perhaps it would justify further study

  9. Methods • from 10/12/07 – 10/30/08 serum 25-OH vitamin D levels were ordered on patients having routine preventative physicals • Ages 20-90 were eligible • Both males and females • All racial types

  10. Methods • 109 serum 25-OH vitamin D levels were ordered • 75 patients were eligible for this study and had the blood work completed.

  11. Methods • Exclusion criteria • Patients that had recently moved to western New York • Patients taking Bisphosphonates, Multivitamins, or OTC vitamin D supplements • Patients without insurance.

  12. Methods • Definition of 25-OH vitamin D levels • ≥ 30 ng/ml = sufficient • 20-29 ng/ml = insufficient • < 20 = deficient

  13. Results • It was found that out of the 75 participants 16 were classified as being 25-OH vitamin D deficient, while 29 participants were found to have insufficient 25-OH vitamin D levels, and 30 persons had sufficient levels. • With breakdown of the data into 3 month intervals, it was found that the highest percentage of 25-OH vitamin D insufficiency and deficiency was seen in the months October - June. • The total percentages for 25-OH vitamin D levels were also examined

  14. Results

  15. Results 21% 40% 39%

  16. Results

  17. Conclusion and discussion • Vitamin D insufficiency and Deficiency were very prevalent in this population with 60% of participants in these groups. • The months with lower amounts of sunlight showed the highest levels of deficiency and insufficiency

  18. Conclusion and discussion • Limitations of this study • Small sample size • Lack of consensus values for adequate 25-OH vitamin D • Comparing results of this study to others is difficult due to wide ranges of vitamin D levels being defined as adequate.

  19. Conclusion and discussion • It is clear that many causes for disease are multifactorial • Current attention has been given to vitamin D as a possible link to a variety of disease states. • Just attention has been given to preventative measures such as lipid levels, smoking cessation, blood pressure, in the primary care setting.

  20. Conclusion and discussion • As more data regarding vitamin D is gathered it may be seen as a marker to be monitored for disease prevention • With this study vitamin D levels were shown to be insufficient or deficient in the majority of patients. • It would seem that in the WNY population vitamin D monitoring could be valuable in a primary care setting.

  21. Conclusion and discussion • If in the future Vitamin D is definitively shown to be a factor in disease states, primary care providers may find benefit in routine screening and treatment of low vitamin D states.

  22. Thank You • Dr. Andrew Harbison (mentor) • Dr. David Martinke • The staff at PCWNY

  23. Questions ?

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