What is the recommended treatment for geriatric patients with vitamin D deficiency?

From the Guidelines

Geriatric patients with vitamin D deficiency should be treated with vitamin D supplementation at a dose of 800 IU per day, as recommended by the American Geriatric Society and supported by the Institute of Medicine's guidelines. This recommendation is based on the evidence from the U.S. Preventive Services Task Force recommendation statement published in the Annals of Internal Medicine in 2012 1. The study suggests that vitamin D supplementation can be beneficial in preventing falls in community-dwelling older adults, and the recommended daily allowance for vitamin D is 600 IU for adults aged 51 to 70 years and 800 IU for adults older than 70 years.

Key points to consider when treating geriatric patients with vitamin D deficiency include:

• The median dose of vitamin D supplementation in trials was 800 IU daily, with a median duration of 12 months 1
• The American Geriatric Society recommends 800 IU per day of vitamin D supplementation for older adults 1
• The Institute of Medicine recommends a daily allowance of 600 IU for adults aged 51 to 70 years and 800 IU for adults older than 70 years 1
• Treatment should aim to achieve serum 25(OH)D levels of at least 30 ng/mL, with follow-up testing recommended after 3-4 months of therapy

It is also important to consider the potential benefits of exercise and physical therapy interventions, including group classes and at-home physiotherapy strategies, as well as balance training 3 or more days per week for older adults at risk for falling 1. However, the primary recommendation for treating vitamin D deficiency in geriatric patients is vitamin D supplementation at a dose of 800 IU per day.

From the FDA Drug Label

Caution Adequate dietary calcium is necessary for response to vitamin D therapy. The FDA drug label does not answer the question.

From the Research

Treatment Recommendations

• The recommended treatment for geriatric patients with vitamin D deficiency is supplementation with 800-1000 IU of vitamin D per day 2, 3, 4, 5.
• A bolus dose of over 24,000 IU/month should be avoided due to the increased risk of falls and fractures 2.
• Oral cholecalciferol is preferred over ergocalciferol for routine supplementation 3.
• For patients with depression or cognitive disorders, screening for vitamin D deficiency and treatment with oral cholecalciferol if present is recommended, with monitoring to target a level of >30 ng/mL 3.

Special Considerations

• Homebound older people who will not get adequate vitamin D from sunlight exposure may require supplementation 4.
• A single oral dose of 100,000 IU of vitamin D (ergocalciferol or cholecalciferol) every 3 to 6 months may be an alternative to daily dosing 4.
• In nursing home settings, systematic supplementation of vitamin D (1,000 IU/day) without the need for a preliminary evaluation of baseline levels may be a practical approach 5.
• Calcium should be prescribed only in case of poor dietary calcium intake 5.

Rationale

• Vitamin D deficiency is widespread in geriatric patients and increases the risk of bone loss, fractures, and falls 2, 6.
• Supplementation with vitamin D has been shown to reduce the risk of falls and fractures in older adults 2, 3.
• Vitamin D deficiency has also been linked to sarcopenia, myalgia, and other musculoskeletal consequences 6.