Clinical Management of Low Vitamin D: A Scoping Review of Physicians' Practices

Nutrients. 2018 Apr 16;10(4):493. doi: 10.3390/nu10040493.


The role of vitamin D in the prevention and treatment of non-skeletal health issues has received significant media and research attention in recent years. Costs associated with clinical management of low vitamin D (LVD) have increased exponentially. However, no clear evidence supports vitamin D screening to improve health outcomes. Authoritative bodies and professional societies do not recommend population-wide vitamin D screening in community-dwelling adults who are asymptomatic or at low risk of LVD. To assess patterns of physicians’ management of LVD in this conflicting environment, we conducted a scoping review of three electronic databases and the gray literature. Thirty-eight records met inclusion criteria and were summarized in an evidence table. Thirteen studies published between 2006 and 2015 across seven countries showed a consistent increase in vitamin D lab tests and related costs. Many vitamin D testing patterns reflected screening rather than targeted testing for individuals at high risk of vitamin D deficiency or insufficiency. Interventions aimed at managing inappropriate clinical practices related to LVD were effective in the short term. Variability and controversy were pervasive in many aspects of vitamin D management, shining a light on physicians’ practices in the face of uncertainty. Future research is needed to inform better clinical guidelines and to assess implementation practices that encourage evidence-based management of LVD in adult populations.

Keywords: 25-OH-D; 25-hydroxyvitamin-D; low value care; low vitamin D; physician practices; screening; test overutilization; vitamin D.

Publication types

  • Review

MeSH terms

  • Humans
  • Practice Patterns, Physicians'*
  • Vitamin D / administration & dosage*
  • Vitamin D / blood*
  • Vitamin D Deficiency / drug therapy*


  • Vitamin D