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 40% 39% 21%

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 ?