What is the treatment for a vitamin D deficiency with a level of 11.7 nanograms per milliliter (ng/mL)?

Treatment of Vitamin D Deficiency with Level of 11.7 ng/mL

For a vitamin D level of 11.7 ng/mL, which indicates severe deficiency, the recommended treatment is prescription-strength vitamin D (ergocalciferol) 50,000 IU once weekly for 8-12 weeks, followed by maintenance therapy of 1000-2000 IU daily. 1, 2

Understanding the Deficiency Status

• A 25-hydroxyvitamin D level of 11.7 ng/mL falls well below the threshold of 20 ng/mL that defines vitamin D deficiency, and is approaching the severe deficiency range of <10-12 ng/mL 3, 1
• Severe vitamin D deficiency significantly increases the risk for osteomalacia, nutritional rickets, and other adverse health outcomes 3, 4
• Common symptoms of vitamin D deficiency include symmetric low back pain, proximal muscle weakness, muscle aches, and bone pain 2

Initial Treatment Approach

Loading Dose Phase

• For vitamin D deficiency (<20 ng/mL), especially at 11.7 ng/mL, a loading dose approach is recommended 1, 2:
  • Oral ergocalciferol (vitamin D2) 50,000 IU once weekly for 8-12 weeks 1, 2
  • The longer 12-week regimen is preferred for levels below 12 ng/mL 1

Maintenance Phase

• After completing the loading dose regimen, transition to maintenance therapy 1, 2:
  • Daily supplementation with 800-2000 IU of vitamin D3 (cholecalciferol) 1, 2
  • Monthly maintenance with 50,000 IU may be an alternative for convenience 1

Monitoring Response to Treatment

• Recheck 25-hydroxyvitamin D levels 3-6 months after initiating treatment to ensure adequate response 1, 5
• The goal of treatment is to achieve 25(OH)D levels of at least 30 ng/mL 1, 6
• Once target levels are achieved, annual reassessment of vitamin D status is sufficient 5

Important Considerations

• Ensure adequate calcium intake alongside vitamin D supplementation, with a recommended daily intake of 1000-1500 mg 1, 5
• Vitamin D3 (cholecalciferol) may be more effective than vitamin D2 (ergocalciferol) for maintaining 25(OH)D levels when using longer dosing intervals for maintenance therapy 1
• Individual response to vitamin D supplementation varies due to genetic factors, so follow-up testing is essential 3, 7
• Standard multivitamin preparations often contain insufficient vitamin D (typically only 400 IU) for treatment of deficiency 5, 8

Special Circumstances

• Patients with malabsorption, obesity, or those not responding to oral supplementation may require higher doses 1, 5
• For patients with severe malabsorption, parenteral vitamin D may be necessary (typically as IM injection of 50,000 IU) 3, 1
• Weight-bearing exercise (30 minutes at least 3 days per week) complements vitamin D supplementation for bone health 5

Expected Outcomes

• Generally, 1,000 IU daily of vitamin D will produce an increase of approximately 10 ng/mL in serum levels 7
• Anti-fall efficacy begins with achieved 25(OH)D levels of at least 24 ng/mL 1
• Anti-fracture efficacy begins with achieved 25(OH)D levels of at least 30 ng/mL 1, 6