Trip Answers

Question answered:20/06/08

This is a very broad based question to answer with no specific population defined. Thus, we will provide general information on the treatment of vitamin D deficiency. We found no UK guidelines advocating screening the general population for vitamin D deficiency. Concerning the treatment of Vitamin D deficiency, a patient information leaflet provides information on treatment strategies for adults, and in pregnant and breast feeding women and in breast fed infants. [1]

 

Further information on treating vitamin D deficiency is given in the online encyclopaedia, GPNotebook:

 

• in adults with confirmed primary vitamin D deficiency
o need a minimum daily dose of oral vitamin D of 20µg (800 IU)
? with this dose, it takes at least a year for bone to normalise
? in some cases higher doses of vitamin D, to a maximum of 55µg (2,200 IU) daily, may be needed to achieve adequate repletion with vitamin D, especially in older patients, and in 'at risk' ethnic minorities (e.g. south Asian, African Caribbean and Middle Eastern) and to achieve optimal health benefits for bone and soft tissue
? once vitamin D deficiency or insufficiency has been corrected, patients will generally need lifelong preventative vitamin D supplementation

 

Notes:
• all patients receiving pharmacological doses of vitamin D should have the plasma-calcium concentration checked at intervals (initially weekly) and whenever nausea or vomiting are present
o serum calcium concentrations should be checked regularly for a few weeks after starting treatment for vitamin D deficiency; then vitamin D, parathyroid hormone (PTH) and calcium concentrations should be checked after 3-4 months of treatment to assess efficacy and adherence to therapy

 

? after this check at 3-4 months then vitamin D and calcium concentrations should be checked every 6-12 months
• Breast milk from women taking pharmacological doses of vitamin D may cause hypercalcaemia if given to an infant
• vitamin D supplementation is contraindicated in patients with hypercalcaemia or metastatic calcification
o relative contraindications include primary hyperparathyroidism, renal stones and severe hypercalciuria
o patients with mild to moderate renal failure or known to have mild hypercalciuria should be supervised carefully when taking vitamin D In patients with a history of renal stones, urinary calcium excretion should be measured to exclude hypercalciuria, a problem which requires specialist referral.” [2]

Of interest also will be a number of questions, the NLH Primary Care Q & A Service has answered on the topic of vitamin D deficiency and supplementation:

 

http://www.tripanswers.org/Answer.aspx?QuestionId=949
In a breastfeeding woman with low vitamin D levels what dose should be given as supplementation? January 2008

 

http://www.tripanswers.org/Answer.aspx?QuestionId=7309
What is the most effective treatment for vitamin D deficiency? January 2008

 

http://www.tripanswers.org/Answer.aspx?QuestionId=3610
In Vitamin D deficiency, at what level of Vitamin D should treatment be started? When should the levels be checked again? Should Vitamin D supplements be taken indefinitely? August 2006

 

http://www.tripanswers.org/Answer.aspx?QuestionId=5832
Should all dark skinned children be started on Vitamin D supplementation indefinitely? August 2007

 

http://www.tripanswers.org/Answer.aspx?QuestionId=4972
What is current evidence for calcium and Vitamin D supplementation in elderly who are housebound/institutionalised.What does NICE on this issue? February 2007.

 

References
1. Patient.co.uk. Vitamin D deficiency. February 2008. (http://www.patient.co.uk/pdf/pilsL821.pdf)
2. GPNotebook. Vitamin D deficiency: treatment. (http://www.gpnotebook.co.uk/simplepage.cfm?ID=1872363567&linkID=35618&cook=yes)

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