Serum alanine aminotransferase elevations correlate with serum creatine phosphokinase levels in myositis.

in all cases as a combined calcium and vitamin D formulation (Table 1). Subjects recruited from primary care were more likely to receive a coprescription for vitamin D, even though subjects recruited from secondary care were older, had more comorbidity, and had higher rates of vitamin D deficiency and insufficiency. A small number of subjects were taking self-prescribed multivitamin or cod liver oil supplements. These subjects were included in the sample and their results did not differ from those for the overall sample. Subjects recruited in secondary care were more likely to have had their initial prescription for bisphosphonate medication from a hospital specialist rather than their general practitioner. In 40% of cases bisphosphonates were being given for the prevention or treatment of steroid-related osteoporosis. Steroid use was more frequent in the secondary care sample. There was no correlation between age and vitamin D levels; four patients from the primary care sample, aged under 50 yr, had vitamin D deficiency and one had insufficiency. Females had non-significantly lower levels of vitamin D. These results demonstrate that there are low levels of coprescription of vitamin D with bisphosphonates among both hospital and non-hospital attendees, and high rates of vitamin D deficiency in those that are not supplemented. On the basis of these results we advocate the widespread coprescription of vitamin D supplements when bisphosphonate drugs are used for the prevention or treatment of osteoporosis. During the study all subjects recruited in secondary care, who were not taking a vitamin D supplement prior to the study, were started on a combined calcium and vitamin D supplement once their blood sample was taken, as it is our policy to coprescribe calcium and vitamin D supplements with bisphosphonate medication. The results of the study have been fed back to participating general practices but we do not know what proportion of the subjects recruited in primary care have subsequently been started on supplements. Although calcium intake was not addressed in this study, many of these patients also require calcium supplementation, so a combined supplement is probably the easiest way of achieving this. The authors have declared no conflicts of interest.