Correspondence Address:
Nallasivan Subramanian
Velammal Medical College Hospital, Madurai, Tamil Nadu
India

Full Text

Dear Editor,

I read with great interest the case-based review by Saba Fathima and others, titled “Supplementing Vitamin D: Dangers of too much of a good thing,” in our journal.[1] There are few clarifications needed for the common readers, which I would like to highlight.

The case referred to was an 85-year-old female with features of hypercalcemia and previous osteoporotic fractures. According to the authors, following the treatment for osteoporosis, she developed hypercalcemia due to excess of Vitamin D. The authors have commented that malignancy screen was normal, but details of those tests were not mentioned, and it would be important to mention those results and whether ectopic parathyroid hormone assay was done? Vascular and lymph node calcification in the Indian population at age 85 is not uncommon, and it may not necessarily be due to hypercalcemia.

I am yet to see a normal Vitamin D level especially 25-hydroxyvitamin D3 even among affluent population in India and hence assuming that Vitamin D may be sufficient at the time of diagnosis of osteoporotic fracture may lead to erroneous judgment. It would be useful to clarify how the Vitamin D level was assayed, as 25-hydroxy Vitamin D3 is most useful to measure in the serum.[2],[3]

I agree that indiscriminate use of Vitamin D without baseline levels and definite indication should not happen but scaremongering is not needed as I suspect in India, Vitamin D deficiency is much more prevalent than what we think, compared to the western population.

Patients' level of understanding and efficient drug delivery systems has to improve as time and again we encounter polypharmacy and inadvertent use of mixture of drugs and older patients struggle to read or comprehend or remember.

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