Vitamin D Supplementation for Severe Deficiency (9 ng/ml)
You should start vitamin D supplementation immediately with 50,000 IU weekly for 4-8 weeks, followed by maintenance therapy, as your level of 9 ng/ml indicates severe vitamin D deficiency requiring aggressive repletion. 1
Understanding Your Vitamin D Status
Your 25-hydroxyvitamin D level of 9 ng/ml falls into the severe deficiency category:
- <20 ng/ml: Deficient (according to most guidelines)
- 5-15 ng/ml: Severe deficiency requiring intensive repletion
- <5 ng/ml: Very severe deficiency requiring individualized treatment
Recommended Treatment Protocol
Initial Repletion Phase
- For your level (9 ng/ml): 50,000 IU of vitamin D weekly for 4-8 weeks 1
- Alternatively, you could take 8,000 IU daily for 4 weeks 1
- Cholecalciferol (vitamin D3) is preferred over ergocalciferol (vitamin D2) due to higher bioefficacy 1
Maintenance Phase (After Initial Repletion)
- After completing the initial repletion phase, transition to 2,000 IU daily or 50,000 IU every 4 weeks 1
- Target 25(OH)D level should be 30-80 ng/ml 1
Monitoring Recommendations
- Check 25(OH)D levels at least 3 months after starting supplementation 1
- Once target level is achieved, monitor yearly 1
- Consider checking calcium levels at 1 month after initiation to ensure safety 1
Additional Considerations
Calcium Intake
- Ensure adequate calcium intake (1000-1500 mg daily) alongside vitamin D supplementation for optimal bone health 1
Safety Profile
- Vitamin D toxicity is rare and typically occurs only with much higher doses (>10,000 IU daily for extended periods) 1
- Long-term supplementation with vitamin D3 in doses ranging from 5,000 to 50,000 IUs/day has been shown to be safe in clinical settings 2
Benefits of Correction
- Correcting severe vitamin D deficiency (<30 nmol/L or 12 ng/ml) can reduce risk of excess mortality, infections, and many other diseases 3
- Achieving adequate vitamin D levels (>30 ng/ml) has been associated with a 20% reduction in non-vertebral fractures and 18% reduction in hip fractures 1
Common Pitfalls to Avoid
- Underdosing: Using less than 800 IU/day is ineffective for correcting vitamin D deficiency 1
- Inadequate monitoring: Failing to recheck levels after initial repletion
- Insufficient duration: Not continuing long enough to reach target levels
- Overlooking calcium: Not ensuring adequate calcium intake alongside vitamin D supplementation
Recent evidence suggests that daily doses of 2,000 IU (50 μg) of vitamin D3 may be sufficient to raise and maintain serum 25(OH)D concentrations above 50 nmol/L (20 ng/ml) in >99% of the general adult population 4. However, given your severe deficiency (9 ng/ml), the more aggressive initial repletion protocol is warranted before transitioning to this maintenance dose.