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Scenario

Deidre O’Brien comes into the pharmacy to buy some paracetamol tablets. Technician Vicky notices that she is looking very tired and asks if she is okay.

“I’m fine thanks, just a bit worn out,” replies Deidre. “Mum had a nasty fall a couple of months ago and broke her hip. I’ve been running back and forth to the hospital, and although she is recovering well, her confidence is shot and she’s decided that she needs to go into a home. I know she is 75 now, but still…”

“Oh, that sounds tough for you,” says Vicky. “Have you found somewhere nice?”

“Yes, White Beams up the road from here has a space, so she is moving in there at the end of the week. I feel terribly guilty, but she wants someone around pretty much all the time, which Connor and I simply can’t do, what with working full-time and looking after the kids. The home and all the staff seem lovely though, so that’s reassuring, and we will pop in to see her and take her out at weekends. But I was thinking that she isn’t going to be out and about as much as she used to be, so does she need some vitamin D tablets?”

Answer

Deidre is correct in thinking that her mum is at risk of vitamin D deficiency. People aged over 65 years and those who are housebound or confined indoors for long periods of time are two of the ‘at risk of vitamin D deficiency’ groups listed by the National Institute for Health and Care Excellence (NICE) in its guidance on the topic. 

It would be sensible for Deidre to check whether her mum is already taking a supplement as she may well have been prescribed one as part of her assessment and treatment after her fall. The recommended daily dose for Deidre’s mum would be 10mcg, and it would be prescribed as ergocalciferol, calciferol or colecalciferol, or as part of a combined preparation, so she may not necessarily have noticed it in her patient notes.

The bigger picture

Vitamin D helps to regulate the amount of calcium and phosphate in the body, which is essential for healthy bones. Unlike other nutrients, there are few dietary sources of vitamin D, and the main way in which it is obtained is from sunlight. Ultraviolet B rays from the sun convert a form of cholesterol into vitamin D3, which is carried to the liver and then the kidneys, where it is transformed into a form of vitamin D that the body can use. But for around half of the year in the UK, there isn’t the right wavelength of sunlight for the skin to start the process of synthesising vitamin D, and as it can only be stored by the body for one to two months, many people become deficient. National surveys suggest that around a fifth of adults and anything from eight to 24 per cent of children may fall into this category.

A deficiency of vitamin D can be asymptomatic or very vague in nature, producing only tiredness and general aches and pains, for example. But a significant shortage of the nutrient in adults can lead to osteomalacia, a serious condition in which the bones become soft and painful, and muscles become weak as a result.

Extend your learning

• There are other population groups that NICE states are at risk of vitamin D deficiency – NICE guidance

• The answer to the question posed in this scenario includes the name by which vitamin D is prescribed. Can you think of any other vitamins that are not prescribed by their widely used names? Have a look in the British National Formulary under ‘vitamins’ or on the side of a multivitamin supplement.

• This scenario mentions that there are only a few dietary sources of vitamin D. Find out what they are at NHS Choices.

• Look at the vitamin D supplements stocked in your pharmacy, including those that are available on prescription and via schemes such as Healthy Start. Do you have products that you could recommend to someone who is vegan? What about a customer who is on a halal or kosher diet? Or allergic to nuts?

• Is it possible to get too much vitamin D? Find out via the Vitamin D Council.