From the Guidelines
For geriatric patients, I recommend vitamin D supplementation of 800 IU daily as a standard dose, as suggested by the Institute of Medicine and the American Geriatric Society 1. This dose is supported by the US Preventive Services Task Force, which recommends vitamin D supplementation to prevent falls in community-dwelling adults aged 65 years or older who are at increased risk for falls because of a history of recent falls or vitamin D deficiency 1. Key considerations for vitamin D supplementation in geriatric patients include:
- Using vitamin D3 (cholecalciferol) due to its better absorption and longer half-life compared to vitamin D2 (ergocalciferol)
- Taking supplements with meals containing some fat to enhance absorption
- Regular monitoring with blood level checks every 3-6 months initially, then annually once stable levels are achieved
- Targeting blood levels of 30-50 ng/mL (75-125 nmol/L) The importance of vitamin D supplementation in geriatric patients lies in its role in supporting bone health, reducing fracture risk, potentially improving muscle strength and balance, and having benefits for immune function and mood 1. Given the decreased absorption with age and limited sun exposure in many older adults, supplementation is particularly crucial in this population. It is essential to note that higher doses may be necessary for patients with documented deficiency, but the standard dose of 800 IU daily is recommended for most geriatric patients 1.
From the Research
Recommended Dosing for Vitamin D Supplements in Geriatric Patients
- The recommended dosing for vitamin D supplements in geriatric patients is 800-1000 IU per day, as stated in studies 2, 3, 4.
- This dosage has been shown to effectively reduce the risk of falls and fractures in institutionalized patients and individuals over 65 years of age living at home 2.
- A daily intake of at least 800-1000 IU supplemental vitamin D(3) per day is recommended to correct hypovitaminosis D and positively impact bone and non-bone morbidities 4.
- Higher doses, such as 7000 IU daily or 30,000 IU per week, may be considered for patients with increased risk of vitamin D deficiency, such as those with obesity, liver disease, or malabsorption syndromes 5.
- However, intermittent long-term high doses vitamin D supplementation (such as 60,000 IU/month or more) may increase the risk of falls, fracture, and premature death in certain populations, and daily doses are generally recommended 6.
Special Considerations
- Measuring the 25(OH)D concentration prior to supplementation is recommended to determine the appropriate dosage and to avoid excessive supplementation 6.
- An initial loading dose may be necessary for patients who need a quick repletion of vitamin D stores, followed by a maintenance dose 6.
- Daily supplementation is preferred, but intermittent dosing with the smallest available dose (≤ 50,000 IU) and the shortest interval between doses may be used as a stopgap until daily forms are available 6.