Endo Vitd No Testing Over75

---
name: endo-vitd-no-testing-over75
description: Recommends against routine 25(OH)D testing in adults aged 75 years and older. Triggered by questions such as "Should I order a vitamin D level for this patient over 75?" or "Is vitamin D testing indicated for asymptomatic elderly adults?"
---

# Against routine vitamin D testing in adults over 75

## STEP 1 — Gather Information
Collect patient age, presence of symptoms or conditions that constitute established indications for 25(OH)D testing (e.g., hypocalcemia, osteoporosis, history of falls/fractures, malabsorption, chronic kidney disease, or current vitamin D supplementation therapy requiring monitoring).

## STEP 2 — Rule In / Rule Out
If patient is <75 years old OR has any established indication for vitamin D testing → consider testing per other guidelines (rule out). If patient is ≥75 years old AND has no established indications for testing → proceed (rule in).

## STEP 3 — Classify or Stratify
Classify as "No routine testing indicated" for all patients meeting rule‑in criteria; further stratification by risk factors (obesity, dark complexion, institutionalization) does not change the recommendation against routine screening.

## STEP 4 — Decide
Do not order a routine 25(OH)D test; if vitamin D supplementation is desired per guideline recommendation 6, prescribe empiric low‑dose supplementation (e.g., 800–1000 IU daily) without prior testing.

## Clinical Guardrails / Mimics / Pitfalls
Do not test solely based on age; do not delay empiric supplementation awaiting test results; do not interpret low 25(OH)D as deficiency in asymptomatic older adults without clinical correlates; avoid testing in patients with hypocalcemia, malabsorption, osteoporosis, or recent fractures—these are indications for testing, not screening.

## Concrete Clinical Example
An 80‑year‑old woman with well‑controlled hypertension asks whether she should have a vitamin D level drawn. She reports no bone pain, falls, fractures, malabsorption, or hypocalcemia, and is not currently taking vitamin D. According to the guideline, routine testing is not recommended; instead, empiric vitamin D supplementation of 800–1000 IU daily may be considered if not already supplementing.

**Source:** Vitamin D for the Prevention of Disease: An Endocrine Society Clinical Practice Guideline, Endocrine Society, 2024, DOI: 10.1210/clinem/dgae290