From the Guidelines
The treatment for low vitamin D (hypovitaminosis D) involves vitamin D supplementation, typically with vitamin D3 (cholecalciferol) or vitamin D2 (ergocalciferol), with dosing dependent on the severity of deficiency. According to the most recent and highest quality study 1, oral vitamin D is most often used to treat vitamin D deficiency, with commonly available forms including vitamin D3 and vitamin D2. For mild deficiency, a daily supplement of 600-800 IU may be sufficient, as recommended by the Institute of Medicine for adults aged 18 to 70 years 1. For moderate to severe deficiency, higher doses such as 50,000 IU weekly for 8-12 weeks, followed by maintenance therapy of 1000-2000 IU daily, may be needed, as suggested by previous studies 1.
Key Considerations
- Supplements should be taken with food containing some fat to enhance absorption
- Increasing sun exposure and consuming vitamin D-rich foods like fatty fish, egg yolks, and fortified dairy products can complement supplementation
- Blood levels should be rechecked after 3-6 months of treatment to ensure normalization
- People with malabsorption disorders, kidney or liver disease may require specialized dosing under medical supervision
Treatment Approaches
- Vitamin D3 (cholecalciferol) is often preferred due to its efficacy and availability
- Vitamin D2 (ergocalciferol) may be used for severe cases or in specific populations
- UVB exposure may also increase vitamin D levels, but its use is limited due to the risk of skin cancer
Special Populations
- Adults older than 70 years may require higher daily dietary vitamin D intake of 800 IU to meet their needs 1
- African Americans and Hispanics may have higher risks for vitamin D deficiency due to factors such as body composition and calcium economy 1
From the FDA Drug Label
Therapeutic dosage should be readjusted as soon as there is clinical improvement. Adequate dietary calcium is necessary for clinical response to vitamin D therapy. The treatment for low vitamin D (hypovitaminosis D) levels involves therapeutic dosages of vitamin D that should be individualized and readjusted as soon as there is clinical improvement. It is essential to have adequate dietary calcium for a clinical response to vitamin D therapy 2.
- Key considerations:
- Dietary calcium is necessary for the treatment to be effective.
- Therapeutic dosage should be adjusted based on clinical improvement.
- Individualization of the dosage is crucial to prevent serious toxic effects.
- Monitoring of blood calcium determinations is necessary when high therapeutic doses are used.
- Additional treatment options may include calcifediol (PO), which is indicated for the treatment of secondary hyperparathyroidism in adults with stage 3 or 4 chronic kidney disease and serum total 25-hydroxyvitamin D levels less than 30 ng/mL 3.
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 following are some key points to consider:
- 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 4.
- Treatment may include oral ergocalciferol (vitamin D2) at 50,000 IU per week for eight weeks, followed by maintenance dosages of cholecalciferol (vitamin D3) at 800 to 1,000 IU per day from dietary and supplemental sources 4.
- Regular dosing with oral cholecalciferol (e.g., 60,000 IU weekly) may have slight advantages over other regimens when replenishing vitamin D stores following deficiency 5.
- For long-term supplementation, smaller regular doses, such as cholecalciferol 1,000 IU daily, or 10,000 IU weekly, are suitable 5.
Comparison of Vitamin D2 and Vitamin D3
Research has compared the efficacy of vitamin D2 (ergocalciferol) and vitamin D3 (cholecalciferol) for improving vitamin D status:
- Cholecalciferol is more potent than ergocalciferol, with a 3.2-fold higher potency in raising serum 25OHD levels 6.
- Calcifediol (25OHD3) may be a more effective option for oral supplementation, with a more rapid increase in serum 25OHD levels and higher potency compared to cholecalciferol 6.
- A systematic review and meta-analysis found that cholecalciferol was more efficacious than ergocalciferol in improving total 25(OH)D levels and reducing PTH levels 7.
Safety and Dosage
The safety and dosage of vitamin D supplementation are important considerations:
- The maximum daily dose of vitamin D currently recommended is 2000 IU, but higher doses may be used to treat vitamin D deficiency 8.
- A case report found no toxicity with megadose daily ergocalciferol (D2) therapy, with a patient receiving 150,000 IU orally daily for 28 years without adverse effects 8.