What is the treatment for Vitamin D deficiency?

From the Guidelines

Vitamin D treatment should involve supplementation with vitamin D3 (cholecalciferol) to correct deficiency or maintain adequate levels, with a common regimen being 50,000 IU of vitamin D3 once weekly for 8-12 weeks, followed by a maintenance dose of 1,000-2,000 IU daily, as recommended by the US Preventive Services Task Force 1.

Key Considerations

• The treatment regimen may vary depending on the individual's age, skin pigmentation, and other factors that affect vitamin D production and absorption.
• Vitamin D supplements should be taken with food containing some fat to enhance absorption.
• Blood levels should be rechecked after the initial treatment period to ensure the deficiency has been corrected.
• Excessive vitamin D can cause hypercalcemia, so doses should not exceed recommended amounts without medical supervision.

Treatment Options

• Oral vitamin D is most often used to treat vitamin D deficiency, with commonly available forms including vitamin D3 (cholecalciferol) and vitamin D2 (ergocalciferol) 1.
• Increasing dietary vitamin D intake or UVB exposure are alternative approaches to prevention, but may not be sufficient for individuals with severe deficiency or limited sun exposure.

Important Notes

• The Institute of Medicine recommends daily dietary vitamin D intake of 600 IU in adults aged 18 to 70 years and 800 IU in adults older than 70 years to meet the needs of 97.5% of the adult population 1.
• The US Preventive Services Task Force has published recommendations on the use of vitamin D supplementation for the prevention of falls and fractures, and vitamin supplementation for the prevention of cardiovascular disease or cancer 1.
• Further research is needed to determine the optimal treatment regimens for specific vitamin D-deficient populations and to address the lack of an accurate screening strategy to identify vitamin D deficiency 1.

From the FDA Drug Label

Caution Adequate dietary calcium is necessary for response to vitamin D therapy. Health Claims DIETARY SUPPLEMENT Vitamin D3 50,000 IU is essential for absorption of calcium and necessary for healthy bones and a healthy immune system. The treatment for vitamin D deficiency involves supplementation with vitamin D, and it is essential to have adequate dietary calcium for the therapy to be effective. Key points to consider for vitamin D treatment are:

• Adequate calcium intake is necessary for response to vitamin D therapy 2
• Vitamin D is essential for calcium absorption and necessary for healthy bones and a healthy immune system 3

From the Research

Vitamin D Treatment

• The goal of treatment is to normalize vitamin D levels to relieve symptoms and decrease the risk of fractures, falls, and other adverse health outcomes 4.
• Treatment may include oral ergocalciferol (vitamin D2) at 50,000 IU per week for eight weeks, and maintenance dosages of cholecalciferol (vitamin D3) at 800 to 1,000 IU per day from dietary and supplemental sources 4.
• Vitamin D supplementation of at least 700 to 800 IU per day reduces fracture and fall rates in adults 4.
• The American Academy of Pediatrics recommends that infants and children receive at least 400 IU per day from diet and supplements to prevent vitamin D deficiency 4.

Diagnosis and Screening

• Vitamin D status is determined by measuring the 25-hydroxyvitamin D serum concentration 5, 6, 7.
• Only individuals at risk for vitamin D deficiency should be screened, as the symptoms of vitamin D deficiency are unspecific and very common 5.
• Determining the accurate thresholds for vitamin D deficiency is still a matter of debate, with some experts considering 800 IU/d and serum 25OHD above 50 nmol/l (20 ng/ml) as sufficient 6.

Supplementation and Dosage

• Vitamin D supplementation should not be offered routinely to other patient populations, except for those with documented vitamin D deficiency 7.
• A cumulative dose of at least 600,000 IU administered over several weeks appears to be necessary to replenish vitamin D stores in patients with documented vitamin D deficiency 7.
• Single large doses of 300,000-500,000 IU should be avoided, and the decision to take vitamin D in doses of 2000 IU/day or lower is unlikely to cause harm in young, otherwise healthy adults 7.
• Cholecalciferol (vitamin D3) and ergocalciferol (vitamin D2) are two forms of vitamin D supplementation, with cholecalciferol being naturally found in very few food sources and produced endogenously from ultraviolet light from the sun 8.