From the Guidelines
Vitamin D supplementation is recommended for individuals with deficiency or those at risk, with a typical therapeutic dose of 50,000 IU once a week for 8 weeks, followed by a maintenance dose of 1500-2000 IU daily, as per the Endocrine Society clinical practice guidelines 1.
Guidelines for Vitamin D Supplementation
The guidelines for vitamin D supplementation vary based on age, population, and deficiency status.
- For vitamin D deficient adults, a dose of 50,000 IU of vitamin D once a week for 8 weeks is recommended, followed by maintenance therapy of 1500-2000 IU daily 1.
- The Endocrine Society clinical practice guidelines provide current recommendations for vitamin D supplementation across age ranges and subpopulations 1.
- Blood levels <50 nmol/L in winter months or <75 nmol/L in summer months should be considered for supplementation 1.
Important Considerations
- Vitamin D3 (cholecalciferol) is preferred over D2 (ergocalciferol) as it is more effective at raising blood levels 1.
- Taking supplements with meals containing some fat improves absorption.
- Regular blood testing (25-hydroxyvitamin D levels) helps monitor status and adjust dosing.
- Excessive supplementation should be avoided as it can lead to toxicity, with symptoms including nausea, vomiting, weakness, and kidney problems.
Population-Specific Recommendations
- Children, pregnant or breastfeeding women, and the elderly may have different supplementation needs, but the provided evidence does not specify these recommendations.
- Individuals with limited sun exposure may require higher doses of vitamin D supplementation. It is essential to consult the Endocrine Society clinical practice guidelines for the most up-to-date recommendations on vitamin D supplementation 1.
From the Research
Guidelines for Vitamin D Supplementation
The guidelines for vitamin D supplementation vary depending on the population and the individual's risk factors.
- The recommended daily dose of vitamin D for adults is between 600-800 IU per day, with a maximum safe dose of 4,000 IU per day 2.
- For adults who want to ensure a sufficient vitamin D status, a dose of 800 to 2000 IU per day is recommended 3.
- In certain populations, such as those with osteoporosis or after bariatric surgery, it is important to know the levels of circulating 25-hydroxyvitamin D, and a "reasonable" level of 30 ng/mL is recommended 2.
- For patients with documented vitamin D deficiency, a cumulative dose of at least 600,000 IU administered over several weeks appears to be necessary to replenish vitamin D stores 4.
- Single large doses of 300,000-500,000 IU should be avoided, and vitamin D supplementation should not be offered routinely to other patient populations 4.
Special Considerations
- For infants and children, the American Academy of Pediatrics recommends at least 400 IU per day from diet and supplements to prevent vitamin D deficiency 5.
- For adults over 65 years old, a daily dose of 800-1,000 IU per day is recommended, especially during periods of inadequate sun exposure 6.
- For patients with malabsorption syndromes, treatment success may be evaluated after at least 6 to 12 weeks by measurement of serum 25(OH)D, with the aim to target concentrations of 30 to 50 ng/mL (75 to 125 nmol/L) 3.
Testing and Monitoring
- A 25-hydroxyvitamin D level should be obtained in patients with suspected vitamin D deficiency, and deficiency is defined as a serum 25-hydroxyvitamin D level of less than 20 ng per mL (50 nmol per L) 5.
- The adequacy of vitamin D stores is determined by measuring the 25-hydroxyvitamin D serum concentrations, and the demarcations between deficiency, insufficiency, and optimal serum concentrations are controversial 4.