The Vitamin D paradox: Bone density testing in females aged 45 to 74 did not increase over a ten-year period despite a marked increase in testing for vitamin D

Abstract

Aim: To determine whether increased vitamin D testing resulted in improved osteoporosis detection in Australian females aged 45–74 yr. Methods: Longitudinal analysis of bone densitometry, 25-hydroxyvitamin D (25(OH)D) and full blood count (FBC) testing between 2001 and 2011. The number and rate of tests per 100,000 individuals and benefit in dollars for bone densitometry, 25(OH)D and FBC from 2001–2011 for individuals aged 45–74 yr were obtained from Medicare Australia. Results: There was a disproportionate increase in 25(OH)D testing compared to bone density testing from 2001 to 2011, whereby 25(OH)D testing increased from 26,666 to 1.65 million p.a. and bone density testing increased from 41,453 to 66,100 p.a. Bone densitometry increased approximately 1.2 fold, whereas 25(OH)D testing increased by 55.2,41.2 and 34.3 fold in females aged 45–54, 55–64 and 65–74 yr, respectively. This represents an increase in annual benefits from approximately $2.5–$4.1 million for bone density testing and $0.7–$40.5 million for 25(OH)D testing over the period. Conclusions: This study demonstrates that improved detection of vitamin D deficiency is not being translated into better detection in at-risk women of the consequences of vitamin D deficiency on target organs such as bone. This failure to translate rising awareness and better detection of vitamin D deficiency into physiological outcomes is a massive missed opportunity for improved bone health and reduced fracture risk. We propose that clinical practice guidelines be introduced not only for the purpose of diagnosis and testing for vitamin D, but to include recommendations for bone health testing in at-risk individuals.