What should I do with a vitamin D level of 23 nmol?

Treatment for Vitamin D Level of 23 nmol/L

You should begin immediate vitamin D supplementation with 50,000 IU weekly for 8-12 weeks as your vitamin D level of 23 nmol/L indicates severe deficiency requiring prompt treatment. 1, 2

Understanding Your Vitamin D Status

• Your vitamin D level of 23 nmol/L is classified as severe deficiency (<30 nmol/L), which significantly increases your risk for osteomalacia, nutritional rickets, and other health complications 2
• Severe vitamin D deficiency can manifest as symmetric low back pain, proximal muscle weakness, muscle aches, and throbbing bone pain 3
• The goal of treatment is to normalize your vitamin D levels to at least 75 nmol/L (30 ng/mL) to reduce risk of fractures, falls, and other adverse health outcomes 1, 4

Treatment Protocol

Initial Loading Phase

• Begin with oral ergocalciferol (vitamin D2) or cholecalciferol (vitamin D3) at 50,000 IU once weekly for 8-12 weeks 1, 3
• Cholecalciferol (vitamin D3) is preferred as it has higher bioefficacy than ergocalciferol (vitamin D2) 1, 5
• This loading dose approach is designed to rapidly correct your severe deficiency 2

Maintenance Phase

• After the loading phase, transition to a maintenance dose of 1,000-2,000 IU vitamin D3 daily 1, 6
• For optimal long-term maintenance, a daily dose of 2,000 IU (50 μg) is recommended as it can maintain serum levels above 75 nmol/L in >90% of adults 6
• Ensure adequate calcium intake alongside vitamin D supplementation, with a recommended daily intake of 1,000-1,500 mg 1

Monitoring and Follow-up

• Recheck your vitamin D level after 3-6 months of treatment to ensure adequate response 1, 2
• The goal is to achieve a serum 25(OH)D level above 75 nmol/L (30 ng/mL) for optimal health benefits 1, 4
• Individual response to vitamin D supplementation varies due to genetic differences in vitamin D metabolism 1

Important Considerations

• Avoid single very large doses (>300,000 IU) as they may be inefficient or potentially harmful 1, 2
• Daily doses up to 4,000 IU are generally considered safe for adults, with the safe upper intake level being 10,000 IU/day 1, 5
• If you have malabsorption issues or don't respond to oral supplementation, parenteral vitamin D may be necessary (typically as IM injection of 50,000 IU) 1
• Vitamin D supplementation benefits are primarily seen in those with documented deficiency, which clearly applies in your case 1

Expected Benefits

• Normalization of vitamin D levels can relieve musculoskeletal symptoms and decrease risk of fractures and falls 3, 7
• Adequate vitamin D status may also provide benefits for immune function, cardiovascular health, and prevention of certain chronic diseases 4, 7
• Anti-fall efficacy begins with achieved 25(OH)D levels of at least 60 nmol/L (24 ng/mL) and anti-fracture efficacy begins with achieved levels of at least 75 nmol/L (30 ng/mL) 1