What is the recommended dose of vitamin D (VitD) for a female patient with a vitamin D level of 19 nanograms per milliliter (ng/ml), indicating vitamin D deficiency?

From the Guidelines

For a female patient with a vitamin D level of 19 ng/ml, the recommended dose of vitamin D is 50,000 IU of vitamin D2 or D3 once weekly for 8 weeks, followed by maintenance therapy of 1,000-2,000 IU daily, as suggested by the NCCN task force report 1. The goal of this treatment is to bring the serum 25(OH) D levels to 30 ng/ml or higher, which is considered adequate for bone health.

• The patient's current vitamin D level of 19 ng/ml indicates a deficiency, and the high initial dose is necessary to restore normal levels.
• After completing the initial 8-week loading dose, the patient should have her vitamin D levels rechecked to ensure they have risen to the sufficient range (above 30 ng/ml).
• For long-term maintenance, taking vitamin D with a meal containing some fat improves absorption, and patients should be counseled that sun exposure alone is often insufficient to correct deficiency, particularly in northern latitudes or in individuals with darker skin tones.
• Vitamin D toxicity is uncommon but may occur with daily doses of more than 50,000 IU per day that produce 25(OH) D levels larger than 150 ng/mL, as noted in the NCCN task force report 1. The recommended dose is based on the NCCN task force report, which suggests that vitamin D3 could be more effective in raising 25(OH) D concentrations and maintaining those levels for a longer time when longer dosing intervals are employed 1.

From the Research

Vitamin D Deficiency Treatment

The patient's vitamin D level is 19 ng/ml, indicating a deficiency. According to 2, treatment may include oral ergocalciferol (vitamin D2) at 50,000 IU per week for eight weeks.

• The goal of treatment is to normalize vitamin D levels to relieve symptoms and decrease the risk of fractures, falls, and other adverse health outcomes.
• After vitamin D levels normalize, maintenance dosages of cholecalciferol (vitamin D3) at 800 to 1,000 IU per day from dietary and supplemental sources are recommended.

Recommended Dose

The recommended dose of vitamin D for a female patient with a vitamin D level of 19 ng/ml is:

• 50,000 IU per week for eight weeks to treat the deficiency, as suggested by 2.
• A maintenance dose of 800 to 1,000 IU per day, as recommended by 2 and 3.
• However, 4 suggests that about 5000 IU vitamin D3/day is usually needed to correct deficiency, and the maintenance dose should be ≥2000 IU/day.
• 5 indicates that a maintenance dose of 2,000 IU of vitamin D3 may not be enough to keep the 25(OH)D levels above 30 ng/mL.
• 6 recommends considering daily doses of 7000 IU or intermittent doses of 30,000 IU/week for a prolonged time as prophylactic or maintenance doses, mainly in obese patients, patients with liver disease, and patients with malabsorption syndromes.

Factors Affecting Vitamin D Replacement

The following factors affect the change in serum concentrations of 25-hydroxyvitamin D:

• Starting serum concentration of 25-hydroxyvitamin D
• Body mass index (BMI)
• Age
• Serum albumin concentration, as reported by 4.