Vitamin D deficiency medical therapy
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Sadaf Sharfaei M.D.[2]
Overview
The mainstay of therapy for vitamin D deficiency is vitamin D, either vitamin D2 (ergocalciferol) or vitamin D3 (cholecalciferol). Vitamin D supplements could be used as a daily loading regimen followed by the maintenance. The alternative regimen is high weekly dose (stoss therapy) and maintenance therapy.
Medical therapy
There are two major forms of vitamin D; ergocalciferol (vitamin D2), cholecalciferol (vitamin D3). Both of them are commonly used. However, a systematic review and meta-analysis of Tripkovic L et al. in 2011, indicated that vitamin D3 compared to vitamin D2 is more effective to raise the serum level of 25OHD and is preferred for treatment and prevention of vitamin D deficiency.[1]
- Endocrine Society published a clinical practice guideline for the treatment of vitamin D deficiency to reach and sustain a serum 25(OH)D level of 30 ng/ml.[2]
| Age | Loading dose | Alternative dose | Maintenance dose |
|---|---|---|---|
| 0-1 y | 2000 IU/d orally for 6 weeks | 50,000 IU/w orally for 6 weeks | 400-1000 IU/d |
| 1-18 y | 2000 IU/d orally for 6 weeks | 50,000 IU/w orally for 6 weeks | 600-1000 IU/d |
| Adults | 50,000 IU/w orally for 8 weeks | 6000 IU/d orally for 6 weeks | 1500–2000 IU/d |
| Nursing home residents | 50,000 IU/three times per week for 1 month | 100,000 IU of vitamin D every 4 months | |
| High risk patients* | 6000-10,000 IU/d | 3000–6000 IU/d |
- High risk patients include African American, obese, patients with malabsorption syndromes and who are on anticonvulsants.
- The American Academy of Pediatrics (AAP) recommends an initial phase of treatment with high dose of vitamin D for 2-3 months to treat vitamin D deficiency rickets. The recommended dose is 1000 IU/d in neonates, 1000-5000 IU/d in infants, and 5000 IU/d for children over 1-year-old. After raising the serum 25 OHD levels to 30 ng/ml, a maintenance dose of 400 IU/d is required for all age groups. Higher maintenance dose (800 IU/d) might be needed in at risk groups.[3][4]
- An alternative strategy for treatment, also known as stoss therapy, is a single dose therapy in patients over 1 month old. 100,000 – 600,000 IU of ergocalciferol orally single dose followed by maintenance therapy is recommended, especially in noncompliant patients.[5]
A more recent randomized controlled trial showed that, among white women with vitamin D insufficiency and deficiency (levels 13 to 50 nmol/L;5 to 20 ng/mL ), a dose of 600 to 800 IU per day of vitamin D3 will raise the level above Institute of Medicine recommendations (20 ng/mL or 50 nmol/L) in 97% of women.[6]
Regarding choice of preparation, D3 (cholecalciferol) may be more effective than D2 (ergocalciferol).[7]
Obese patients need more vitamin D to raise their level.[8]
Does higher than at least 800 IU daily may be best for the prevention of fractures.[9]
One option is a combination pill. Either the size below once per day, or a half size twice per day.
- Elemental calcium 1200 mg, daily
- Vitamin D3 800 international units (20 micrograms), daily
Special circumstances
- Patients on anticonvulsant drugs are at risk of vitamin D deficiency. If osteopenia occurs, treatment with 2000-4000 IU/d must be started. In case of osteomalacia, a larger dose of vitamin D, 5000-15000 IU/d is required.[10]
References
- ↑ Tripkovic, L.; Lambert, H.; Hart, K.; Smith, C. P.; Bucca, G.; Penson, S.; Chope, G.; Hypponen, E.; Berry, J.; Vieth, R.; Lanham-New, S. (2012). "Comparison of vitamin D2 and vitamin D3 supplementation in raising serum 25-hydroxyvitamin D status: a systematic review and meta-analysis". American Journal of Clinical Nutrition. 95 (6): 1357–1364. doi:10.3945/ajcn.111.031070. ISSN 0002-9165.
- ↑ Holick, Michael F.; Binkley, Neil C.; Bischoff-Ferrari, Heike A.; Gordon, Catherine M.; Hanley, David A.; Heaney, Robert P.; Murad, M. Hassan; Weaver, Connie M. (2011). "Evaluation, Treatment, and Prevention of Vitamin D Deficiency: an Endocrine Society Clinical Practice Guideline". The Journal of Clinical Endocrinology & Metabolism. 96 (7): 1911–1930. doi:10.1210/jc.2011-0385. ISSN 0021-972X.
- ↑ Misra M, Pacaud D, Petryk A, Collett-Solberg PF, Kappy M (2008). "Vitamin D deficiency in children and its management: review of current knowledge and recommendations". Pediatrics. 122 (2): 398–417. doi:10.1542/peds.2007-1894. PMID 18676559.
- ↑ Lee, Ji Yeon; So, Tsz-Yin; Thackray, Jennifer (2013). "A Review on Vitamin D Deficiency Treatment in Pediatric Patients". The Journal of Pediatric Pharmacology and Therapeutics. 18 (4): 277–291. doi:10.5863/1551-6776-18.4.277. ISSN 1551-6776.
- ↑ Shah BR, Finberg L (1994). "Single-day therapy for nutritional vitamin D-deficiency rickets: a preferred method". J. Pediatr. 125 (3): 487–90. PMID 8071764.
- ↑ Gallagher JC, Sai A, Templin T, Smith L (2012). "Dose response to vitamin d supplementation in postmenopausal women: a randomized trial". Ann Intern Med. 156 (6): 425–37. doi:10.1059/0003-4819-156-6-201203200-00005. PMID 22431675.
- ↑ Lehmann U, Hirche F, Stangl GI, Hinz K, Westphal S, Dierkes J (2013). "Bioavailability of vitamin D(2) and D(3) in healthy volunteers, a randomized placebo-controlled trial". J Clin Endocrinol Metab. 98 (11): 4339–45. doi:10.1210/jc.2012-4287. PMID 24001747.
- ↑ Drincic A, Fuller E, Heaney RP, Armas LA (2013). "25-hydroxyvitamin D response to graded vitamin D3 supplementation among obese adults". J Clin Endocrinol Metab. 98 (12): 4845–51. doi:10.1210/jc.2012-4103. PMID 24037880.
- ↑ Bischoff-Ferrari HA, Willett WC, Orav EJ, Lips P, Meunier PJ, Lyons RA; et al. (2012). "A pooled analysis of vitamin D dose requirements for fracture prevention". N Engl J Med. 367 (1): 40–9. doi:10.1056/NEJMoa1109617. PMID 22762317.
- ↑ Drezner MK (2004). "Treatment of anticonvulsant drug-induced bone disease". Epilepsy Behav. 5 Suppl 2: S41–7. doi:10.1016/j.yebeh.2003.11.028. PMID 15123011.