Inappropriate vitamin D supplementation among multimorbid older patients: a multicountry analysis.

Drahomir Aujesky, Martin Feller, Nicolas Rodondi, Carole E Aubert, Elisavet Moutzouri, Shanthi Beglinger, Anne Eichenberger, Olivia Dalleur, Wilma Knol, Marielle Emmelot-Vonk, Denis O'Mahony, Benoit Boland, Patricia O Chocano-Bedoya, Anne Spinewine

Journal: BMC geriatrics 2025;25(1):541

PMID: 40684074

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Abstract

BACKGROUND

The prevalence of vitamin D supplementation and the percentage of participants with a lack of appropriate vitamin D supplementation ("potential underuse") or potentially inappropriate vitamin D supplementation ("potential overuse") and risk factors for these are currently unclear.

METHODS

Cross-sectional analysis from the OPERAM study, a multicenter cluster randomized controlled trial in four European countries (Belgium, Ireland, The Netherlands, Switzerland) including multimorbid (≥ 3 chronic conditions) older patients, with polypharmacy (≥ 5 chronic medications). For the definition of potential underuse and overuse we used high-risk conditions, which were defined according to the START criteria (version 2) for potential prescribing omissions in older people i.e., E2) long-term systemic corticosteroid therapy, known osteoporosis or osteopenia, E3) previous fragility fractures, and E5) housebound/in nursing homes or experiencing falls. We used mixed effect logistic regression to identify factors associated with underuse and overuse.

RESULTS

2008 patients (79.4y, SD 6.3, 45% female) were included. 825/2008 (41.1%) were supplemented with vitamin D. We identified 681 participants with potential underuse (33.9% of all participants, 69.7% of non-vitamin D users) and 204 with potential overuse (10.2% of all participants, 24.7% of vitamin D users). In the multivariable logistic regression analysis increasing age and being male were associated with underuse, while the number of baseline medications and previous hospitalizations were associated with both underuse and overuse. Specifically, underuse decreased with an increasing number of medications (OR: 0.93, 95% CI: 0.90-0.95), while overuse increased (OR: 1.08, 95% CI: 1.04-1.12). Previous hospitalizations were linked to underuse (OR: 1.08, 95% CI: 1.00-1.17) and inversely associated with overuse (OR: 0.88, 95% CI: 0.77-0.99).

CONCLUSIONS

One-third of multimorbid older adults experienced potential underuse, while up to 10% potential overuse of vitamin D supplementation. Polypharmacy, previous hospitalizations, increasing age and being male are factors associated with inappropriate use of vitamin D. A better targeted vitamin D supplementation is warranted.

TRIAL REGISTRATION

NCT02986425, Registration date 2016-10-21.

Address: Institute of Primary Health Care (BIHAM), University of Bern, Bern, Switzerland. [email protected].; Department of General Internal Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland. [email protected].; Institute of Primary Health Care (BIHAM), University of Bern, Bern, Switzerland.; Institute of Hospital Pharmacy, Bern University Hospital, University of Bern, Bern, Switzerland.; Louvain Drug Research Institute, Clinical Pharmacy and Pharmacoepidemiology research group, Université catholique de Louvain, Brussels, Belgium.; Pharmacy, Cliniques Universitaires Saint-Luc, Brussels, Belgium.; University Medical Center Utrecht, Utrecht University, Utrecht, Netherlands.; Department of Medicine, University College Cork & Department of Geriatric & Stroke Medicine, Cork University Hospital, Wilton, Cork, Ireland.; Geriatric, Medicine Division, Cliniques Universitaires Saint-Luc, Brussels, Belgium.; Institute of Health and Society, Université Catholique de Louvain, Belgium, Louvain-la-Neuve.; Institute of Primary Health Care (BIHAM), University of Bern, Bern, Switzerland.; Department of General Internal Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.; Department of General Internal Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.; Louvain Drug Research Institute, Clinical Pharmacy and Pharmacoepidemiology research group, Université catholique de Louvain, Brussels, Belgium.; CHU UCL Namur, Pharmacy department, Yvoir, Belgium.

DOI: 10.1186/s12877-025-06189-w

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MeSH Terms: Humans, Male, Female, Aged, Cross-Sectional Studies, Vitamin D, Aged, 80 and over, Dietary Supplements, Multimorbidity, Risk Factors, Europe, Polypharmacy, Inappropriate Prescribing, Belgium