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Background:A previous study reported that 70% of 4,793 Japanese rheumatoid arthritis (RA) patients had 25(OH) vitamin D (25(OH) D) deficiency[1]). We have also reported that 82% of 122 RA patients in our rheumatic center had 25(OH) D deficiency[2]). In a report on the effectiveness of 25(OH) D-containing Japanese cakes in 28 volunteers, the rate of 25(OH) D deficiency decreased from 93% to 36%[3]). However, there have been no reports on the effectiveness of nutritional guidance for improving 25(OH) D deficiency. During the study, Japan experienced serious supply shortages of both alfacalcidol and eldecalcitol. In Japan, unlike Western countries, cholecalciferol cannot be prescribed alone. Instead, only calcium carbonate, cholecalciferol, and magnesium carbonate (Ca/VD) are allowed to be prescribed when denosumab is used.Objectives:To analyze 25(OH) D deficiency and shortage and investigate the effectiveness of nutritional guidance in patients with rheumatic diseases.Methods:We measured 25(OH) D levels in 688 patients (male, n=161; female, n=527; mean age, 65.6±4.9 years) and provided nutritional guidance to patients with a deficiency (less than 20 ng/ml) or shortage (greater than 20 ng/ml, less than 30 ng/ml) of 25(OH) D. The doctors in charge of the outpatient ward provided most of the nutritional guidance. A small number of patients received nutritional guidance from nutritionists. The recommended foods included milk, eggs, fish (especially salmon), and mushrooms (especially dried shiitake mushrooms). It was also suggested that patients consume milk or yogurt containing 25(OH) D. We initiated denosumab and Ca/VD therapy in patients with osteoporosis (according to Japanese guidelines) diagnosed based on bone mineral density (BMD) measured by dual-energy X-ray absorptiometry (DXA). Patients with osteoporosis who had already been treated with drugs with other modes of action were switched to denosumab or Ca/VD.Results:Among the 688 patients, there were 515 patients with RA, 37 patients with systemic sclerosis,34 patients with polymyalgia rheumatica, and others (n=102). 25(OH) D deficiency was observed in 475 patients (69. 0%) and shortage was observed in 171 patients (24.9%). Only 42 patients (6.1 %) had a normal level of 25(OH) D. The mean age of patients with deficiency (63.9±15.4 years) was younger than that of patients with a shortage (68.5±13.6 years; p<0.001) and normal patients (72.5±9.4 years; p=0.002). Patients with a 25(OH) D shortage were younger than normal patients (p=0.0015). In 413 patients with deficiency, who received only nutritional guidance (patients who started Ca/VD were excluded), the mean 25 (OH) D level significantly increased from 13.2±4.2 to 18.3±6.7 (p<0.001) after one year; 140 patients (20.3%) had a shortage, while the levels of 18 patients (26.1%) normalized. Based on the results of DXA, 53 of 688 patients (7.7 %) started denosumab and Ca/VD. Thirty-nine patients (5.6%) did not use glucocorticoids and BMD was not measured. Thirty-one patients were identified with 25 (OH) D deficiency and 10 with a shortage.Conclusion:Many patients with rheumatic diseases suffer from a deficiency or shortage of 25(OH) D. The measurement of BMD is a good screening tool for osteoporosis in these patients especially those who are not using glucocorticoids when the doctors in charge are not concerned about osteoporosis. Patients were able to increase their 25(OH) D levels without medication with nutritional guidance. The effectiveness of denosumab and Ca/VD should be clarified in follow-up studies.REFERENCES:[1]  Furuya T, Hosoi T, Tanaka E, et al. Prevalence of and factors associated with vitamin D deficiency in 4,793 Japanese patients with rheumatoid arthritis. Clin Rheumatol 32::1081-7, 2013.[2] Ito S, Sato H, Narita I, et al. An analysis of the level of serum 25(OH) vitamin D in patients with rheumatoid arthritis. J New Rem & Clin 69: 1176-1187, 2020 (in Japanese).[3] Fujii M, Miyakoshi N, Owan I, et al. A new idea for improving serum vitamin D by taking natural vitamin D (Cholecalciferol) -supplemented bun with sweet paste. Jpn J orthopedic Surgery 7: 59-67, 2021 (in Japanese with English abstract).Acknowledgements:NIL.Disclosure of Interests:None declared.