What is the treatment for low vitamin D (hypovitaminosis D) levels?

From the Guidelines

The treatment for low vitamin D (hypovitaminosis D) involves vitamin D supplementation, typically with vitamin D3 (cholecalciferol), with a recommended daily dose of 600-800 IU for adults, as suggested by the Institute of Medicine 1.

Treatment Options

• Oral vitamin D is most often used to treat vitamin D deficiency, with commonly available forms including vitamin D3 (cholecalciferol) and vitamin D2 (ergocalciferol) 1.
• For severe deficiency, higher doses may be prescribed, such as 50,000 IU weekly for 8-12 weeks, followed by maintenance therapy of 1,000-2,000 IU daily 1.

Lifestyle Modifications

• Increased sun exposure (15-30 minutes several times weekly) can help increase vitamin D levels, but it is not generally recommended due to the risk of skin cancer associated with UVB radiation 1.
• Consuming vitamin D-rich foods like fatty fish, egg yolks, and fortified dairy products can also help support bone health.

Monitoring and Supplementation

• Regular monitoring of vitamin D levels is important, typically 3-6 months after beginning treatment.
• Calcium supplementation (1,000-1,200 mg daily) is often recommended alongside vitamin D to support bone health.

Important Considerations

• The sensitivity and specificity of vitamin D assays are unknown due to the lack of studies using an internationally recognized reference standard, which may complicate interpretation of test results 1.
• Vitamin D levels may decrease in response to inflammation, and common laboratory reference ranges may not be appropriate for all ethnic groups 1.

From the FDA Drug Label

The source of vitamin D in the body is from synthesis in the skin as vitamin D3 and from dietary intake as either vitamin D2 or D3. Decreased levels of 1,25(OH)2D3 have been observed in early stages of chronic kidney disease The decreased levels of 1,25(OH)2D3 and resultant elevated PTH levels, both of which often precede abnormalities in serum calcium and phosphorus, affect bone turnover rate and may result in renal osteodystrophy.

The treatment for low vitamin D (hypovitaminosis D) levels is not directly stated in the provided drug labels. However, vitamin D supplements such as paricalcitol, calcifediol, and ergocalciferol are used to treat conditions related to vitamin D deficiency.

• Paricalcitol is a synthetic, biologically active vitamin D2 analog of calcitriol, which decreases serum intact parathyroid hormone (iPTH) and increases serum calcium and serum phosphorous in both HD and PD patients 2.
• Calcifediol is a metabolite of vitamin D, and prescription-based doses of vitamin D and its derivatives should be withheld or used with caution during treatment to avoid the risk of hypercalcemia 3.
• Ergocalciferol requires adequate dietary calcium for response to vitamin D therapy 4. It is essential to consult a healthcare professional for proper diagnosis and treatment of low vitamin D levels.

From the Research

Treatment for Low Vitamin D Levels

The treatment for low vitamin D levels, also known as hypovitaminosis D, typically involves supplementation with vitamin D to normalize levels and alleviate symptoms. The goal of treatment is to relieve symptoms such as symmetric low back pain, proximal muscle weakness, muscle aches, and throbbing bone pain, as well as decrease the risk of fractures, falls, and other adverse health outcomes 5.

Supplementation Options

There are several supplementation options available, including:

• Oral ergocalciferol (vitamin D2) at 50,000 IU per week for eight weeks to treat deficiency 5
• Cholecalciferol (vitamin D3) at 800 to 1,000 IU per day from dietary and supplemental sources for maintenance 5
• Regular dosing with oral cholecalciferol, such as 60,000 IU weekly, may have slight advantages over other regimens when replenishing vitamin D stores following deficiency 6
• Calcifediol (25OHD3) may be considered for oral supplementation, as it results in a more rapid increase in serum 25OHD compared to oral cholecalciferol and is more potent, requiring lower dosages 7

Dosage and Frequency

The dosage and frequency of supplementation may vary depending on the individual's needs and the severity of the deficiency. Some studies suggest that:

• Daily doses of 1,000 IU or weekly doses of 10,000 IU may be suitable for long-term supplementation 6
• Higher doses, such as 50,000 IU per week, may be necessary to treat deficiency 5
• The efficacy of cholecalciferol and ergocalciferol may vary depending on the dosage and frequency of supplementation, with cholecalciferol appearing to be more efficacious at higher doses 8

Important Considerations

It is essential to note that:

• Vitamin D toxicity is rare, even with high doses of supplementation 9
• The choice of supplementation regimen should be based on individual needs and medical guidance
• Regular monitoring of vitamin D levels is necessary to ensure that supplementation is effective and to adjust the regimen as needed 5, 6, 7, 8