Vitamin D and adult bone health in Australia and New Zealand: a position statement

The document attached has been archived with permission from the editor of the Medical Journal of Australia. An external link to the publisher’s copy is included.See page 3 of PDF for this item.Simon J Vanlin

A qualitative exploration of GPs’ perspectives on managing chronic nonspecific musculoskeletal pain in Australian general practice – a focus group study

Creative Commons Attribution-NonCommercial 4.0 International LicenseObjective: Chronic nonspecific musculoskeletal pain (CNMP) is a complex idiopathic condition that causes significant disruption to patients’ lives, their relationships, and functionality. The cause of CNMP is not fully understood, which makes diagnosis and management challenging. As general practitioners (GPs) are central to the management of chronic pain, their perspectives on managing CNMP are important. Purpose: To explore the clinical reasoning GPs use when diagnosing and managing CNMP. Methods: A qualitative study design using focus group discussion was conducted with Australian GPs. Five focus group discussion were conducted across Adelaide. All focus group discussions were audio-recorded, and transcripts were coded and analyzed thematically with the program NVivo. Results: The main themes remained consistent across the five focus group discussion’s: the ambiguous cause of CNMP; sex differences; developing the “right strategy”; patient-centered care; and verifying vitamin D levels. Conclusion: The findings show that GPs use a patient-centered approach tailored to individual patients’ medical history, physical examination findings, and psychosocial health. There was general concern about low levels of vitamin D in patients with CNMP, and vitamin D supplements were recommended if indicated by a patient’s history

Vitamin D and obesity

Obesity is a significant health problem world-wide, particularly in developed nations. Vitamin D deficiency is pandemic, and has been implicated in a wide variety of disease states. This paper seeks to examine the consistently reported relationship between obesity and low vitamin D concentrations, with reference to the possible underlying mechanisms. The possibility that vitamin D may assist in preventing or treating obesity is also examined, and recommendations for future research are made. There is a clear need for adequately-powered, prospective interventions which include baseline measurement of 25D concentrations and involve adequate doses of supplemental vitamin D. Until such studies have been reported, the role of vitamin D supplementation in obesity prevention remains uncertain.Simon Vanlin

Dental notes: Bisphosphonates and osteonecrosis of the jaw

Letter to the editorSimon Vanlin

Community perspectives on vitamin D and bone health in three at-risk populations.

Background: Disorders affecting bone health, including osteoporosis and fractures, cause significant morbidity and mortality in Australia. Specific sub-groups within the general population are at increased risk of poor bone health and fracture. Such groups include people with intellectual disability, Aboriginal Australians and people known to have osteopenia. These studies aim to document the extent of this increase in risk, examine the underlying reasons and evaluate possible treatment options. Methods: Three studies are described: a) A 5 year retrospective audit of 280 individuals with intellectual disability examined data including age, gender, mobility, dietary status, incident fractures, medications and 25-hydroxyvitamin D (25D) levels, as well as response to vitamin D supplementation. b) A cross-sectional study of 58 South Australian Aboriginal people investigating the adequacy of vitamin D status and the relationship between serum 25D levels and biochemical variables of calcium and bone mineral homeostasis. c) A prospective, randomised, placebo-controlled pilot study of the efficacy, acceptability and tolerability of docosahexanoic acid (DHA) supplementation in addition to calcium and vitamin D₃ in 40 individuals with osteopenia. Results: a) 57% of intellectually disabled individuals tested were vitamin D insufficient. Vitamin D insufficiency was strongly correlated with reduced mobility (p<0.001) and difficulty consuming solids (p<0.001). The correlation between 25D levels and fractures was not significant (p = 0.3). Oral supplementation using vitamin D₃ 100,000 IU every 4 months was effective in correcting vitamin D insufficiency. 68 fractures occurred over the audit period in 52 individuals, a rate of 1 fracture every 23.8 person years. Peripheral fractures accounted for 54% of all fractures, being particularly prevalent in the most mobile individuals. b) Serum 25D levels varied seasonally in South Australian Aboriginal people, being higher in summer (P < 0.001). The overall mean of 56.8 nmol/L (SD, 22.1) is below the recommended target level of 60 nmol/L. Serum 25D levels correlated significantly with c-terminal telopeptide (CTx) (P = 0.03), but not with age, body mass index, levels of fasting glucose or PTH. BMI and PTH levels were significantly correlated with each other (P = 0.001). c) CTx was suppressed after 12 months for all osteopenic participants (p=0.04) with no difference in effect size between DHA and control groups (p=0.53). Changes in CTx at 12 months were significantly correlated with changes in bone density at the lumbar spine (p=0.01) and total proximal femur (TPF) (p=0.03). Participants rated the supplements as tolerable and acceptable, with few adverse events. Conclusions: a) Fractures are common in people with intellectual disability. Vitamin D insufficiency may contribute to this increased risk, although this study did not conclusively establish this. Oral vitamin D₃ supplementation is effective in restoring normal vitamin D levels. b) Vitamin D insufficiency is highly prevalent in adult Aboriginal Australians, with low mean values found in all seasons other than summer. c) The combination of oral calcium, vitamin D₃ and DHA was safe, tolerable and acceptable when used for 12 months by osteopenic individuals. Both combinations (i.e. calcium, vitamin D₃ and DHA; and calcium, vitamin D₃ and placebo) had a positive effect on bone health, with no significant effect from the addition of DHA.Thesis (Ph.D.)--University of Adelaide, School of Population Health, 2013

Why older women do or do not seek help from the GP after a fall: a qualitative study

Background. It is recommended that older people report their falls to their general practitioner (GP), to identify falls risk factors. However, many older people do not report falling to their GP. Little is known about the reasons why older people do and do not seek help about falling. Objective. To explore why older women do or do not seek GP help after a fall. Methods. A qualitative study, using semi-structured interviews with 11 community-dwelling women aged ≥65 years, living in Adelaide, Australia, who had fallen in the last 12 months. Interviews focused on women’s experience of falling and seeking GP help. Interviews were analysed using constant comparison. Results. Four women sought GP help when they believed their fall-related injury was serious enough. Family and a bystander persuaded three women to attend for a fall-related injury. The four women who did not seek help believed their fall or fall-related injury was not serious enough to seek help and justified this by using internal rationales (they monitored and managed the outcome of falling, they wanted to be associated with a positive image and attitude, and they recognized and interpreted the cause and control of falling) and external rationales (they did not want to waste GPs’ time for trivial reasons and they believed they did not have timely access to their GP). Conclusions. Given the reasons why some older women do not seek help for falling, GPs should routinely ask older women for their 12-month fall history