VITAMIN D DEFICIENCY IN SUNNY CALIFORNIA | Arthritis Information

AB0715 VITAMIN D DEFICIENCY IN SUNNY SOUTHERN CALIFORNIA: A CATCH 22.

S. K. Metyas*¹, J. Ibrahim¹, D. Arkfeld²
¹Rheumatology, University of Southern California - Keck School of Medicine, Covina, ²Rheumatology, University of Southern California - Keck School of Medicine, Los Angeles, United States

Background: Hypovitaminosis D is associated with impaired neuromuscular function, bone loss, and fracture. While severe Vitamin D deficiency leads to osteomalacia and rickets, mild to moderate deficiency can result in osteoporosis and increase fracture risk. In the elderly, hypovitaminosis D is also associated with increased impaired neuromuscular function and increased falls. Common causes of vitamin D deficiency include a diet low in vitamin D and reduced exposure to sunlight. Very few foods, such as fish oils, fatty fish, and eggs, naturally contain significant amounts of vitamin D, and in the United States few foods are fortified with vitamin D, mostly milk and cereals. Residing in a sunny environment is supposedly helpful in preventing Vitamin D deficiency. Yet, in assessing patients with osteoporosis as well as other rheumatic disorders, we were surprised at the high numbers of such deficient patients. Sun avoidance to prevent skin cancers and skin aging has been widely promoted, which may be a factor in lowering vitamin D levels. Thus we decided to study vitamin D (25 hydroxyvitamin D) levels in patients with rheumatological disorders looking for patterns that may be significant.

Methods: Vitamin D levels were obtained from 695 rheumatology patients (median age 57.19 years, 622 female and 73 male) in the San Gabriel Valley area of Southern California, a sunny environment. Total percentage of patients with low vitamin D was 45.03 % and a level of 30 ng/ml was considered the cutoff for abnormal. (Table 1)

Results: T and Chi-square tests were performed on numerous lab values and clinical diagnosis to identify statistically significant associations present. One variable, “total cholesterol”, approached statistical significance: patients with low vitamin D, had lower mean total cholesterol than those with normal D levels (192.2 vs. 203.15, p= 0.09). There was a statistically significant association between age and required vitamin D supplementation. Patients that were 65 or older had a lower risk of requiring vitamin D supplementation (OR=0.688, 95% CI = 0.498 - 0.952, p=0.0238). Interestingly, 47.98% of patients less than 65 years of age had vitamin D levels requiring supplementation compared to 38.84% of Patients 65 years or older.
Table:

(Table 1): 25 hydroxyvitamin D levels
Vitamin D Level (ng/ml)	Number of Patients	Percent of Total

Less than 10 ( Severe Deficiency )	24	3.45%
10 to less than 20 ( Moderate Deficiency )	108	15.54 %
20 to less than 30 ( Mild Deficiency )	181	26.04 %
30 or more	382	54.96 %
TOTAL	695	100%