![]() Special populations (eg, obesity, patients on medications known to affect vitamin D metabolism, malabsorption, gastrectomy): Higher doses or longer durations may be necessary for adequate replacement. ![]() Maintenance dosing: Oral: Once target 25(OH)D level is achieved, continue at a maintenance dose of 600 to 2,000 units (15 to 50 mcg) once daily (Dawson-Hughes 2022 NOF ). Some experts suggest modest dose increases (eg, to 2,000 units once daily) if serum 25(OH)D levels have substantially increased but remain below target or switching to high-dose therapy if serum 25(OH)D levels remain substantially below target (Dawson-Hughes 2022). Oral: 800 to 1,000 units (20 to 25 mcg) once daily for ~3 to 4 months may adjust dose if needed every 3 to 4 months based on 25(OH)D level. Low-dose therapy: May be preferred in patients with a serum 25(OH)D level 12 to <20 ng/mL (30 to <50 nmol/L) without symptoms or concomitant hypocalcemia (Dawson-Hughes 2022). Oral: 50,000 units (1,250 mcg) once weekly (or equivalent dose administered once daily) for 6 to 12 weeks, then recheck 25(OH)D level may repeat high-dose therapy if needed to achieve target 25(OH)D level (Dawson-Hughes 2022 Goltzman 2022 NOF ). High-dose therapy: May be preferred in patients with a serum 25(OH)D level <12 ng/mL (<30 nmol/L) or who are symptomatic (eg, bone fracture/pain, muscle weakness), or in patients with concomitant hypocalcemia (Dawson-Hughes 2022 Goltzman 2022 NOF ). The following recommendations are based primarily on expert opinion and clinical experience: Individualize dose based on patient-specific factors (eg, presence of malabsorption, liver disease, kidney disease) and target 25(OH)D level and ensure adequate calcium intake during therapy (Dawson-Hughes 2022 NOF ). Therefore, some experts suggest a target range of 20 to 40 ng/mL (50 to 100 nmol/L) for most patients (Dawson-Hughes 2022). Note: The optimal serum 25-hydroxyvitamin D (25D) level has not been established generally, deficiency is defined as 25(OH)D levels <12 ng/mL (<30 nmol/L), and insufficiency is defined as 25(OH)D levels 12 to <20 ng/mL (30 to <50 nmol/L) (Giustina 2019). read more ).Vitamin D insufficiency/deficiency (off-label use): Deficiency impairs bone mineralization, causing rickets in children and osteomalacia in adults and possibly contributing. ![]() As the causes of falls are multifactorial, other studies have not found that vitamin D supplements alone reduce falls in older adults ( 9 Physiology references Inadequate exposure to sunlight predisposes to vitamin D deficiency. read more ), but primarily in patients who are vitamin D deficient. read more ) and falls ( 8 Physiology references Inadequate exposure to sunlight predisposes to vitamin D deficiency. Some evidence suggests that taking the combined recommended daily allowance of both vitamin D and calcium reduces the risk of fractures ( 6, 7 Physiology references Inadequate exposure to sunlight predisposes to vitamin D deficiency. Vitamin D supplementation does not effectively treat or prevent depression or cardiovascular disease ( 4, 5 Physiology references Inadequate exposure to sunlight predisposes to vitamin D deficiency. Vitamin D's usefulness in preventing leukemia and breast, prostate, colon, or other cancers has not been proved, nor has its efficacy in treating various other nonskeletal disorders in adults ( 1–3 Physiology references Inadequate exposure to sunlight predisposes to vitamin D deficiency. read more, and renal osteodystrophy Calcium and phosphate. read more, hypoparathyroidism Hypoparathyroidism Hypoparathyroidism is a deficiency of parathyroid hormone often caused by an autoimmune disorder or by iatrogenic damage or removal of the glands during thyroidectomy or parathyroidectomy. Vitamin D and related analogs may be used to treat psoriasis Psoriasis Psoriasis is an inflammatory disease that manifests most commonly as well-circumscribed, erythematous papules and plaques covered with silvery scales.
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