What is the appropriate treatment for a 30-year-old female with a history of eating disorder and vitamin D deficiency (hypovitaminosis D) with a level of 18 ng/mL?

Treatment for Vitamin D Deficiency in a 30-Year-Old Female with History of Eating Disorder

For a 30-year-old female with a history of eating disorder and vitamin D level of 18 ng/mL, the appropriate treatment is 50,000 IU of vitamin D (preferably cholecalciferol/D3) weekly for 8 weeks, followed by a maintenance dose of 2,000 IU daily. 1

Initial Treatment Regimen

For vitamin D deficiency (level <20 ng/mL) in this patient population:

• First-line therapy:

  • Cholecalciferol (Vitamin D3) 50,000 IU weekly for 8 weeks 1, 2
  • Take with food to enhance absorption 3
  • Cholecalciferol (D3) is preferred over ergocalciferol (D2) due to higher bioefficacy 1

• Alternative regimens (if weekly dosing is not feasible):

  • 8,000 IU daily for 4 weeks, then 4,000 IU daily for 2 months 1
  • For patients with malabsorption: Consider 30,000 IU twice weekly for 6-8 weeks 4

Special Considerations for Patients with Eating Disorders

Patients with eating disorders have a high prevalence of vitamin D deficiency and insufficiency 5. This patient population requires special attention due to:

• Risk of compromised bone health
• Potential malabsorption issues
• Need for adequate calcium intake alongside vitamin D supplementation

Calcium Supplementation

• Ensure adequate calcium intake of 1,000 mg daily for a 30-year-old female 1
• Sources include:
  • Dietary calcium (dairy products, fortified foods)
  • Calcium supplements if dietary intake is insufficient
  • Adequate calcium is necessary for response to vitamin D therapy 6

Monitoring and Maintenance

• Recheck 25(OH)D levels 3 months after initiating treatment 1
• After normalization of vitamin D levels (≥30 ng/mL):
  • Transition to maintenance therapy of 2,000 IU vitamin D3 daily 1
  • Alternative maintenance: 50,000 IU monthly 1
• Annual monitoring of vitamin D levels is recommended, preferably at the end of winter months 1

Target Levels and Safety

• Target 25(OH)D level: ≥30 ng/mL (75 nmol/L) 1
• Optimal range for patients with recurrent deficiency: 40-60 ng/mL 1
• Monitor for signs of vitamin D toxicity (rare but possible):
  • Hypercalcemia
  • Hypercalciuria
  • Renal dysfunction
  • Toxicity is unlikely with recommended dosing regimens 7

Additional Recommendations

• Encourage weight-bearing exercise as appropriate
• Address underlying eating disorder with appropriate psychiatric/psychological support
• Consider bone density testing if clinically indicated
• Emphasize the importance of treatment adherence for bone health and overall wellbeing

This treatment approach balances the need for rapid correction of vitamin D deficiency while considering the patient's history of eating disorder and potential for malabsorption issues.