Vitamin D Deficiency Amongst Our New Arrivals in Ballarat

Karen Werner, Refugee Health Nurse BCHC November 08

With increasing numbers of refugees settling into Ballarat, there needs to be increased awareness and vigilance regarding Vitamin D deficiency.

Those most at risk of Vit D deficiency include dark skinned people, people who for cultural reasons wear covering clothing, clients who spend large amounts of time indoors, and being a breastfed infant of a Vit D deficient mother (to name some of the most common reasons).

According to the Royal Children's Hospital, up to 90% of the recently arrived African population will have low Vit D. The normal level is 50-160nmol/L. Deficiency is defined as levels<25 nmol/L, insufficiency as levels 25-50 nmol/L. ¹

Complications of Vit D deficiency are well documented and include rickets, osseus and non osseus effects in children, oesteomalacia in children and adults and oesteopenia and oesteoporosis in adults.

The most recent clinical information is indicating that any dark skinned individual, residing in southern Australia, will have difficulty maintaining satisfactory Vit D levels without supplementation. Although levels may be satisfactory on arrival, they will soon fall and should be checked at least 1 year after arrival.

Other literature is suggesting they should be rechecked after the clients first winter in Australia. Anecdotally, what I am seeing among the refugee clients in Ballarat, is that their levels do drop considerably after 12 months here.

I have also found people who have been living in Australia for some 10-20 years, of Asian descent, (Indian, Malaysian) have also been found to be severely low in Vit D. Levels of 22nmol/L and 32nmol/L, being tested for the first time recently after complaining of aching bones.

Could I encourage any GPs caring for any client with any of the above indications to consider testing them and their family for Vit D levels.

Current treatment involves over the counter supplements for adults. For children a great resource for treatment and management is on the RCH website. Dr Georgie Paxton is a great resource at this clinic and has indicated she is only too happy to be consulted if you have any queries. The paediatric treatment involves high dosage cholecalciferol.

Currently I am working on establishing a Vit D clinic in Ballarat so that we can support yourselves and clients with Vit D issues. The clinic would be run assuming GP management of the clients, but could be a one stop shop for dosage, phlebotomy and information on increasing dietary calcium intake following Vit D therapy.

This would involve the prescribing of high dosage cholecalciferol for adults. This however is off label prescribing, so I am in the throws of collating all information and documents to facilitate the possibility of local GPs becoming approved prescibers for this medication.

So what am I saying! I encourage all GPs caring for clients of dark skin or those who wear covering clothing to be vigilant for Vit D deficiency, and be on the lookout for new information regarding the establishment of a Vit D clinic to enhance your management of Vit D deficient clients.

In the meantime, for information re dosage check the RCH website or Pauline Molloy from UFS may be able to help you, ph 5330 2644.

Footnotes

¹ http://www.rch.org.au/immigranthealth/resources.cfm?doc_id=12349

This article is available online at http://bddgp.org.au/article/2008/11/vitamin-d-deficiency

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