Please note: this guideline has exceeded its review date and is currently under review by specialists. Exercise caution in the use of the clinical guideline.

Vitamin D Prevention and Treatment of Deficiency in Adults 

This guidance gives a summary of how to treat adults who are at risk of or who are known to have deficient / insufficient levels of vitamin D. It is based on full guidance located on NHSAAA AthenA / Guidelines - Prescribing / Nutrition and Blood (link only active if accessing via NHS network).

Introduction

Deficiency of vitamin D can result in osteomalacia. The prime aim of vitamin D supplementation is to prevent this vitamin D deficiency syndrome and the long-term consequences of it i.e. osteoporosis and increased fracture risk.

In the asymptomatic general population there is no need to measure vitamin D levels although supplementation may be considered - refer to the following extract from the full guideline.

 

Assessment and Monitoring

When to Measure Vitamin D

  • In patients with low serum adjusted calcium (<2.2mmol/L) and/or where other blood results suggest possible osteomalacia (see below)
  • Patients with malabsorption syndromes
  • CKD (eGFR <30ml/minute/1.73m2) - measurement of vitamin D in this context should usually be carried out by specialist clinics only.

Follow up measurements are rarely required – seek specialist advice before requesting.

Signs and Symptoms of Osteomalacia

Osteomalacia is clinically characterised by joint and bone pain and is associated with abnormal biochemistry as follows:

  • high serum alkaline phosphatase 
  • low/low normal serum calcium 
  • high plasma parathyroid hormone
  • low serum vitamin D, usually <25nmol/L.

Drug Therapy/Treatment Options

See recommended treatments and dosage regimes in patients with, or at increased risk of, osteomalacia, osteoporosis or increased risk of fracture. Wherever possible, licensed products should be used in preference to unlicensed preparations. 

Calcium and Vitamin D supplementation

If a combined calcium and vitamin D preparation is recommended from the table within the guideline, then consult the NHSAAA Formulary (link only active if accessing via NHS network) for choice.

 

Guideline reviewed and content updated March 2022.




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