How prevalent is vitamin D deficiency in the Hispanic population? Should we routinely check vitamin D levels in Hispanic patients as we do in others? — Beth Pretti, NP, Indianapolis

In a 2009 national survey of adolescent health, vitamin D levels were consistent with the level of skin pigmentation (Pediatrics. 2009;123:797-803). Since cutaneous formation of vitamin D (specifically from UVB light) is one of the most significant sources, it makes sense that, regardless of age, the amount of melanin in the skin, functioning as sun block, will have the greatest impact on vitamin D levels.

Applying this logic to the Hispanic population, it would be difficult to make a blanket recommendation on screening given the wide variation in skin color among this group. Rather than focusing on patient ethnicity, it makes more sense to screen based on skin color. — Rebecca H. Bryan, APRN, CNP (160-1)

These are letters from practitioners around the country who want to share their clinical problems and successes, observations and pearls with their colleagues. We invite you to participate. If you have something you would like to share, send us an email.