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Vitamin D deficiency and osteoporosis as side effects from drugs often overlooked in healthcare

Drug-related vitamin D deficiency and osteoporosis are often overlooked when it comes to testing and treatment with supplementation in Swedish healthcare. This is shown in a new dissertation in biomedical science by Ola Nordqvist. He has also developed a tool that can help doctors easily detect patients at risk.

Several drugs have side effects in the form of deficient levels of vitamin D and a negative impact on skeletal bone. Examples of such drugs are some glucocorticoids for inflammatory diseases and some anticonvulsant drugs, used to treat epileptic patients, but also for treatment of neuropathic pain and certain types of anxiety. The healthcare is tasked with discovering and treating any vitamin D deficiency in persons who use these “risk drugs”, in accordance with applicable medical guidelines.

Fractures are common in Sweden

Every year, more than 100 000 osteoporotic-related fractures occur in Sweden. This means that every second woman and every third man above the age of 50 will suffer an osteoporotic fracture at some point in life. Vitamin D deficiency is one of the causes behind a fragile skeleton, which increases the risk of fractures.

“Vitamin D deficiency leads to an increased risk of osteoporotic fractures. Therefore, it is important that the healthcare personnel monitor patients who risk being affected by vitamin D deficiency”, Nordqvist explains.

Few patients are tested for vitamin D

Nordqvist’s dissertation shows that the healthcare system fails to identify and treat patients who are at risk. Out of roughly 12 000 patients in Region Kalmar County who have been given prescriptions for the included glucocorticoids, anticonvulsant drugs, and other drugs that reduces the body’s ability to take up vitamin D, fewer than every 15th person was tested for vitamin D. Only every third person was prescribed vitamin D pills to compensate for the side effects of the drugs. This is shown in Nordqvist’s analysis of the county’s digital journal system.

Low risk awareness

Vitamin D deficiency was particularly common among people who used anticonvulsive drugs. The explanation for this could be a lack of awareness in primary care about the risks, as well as what part of the healthcare system has responsibility for this, shows interviews with doctors conducted by Nordqvist.

“While awareness concerning risks with glucocorticoid drugs was high, the risks were accepted, and the doctors thought it was their responsibility to take care of the patients who were treated with glucocorticoids, it was completely the other way around for patients who were prescribed anticonvulsive drugs. The awareness was low, the risks were questioned, and responsibility was considered to rest with the hospital specialists, not the primary care, despite the fact that the prescriptions were sometimes renewed there”, Nordqvist continues.

New tool can help doctors

In order to help doctors discover and handle the risks of osteoporosis in patients at risk, Nordqvist has used an index based on data from 15 000 patients. The index indicates what patients can be in need of further investigation and treatment.

“This tool could help reduce the risk of unnecessary side effects and suffering by providing better and more individualised care for the patients”, Nordqvist concludes.


More information:

Ola Nordqvist’s dissertation in biomedical science:
Epidemiological aspects of drug-related vitamin D deficiency and osteoporotic fractures

Learn more about Linnaeus University’s research for a healthier life with the help of digital technology on the eHealth Institute’s webpage.