What type and dose of Vitamin D (Vit D) supplementation is recommended for a 30-year-old patient with vitamin D deficiency, characterized by a serum level of 15.5 nanograms per milliliter (ng/mL)?

From the Guidelines

For a 30-year-old patient with a vitamin D level of 15.5 ng/mL, I recommend vitamin D3 (cholecalciferol) supplementation at a dose of 50,000 IU once weekly for 8 weeks, followed by a maintenance dose of 1,000-2,000 IU daily. This recommendation is based on the most recent and highest quality evidence available, which suggests that vitamin D3 is more effective in raising serum 25(OH)D levels and maintaining them for a longer period compared to vitamin D2 1.

Key Considerations

• The initial high dosing is necessary to rapidly correct the deficiency, while the maintenance dose prevents recurrence 1.
• Vitamin D3 is preferred over vitamin D2 because it raises serum levels more effectively and has a longer half-life in the body 1.
• The target range for serum 25(OH)D levels is 30-50 ng/mL, and patients should have their levels rechecked after completing the 8-week loading dose regimen 1.
• Vitamin D is essential for calcium absorption, bone health, immune function, and may have other health benefits including mood regulation 1.

Administration and Monitoring

• The supplement should be taken with food containing some fat to enhance absorption 1.
• Common side effects are rare but may include nausea or stomach discomfort 1.
• Patients should be aware that extremely high doses over prolonged periods could lead to vitamin D toxicity, though this is uncommon with the recommended regimen 1.
• The need for the addition of calcium to vitamin D is dependent on the patient’s diet, and strict vegetarians may prefer supplementation with vitamin D2 (plant origin) instead of D3 (animal origin) 1.

From the FDA Drug Label

PRECAUTIONS General Vitamin D administration from fortified foods, dietary supplements, self-administered and prescription drug sources should be evaluated. Therapeutic dosage should be readjusted as soon as there is clinical improvement. Dosage levels must be individualized and great care exercised to prevent serious toxic effects When high therapeutic doses are used progress should be followed with frequent blood calcium determinations.

The FDA drug label does not provide a specific type and dose of Vitamin D supplementation recommended for a 30-year-old patient with vitamin D deficiency, characterized by a serum level of 15.5 ng/mL.

• Individualized dosage is recommended, and
• great care should be exercised to prevent serious toxic effects. 2

From the Research

Vitamin D Supplementation Recommendations

The patient's serum level of 15.5 ng/mL indicates a vitamin D deficiency, as defined by a serum 25-hydroxyvitamin D level of less than 20 ng/mL 3. To treat this deficiency, several studies provide recommendations for vitamin D supplementation.

Treatment Options

• Oral ergocalciferol (vitamin D2) at 50,000 IU per week for eight weeks may be used to treat vitamin D deficiency 3.
• 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 3.
• The National Osteoporosis Society recommends oral vitamin D3 with fixed loading doses followed by regular maintenance therapy for rapid correction of vitamin D deficiency 4.

Dosage Guidelines

• A daily dose of at least 700-800 IU of vitamin D is recommended to raise serum concentrations of 25(OH)D to the desirable range of at least 75 nmol/l 5.
• Daily supplementation with 2000 IU/day (50 mcg/day) of vitamin D3 can help achieve serum concentrations > 30 ng/mL (75 nmol/L) and reduce disease and mortality risks 6.
• A daily dose between 4000 and 6000 IU of vitamin D3 may provide greater protection against many adverse health outcomes 6.

Key Considerations

• Serum 25(OH)D levels should be measured to estimate vitamin D status, and treatment should aim to normalize vitamin D levels 3, 4.
• The goal of treatment is to relieve symptoms and decrease the risk of fractures, falls, and other adverse health outcomes 3.
• Vitamin D supplementation holds significant public health potential due to its low cost, excellent tolerability, and combined musculo-skeletal benefits 5.