What is the treatment for hypovitaminosis D in males?

Treatment for Vitamin D Deficiency in Males

The recommended treatment for hypovitaminosis D in males is vitamin D supplementation with a loading dose of 50,000 IU weekly for 8-12 weeks for deficiency (<20 ng/mL), followed by maintenance therapy of 800-2,000 IU daily to achieve and maintain a target 25(OH)D level of at least 30 ng/mL. 1

Diagnosis and Classification

• Vitamin D deficiency is defined as serum 25-hydroxyvitamin D [25(OH)D] levels below 20 ng/mL, while insufficiency is defined as levels between 20-30 ng/mL 1, 2
• Severe vitamin D deficiency is defined as levels below 10-12 ng/mL, which significantly increases risk for osteomalacia 1
• Common symptoms of vitamin D deficiency include symmetric low back pain, proximal muscle weakness, muscle aches, and bone pain 2

Treatment Protocol Based on Deficiency Severity

For Vitamin D Deficiency (<20 ng/mL):

• Initial loading dose: 50,000 IU of vitamin D2 (ergocalciferol) or D3 (cholecalciferol) once weekly for 8-12 weeks 1, 2
• For severe deficiency (<10 ng/mL), especially with symptoms or high fracture risk, extend the loading dose period to 12 weeks 1

For Vitamin D Insufficiency (20-30 ng/mL):

• Add 1,000 IU vitamin D daily to current intake and recheck levels in 3 months 1
• Alternatively, 50,000 IU weekly for 8 weeks can be used 1

Maintenance Therapy:

• After achieving target levels, transition to maintenance therapy with 800-2,000 IU daily or 50,000 IU monthly 1, 2
• For men over 70 years old, a minimum of 800 IU daily is recommended 1, 3
• For men aged 19-70 years, at least 600 IU daily is recommended 1

Special Populations and Considerations

• For elderly men (≥65 years), higher doses of 700-1,000 IU daily are recommended to reduce fall and fracture risk 1, 3
• Dark-skinned or men with limited sun exposure should receive at least 800 IU/day 1
• Obese men are at higher risk for vitamin D deficiency and may require higher doses due to sequestration of vitamin D in adipose tissue 4, 5
• Men with malabsorption syndromes or those who have undergone bariatric surgery may require intramuscular (IM) vitamin D administration 1
• Men with chronic kidney disease (CKD) require special attention as kidney disease is a major risk factor for deficiency 1

Calcium Supplementation

• Ensure adequate calcium intake alongside vitamin D supplementation 1, 3
• Men should receive 1,000-1,500 mg of elemental calcium daily 4, 3
• Calcium supplements should be taken in divided doses of no more than 600 mg at a time 1

Monitoring Response to Treatment

• Recheck vitamin D levels after 3-6 months of treatment to ensure adequate dosing and response 1
• If using an intermittent regimen (weekly, monthly), measurement should be performed just prior to the next scheduled dose 1
• Target 25(OH)D level should be at least 30 ng/mL for optimal health benefits 1, 6

Expected Benefits and Outcomes

• Anti-fall efficacy starts with achieved 25(OH)D levels of at least 24 ng/mL 1
• Anti-fracture efficacy starts with achieved 25(OH)D levels of at least 30 ng/mL 1, 3
• Vitamin D supplementation can help reverse secondary hyperparathyroidism 3
• Adequate vitamin D levels may also benefit cardiovascular health, immune function, and reduce mortality risk 7

Safety Considerations

• Daily doses up to 4,000 IU are generally considered safe for adults 1
• Vitamin D toxicity is rare but can occur with prolonged high doses (typically >10,000 IU daily) 1
• Symptoms of toxicity include hypercalcemia, hyperphosphatemia, suppressed parathyroid hormone, and hypercalciuria 4, 1
• The expert panel agreed on an upper safety limit for 25(OH)D of 100 ng/mL 1

Common Pitfalls and Caveats

• Vitamin D deficiency is particularly common in men during winter and spring, especially in northern latitudes 5
• Despite supplement use, low vitamin D levels remain frequent in older men, suggesting that commonly used supplement doses may be inadequate 5
• Seasonal variation in vitamin D levels should be considered when interpreting results and planning treatment 1
• Individual response to vitamin D supplementation is variable due to genetic differences in vitamin D metabolism 1