ROCHESTER -- Nearly nine out of 10 upstate New Yorkers have no medical reason to have their vitamin D levels tested, yet health care providers and patients continue to frequently request the test, according to an analysis released today by Excellus BlueCross BlueShield.
Last year, 641,000 upstate New Yorkers had their vitamin D levels tested, and about 42 percent did so without a medical indication for it. Typically, only people with certain conditions, including but not limited to osteoporosis, kidney and liver disease, malabsorption syndromes, bone disorders and certain endocrine conditions, are candidates for testing. Older adults and some pregnant or lactating women also can expect to have their doctors recommend vitamin D testing.
“Even with a medical indication to test for vitamin D deficiency, it’s valid to question the need for the test, because the outcome won’t necessarily change the treatment,” said Matthew Bartels, M.D., Excellus BCBS medical director for health care improvement. “If your doctor suspects a low vitamin D level, taking an over-the-counter supplement or getting more vitamin D from your diet may be sufficient.”
Widespread testing is associated with potentially unnecessary treatments with supplements, retesting and increased medical costs. On average, a vitamin D deficiency test can cost $50, typically covered by health insurance. In 2014 in upstate New York, an estimated $33 million was spent on vitamin D testing, according to an Excellus BCBS infographic, “Vitamin D Tests.” High-dose, prescription-strength vitamin D supplements may have an out-of-pocket cost for the patient, depending on his or her level of health insurance coverage.
Vitamin D is an essential vitamin in how our bodies function. It helps our bodies absorb calcium, which keeps our bones and muscles — including the heart — healthy and strong. “Most people get enough vitamin D through the foods they eat and the time they spend in the sun,” said Bartels.
“Past studies have linked vitamin D deficiency to numerous conditions, such as heart disease and cancer, so patients and physicians started demanding more tests,” said Bartels. “A more recent critical analysis of these reports shows significant flaws, leading many in the medical community to question the necessity of widespread testing.”
The U.S. Preventive Services Task Force recently found the current medical evidence insufficient to assess the balance of benefits and harms of screening for vitamin D deficiency in asymptomatic adults.
The American Society of Clinical Pathology contributed the following recommendation to Choosing Wisely®, “Many people have low levels of vitamin D, but few have seriously low levels. Most of us don’t need a vitamin D test. We just need to make simple changes so we get enough vitamin D.”
Choosing Wisely is an American Board of Internal Medicine (ABIM) Foundation initiative that includes more than 300 care recommendations submitted by physician-led medical specialty societies to improve the quality of care and encourage conversations between physicians and patients about services which may be unnecessary and may cause harm.
Bartels noted that the recommended daily vitamin D intake through food and/or supplements is 600 international units for those 70 years and younger and 800 international units for those older than age 70. “To ensure that you actually consume the recommended amount, it may not hurt to take a multivitamin or vitamin D supplement,” he said.
Aside from multivitamins and vitamin D supplements, the Excellus BCBS infographic lists cod liver oil, salmon and tuna as foods high in vitamin D. Other, more commonly consumed foods, such as milk, cereal and orange juice, are fortified with vitamin D.
Our bodies also can produce all of the vitamin D we need throughout the year by getting five to 30 minutes of sun twice a week during the spring, summer and fall. The U.S. Preventive Services Task Force doesn’t recommend sun exposure as a way to boost vitamin D levels, because it increases the risk for skin cancer.
“The reality is that only about one in ten upstate New Yorkers has a medical reason to be tested,” said Bartels, adding that it is difficult to determine what a normal vitamin D level is. People who have darker skin pigmentation can have low levels of vitamin D, as can individuals whose body mass index categorizes them as obese. It’s unclear whether the low levels of vitamin D are linked with adverse health outcomes.
“The medical evidence for any benefits of routine testing for vitamin D deficiency in healthy adults and children is insufficient,” concluded Bartels. “Excellus BCBS’s goal in reviewing the data and publishing an infographic on the subject is to encourage informed discussions between patients and their doctors.”
For additional information from Choosing Wisely at Consumer Reports, go to:
About Excellus BlueCross BlueShield
Excellus BlueCross BlueShield, a nonprofit independent licensee of the BlueCross BlueShield Association, is part of a family of companies that finances and delivers vital health care services to about 1.6 million people across upstate New York. Excellus BlueCross BlueShield provides access to high-quality, affordable health coverage, including valuable health-related resources that our members use every day, such as cost-saving prescription drug discounts and wellness tracking tools. To learn more, visit excellusbcbs.com.