Back to Journals » Drug, Healthcare and Patient Safety » Volume 11

Adherence to risk management guidelines for drugs which cause vitamin D deficiency – big data from the Swedish health system

Authors Nordqvist O, Lönnbom Svensson U, Brudin L, Wanby P, Carlsson M

Received 20 September 2018

Accepted for publication 8 January 2019

Published 22 March 2019 Volume 2019:11 Pages 19—28


Checked for plagiarism Yes

Review by Single anonymous peer review

Peer reviewer comments 3

Editor who approved publication: Professor Siew Siang Chua

Ola Nordqvist,1,2 Ulrika Lönnbom Svensson,3 Lars Brudin,4,5 Pär Wanby,2,6 Martin Carlsson2,7

1The Pharmaceutical Department, Region Kalmar County, Kalmar, Sweden; 2eHealth Institute, Data Intensive Sciences and Applications (DISA), Department of Medicine and Optometry, Linnaeus University, Kalmar, Sweden; 3Department of Chemistry and Biomedical Sciences, Linnaeus University, Kalmar, Sweden; 4Department of Clinical Physiology, County Hospital of Kalmar, Kalmar, Sweden; 5Department of Medical and Health Sciences, University of Linkoping, Linköping, Sweden; 6Section of Endocrinology, Department of Internal Medicine, County Hospital of Kalmar, Kalmar, Sweden; 7Department of Clinical Chemistry, County Hospital of Kalmar, Kalmar, Sweden

Several medications are known to cause vitamin D deficiency. The aim of this study is to describe vitamin D testing and supplementation in patients using these “risk medications”, thereby assessing adherence to medical guidelines.
Patients and methods: A database with electronic health records for the population in a Swedish County (≈240,000 inhabitants) was screened for patients prescribed the pre-defined “risk medications” during a 2-year period (2014–2015). In total, 12,194 patients were prescribed “risk medications” pertaining to one of the three included pharmaceutical groups. Vitamin D testing and concomitant vitamin D supplementation, including differences between the included pharmaceutical groups, was explored by matching personal identification numbers.
Results: Corticosteroids were prescribed to 10,003 of the patients, antiepileptic drugs to 1,101, and drugs mainly reducing vitamin D uptake to 864. Two hundred twenty-six patients were prescribed >1 “risk medication”. Seven hundred eighty-seven patients (6.5%) had been tested during the 2-year period. There were no differences regarding testing frequency between groups. Concomitant supplements were prescribed to 3,911 patients (32.1%). It was more common to be prescribed supplements when treated with corticosteroids. Vitamin D supplementation was more common among tested patients in all three groups. Women were tested and supplemented to a higher extent. The mean vitamin D level was 69 nmol/L. Vitamin D deficiency was found in 24.1% of tested patients, while 41.3% had optimal levels. It was less common to be deficient and more common to have optimal levels among patients prescribed corticosteroids.
Conclusion: Adherence to medical guidelines comprising testing and supplementation of patients prescribed drugs causing vitamin D deficiency needs improvement in Sweden.

Keywords: drug-induced vitamin D deficiency, medication risk management, big data, electronic health records, vitamin D, precision medicine

Creative Commons License This work is published and licensed by Dove Medical Press Limited. The full terms of this license are available at and incorporate the Creative Commons Attribution - Non Commercial (unported, v3.0) License. By accessing the work you hereby accept the Terms. Non-commercial uses of the work are permitted without any further permission from Dove Medical Press Limited, provided the work is properly attributed. For permission for commercial use of this work, please see paragraphs 4.2 and 5 of our Terms.

Download Article [PDF]  View Full Text [HTML][Machine readable]