eMedicine Specialties > Endocrinology > Metabolic Disorders

Vitamin D Deficiency and Related Disorders: Treatment & Medication

Author: Vin Tangpricha, MD, PhD, Associate Professor of Medicine, Division of Endocrinology, Metabolism and Lipids, Emory University School of Medicine
Coauthor(s): Natasha B Khazai, MD, Instructor of Medicine, Division of Endocrinology, Emory University School of Medicine
Contributor Information and Disclosures

Updated: Oct 5, 2009

Treatment

Medical Care

Vitamin D deficiency can be corrected using various methods, although no standard treatment regimen exists. The following are expert recommendations for the prevention and treatment of vitamin D deficiency.45

Prevention of Vitamin D Deficiency

  • Children
    • Breastfeeding (up to age 1 y) - 400 IU vitamin D3 per day + sensible sun exposure
    • Inadequate sun exposure or dark skin (ages 1-18 y) - 400-1000 IU vitamin D3 per day + sensible sun exposure
  • Adults
    • Inadequate sun exposure or if aging (age >50 y), pregnant, or lactating
      • 800-1000 IU vitamin D3 per day + sensible sun exposure, or
      • 50,000 IU vitamin D3 per month + sensible sun exposure
    • Malabsorption syndromes - 50,000 IU of vitamin D2 every week
    • Drugs that increase the metabolism of activated vitamin D - 50,000 IU vitamin D2 every 1, 2, or 4 weeks

Treatment of Vitamin D deficiency

  • Children
    • Breastfeeding without vitamin D supplementation (up to age 1 y) - Vitamin D2 or vitamin D3, 1000-2000 IU per day with calcium supplementation
    • Inadequate sun exposure or dark skin (ages 1-18 y) - 50,000 IU vitamin D2 every week for 8 weeks
  • Adults
    • Inadequate sun exposure, or if aging (age >50 y), pregnant, or lactating - 50,000 IU vitamin D2 per week for 8 weeks (Repeat for another 8 weeks if 25(OH)D remains less than 30 ng/mL.
    •  Malabsorption syndromes
      • UVB irradiation (tanning bed or portable UVB device)
      • 50,000 IU of vitamin D2 every day or every other day
    • Drugs that increase the metabolism of activated vitamin D - 50,000 IU vitamin D2 every 2 weeks for 8-10 weeks or every week if 25(OH)D is less than 30 ng/dL

Diet

Individuals who do not have exposure to sunlight are at risk for vitamin D deficiency if they do not ingest adequate amounts of foods that contain vitamin D.

However, most dietary sources of vitamin D do not contain sufficient amounts of vitamin D to satisfy daily requirements. Foods thought to contain high amounts of vitamin D3 are oily fish, such as salmon, mackerel, and blue fish, as well as fortified milk and other dairy products. A single serving (3.5 oz) of wild-caught salmon has 988 ± 524 IU vitamin D3, an amount that remains unchanged after baking but that decreases by 50% if the salmon is fried in vegetable oil.46 In comparison, farm-raised salmon has only 25% the content of vitamin D3 found in the flesh of wild salmon, whereas blue fish and mackerel have even lower vitamin D3 levels, at 280 ± 68 and 24 IU, respectively.46 Fortified milk may contain less than the stated amount of vitamin D3 on the product (in some cases less than 80% of the amount).47 Vegetables are not a good source for vitamin D.

The following foods contain the indicated amounts of vitamin D, as reported by the US Department of Agriculture's (USDA's) Nutrient Data Laboratory:

  • Fortified milk (8 oz) - 100 IU
  • Fortified orange juice (8 oz)48 - 100 IU
  • Fortified cereal (1 serving) - 40-80 IU
  • Pickled herring (100 g) - 680 IU
  • Canned salmon with bones (100 g) - 624 IU
  • Mackerel (100 g) - 360 IU
  • Canned sardines (100 g) - 272 IU
  • Codfish (100 g) - 44 IU
  • Swiss cheese (100 g) - 44 IU
  • Raw shiitake mushrooms (100 g) - 76 IU
  • Most multivitamins (1 tab) - 400 IU

Medication

The goals of pharmacotherapy are to correct the vitamin D deficiency, reduce morbidity, and prevent complications.

Fat-soluble vitamins

Vitamin D promotes absorption of calcium and phosphorus in the small intestine. It also promotes renal tubule resorption of phosphate.


Ergocalciferol (Calciferol, Drisdol)

Most widely available form of vitamin D. Ergocalciferol stimulates calcium and phosphate absorption from the small intestine and promotes calcium release from bone into the blood.

Adult

625 mcg/d to 5 mg/d (25,000-200,000 U) PO

Pediatric

1.25-5 mg/d (50,000-200,000 U) PO

Colestipol, mineral oil, and cholestyramine may decrease absorption of ergocalciferol from small intestine; thiazide diuretics may increase effects of vitamin D

Documented hypersensitivity; hypercalcemia, malabsorption syndrome

Pregnancy

A - Fetal risk not revealed in controlled studies in humans

C - Fetal risk revealed in studies in animals but not established or not studied in humans; may use if benefits outweigh risk to fetus

Precautions

Pregnancy category C if dose exceeds the RDA; caution with impaired renal function, renal stones, heart disease, or arteriosclerosis

More on Vitamin D Deficiency and Related Disorders

Overview: Vitamin D Deficiency and Related Disorders
Differential Diagnoses & Workup: Vitamin D Deficiency and Related Disorders
Treatment & Medication: Vitamin D Deficiency and Related Disorders
Follow-up: Vitamin D Deficiency and Related Disorders
Multimedia: Vitamin D Deficiency and Related Disorders
References
Further Reading
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References

  1. Holick MF. Vitamin D deficiency: what a pain it is. Mayo Clin Proc. Dec 2003;78(12):1457-9. [Medline].

  2. Armas LA, Hollis BW, Heaney RP. Vitamin D2 is much less effective than vitamin D3 in humans. J Clin Endocrinol Metab. Nov 2004;89(11):5387-91. [Medline]. [Full Text].

  3. Trang HM, Cole DE, Rubin LA, et al. Evidence that vitamin D3 increases serum 25-hydroxyvitamin D more efficiently than does vitamin D2. Am J Clin Nutr. Oct 1998;68(4):854-8. [Medline]. [Full Text].

  4. Holick MF, Biancuzzo RM, Chen TC, et al. Vitamin D2 is as effective as vitamin D3 in maintaining circulating concentrations of 25-hydroxyvitamin D. J Clin Endocrinol Metab. Mar 2008;93(3):677-81. [Medline].

  5. Heaney RP, Dowell MS, Hale CA, et al. Calcium absorption varies within the reference range for serum 25-hydroxyvitamin D. J Am Coll Nutr. Apr 2003;22(2):142-6. [Medline]. [Full Text].

  6. Elliott ME, Binkley NC, Carnes M, et al. Fracture risks for women in long-term care: high prevalence of calcaneal osteoporosis and hypovitaminosis D. Pharmacotherapy. Jun 2003;23(6):702-10. [Medline].

  7. Thomas MK, Lloyd-Jones DM, Thadhani RI, et al. Hypovitaminosis D in medical inpatients. N Engl J Med. Mar 19 1998;338(12):777-83. [Medline]. [Full Text].

  8. Tangpricha V, Pearce EN, Chen TC, et al. Vitamin D insufficiency among free-living healthy young adults. Am J Med. Jun 1 2002;112(8):659-62. [Medline].

  9. van der Wielen RP, Löwik MR, van den Berg H, et al. Serum vitamin D concentrations among elderly people in Europe. Lancet. Jul 22 1995;346(8969):207-10. [Medline].

  10. Gannagé-Yared MH, Chemali R, Yaacoub N, et al. Hypovitaminosis D in a sunny country: relation to lifestyle and bone markers. J Bone Miner Res. Sep 2000;15(9):1856-62. [Medline].

  11. Looker AC, Gunter EW. Hypovitaminosis D in medical inpatients. N Engl J Med. Jul 30 1998;339(5):344-5; author reply 345-6. [Medline].

  12. Fuleihan GE, Deeb M. Hypovitaminosis D in a sunny country. N Engl J Med. Jun 10 1999;340(23):1840-1. [Medline].

  13. Mishal AA. Effects of different dress styles on vitamin D levels in healthy young Jordanian women. Osteoporos Int. 2001;12(11):931-5. [Medline].

  14. Chapuy MC, Arlot ME, Duboeuf F, et al. Vitamin D3 and calcium to prevent hip fractures in the elderly women. N Engl J Med. Dec 3 1992;327(23):1637-42. [Medline].

  15. Trivedi DP, Doll R, Khaw KT. Effect of four monthly oral vitamin D3 (cholecalciferol) supplementation on fractures and mortality in men and women living in the community: randomised double blind controlled trial. BMJ. Mar 1 2003;326(7387):469. [Medline]. [Full Text].

  16. Boonen S, Lips P, Bouillon R, et al. Need for additional calcium to reduce the risk of hip fracture with vitamin d supplementation: evidence from a comparative metaanalysis of randomized controlled trials. J Clin Endocrinol Metab. Apr 2007;92(4):1415-23. [Medline]. [Full Text].

  17. [Best Evidence] Bischoff-Ferrari HA, Willett WC, Wong JB, et al. Prevention of nonvertebral fractures with oral vitamin D and dose dependency: a meta-analysis of randomized controlled trials. Arch Intern Med. Mar 23 2009;169(6):551-61. [Medline].

  18. Heaney RP. Vitamin D depletion and effective calcium absorption. J Bone Miner Res. Jul 2003;18(7):1342; author reply 1343. [Medline].

  19. Dawson-Hughes B, Harris SS, Krall EA, et al. Effect of calcium and vitamin D supplementation on bone density in men and women 65 years of age or older. N Engl J Med. Sep 4 1997;337(10):670-6. [Medline]. [Full Text].

  20. Harwood RH, Sahota O, Gaynor K, et al. A randomised, controlled comparison of different calcium and vitamin D supplementation regimens in elderly women after hip fracture: The Nottingham Neck of Femur (NONOF) Study. Age Ageing. Jan 2004;33(1):45-51. [Medline]. [Full Text].

  21. Bischoff-Ferrari HA, Dietrich T, Orav EJ, et al. Positive association between 25-hydroxy vitamin D levels and bone mineral density: a population-based study of younger and older adults. Am J Med. May 1 2004;116(9):634-9. [Medline].

  22. Bischoff HA, Stahelin HB, Dick W, et al. Effects of vitamin D and calcium supplementation on falls: a randomized controlled trial. J Bone Miner Res. Feb 2003;18(2):343-51. [Medline].

  23. Bischoff-Ferrari HA, Dawson-Hughes B, Staehelin HB, et al. Fall prevention with supplemental and active forms of vitamin D: a meta-analysis of randomised controlled trials. BMJ. Oct 1 2009;339:b3692. [Medline].

  24. [Best Evidence] Lappe JM, Travers-Gustafson D, Davies KM, et al. Vitamin D and calcium supplementation reduces cancer risk: results of a randomized trial. Am J Clin Nutr. Jun 2007;85(6):1586-91. [Medline]. [Full Text].

  25. Chen TC, Holick MF. Vitamin D and prostate cancer prevention and treatment. Trends Endocrinol Metab. Nov 2003;14(9):423-30. [Medline].

  26. Garland CF, Comstock GW, Garland FC, et al. Serum 25-hydroxyvitamin D and colon cancer: eight-year prospective study. Lancet. Nov 18 1989;2(8673):1176-8. [Medline].

  27. Garland CF, Garland FC, Gorham ED. Calcium and vitamin D. Their potential roles in colon and breast cancer prevention. Ann N Y Acad Sci. 1999;889:107-19. [Medline].

  28. Garland FC, Garland CF, Gorham ED, et al. Geographic variation in breast cancer mortality in the United States: a hypothesis involving exposure to solar radiation. Prev Med. Nov 1990;19(6):614-22. [Medline].

  29. Chen TC, Wang L, Whitlatch LW, et al. Prostatic 25-hydroxyvitamin D-1alpha-hydroxylase and its implication in prostate cancer. J Cell Biochem. Feb 1 2003;88(2):315-22. [Medline].

  30. Freedman DM, Rajaraman P, Fuhrman B, et al. Sunlight, hormone replacement status and colorectal cancer risk in post-menopausal women. Int J Cancer. Sep 30 2009;[Medline].

  31. Tangpricha V, Flanagan JN, Whitlatch LW, et al. 25-hydroxyvitamin D-1alpha-hydroxylase in normal and malignant colon tissue. Lancet. May 26 2001;357(9269):1673-4. [Medline].

  32. Mathieu C, Gysemans C, Giulietti A, et al. Vitamin D and diabetes. Diabetologia. Jul 2005;48(7):1247-57. [Medline].

  33. Holick MF. Vitamin D: importance in the prevention of cancers, type 1 diabetes, heart disease, and osteoporosis. Am J Clin Nutr. Mar 2004;79(3):362-71. [Medline]. [Full Text].

  34. Scragg R, Sowers M, Bell C. Serum 25-hydroxyvitamin D, ethnicity, and blood pressure in the Third National Health and Nutrition Examination Survey. Am J Hypertens. Jul 2007;20(7):713-9. [Medline].

  35. [Best Evidence] Autier P, Gandini S. Vitamin D supplementation and total mortality: a meta-analysis of randomized controlled trials. Arch Intern Med. Sep 10 2007;167(16):1730-7. [Medline].

  36. Clemens TL, Adams JS, Henderson SL, et al. Increased skin pigment reduces the capacity of skin to synthesise vitamin D3. Lancet. Jan 9 1982;1(8263):74-6. [Medline].

  37. Harris SS, Soteriades E, Coolidge JA, et al. Vitamin D insufficiency and hyperparathyroidism in a low income, multiracial, elderly population. J Clin Endocrinol Metab. Nov 2000;85(11):4125-30. [Medline]. [Full Text].

  38. Nesby-O'Dell S, Scanlon KS, Cogswell ME, et al. Hypovitaminosis D prevalence and determinants among African American and white women of reproductive age: third National Health and Nutrition Examination Survey, 1988-1994. Am J Clin Nutr. Jul 2002;76(1):187-92. [Medline]. [Full Text].

  39. Liu BA, Gordon M, Labranche JM, et al. Seasonal prevalence of vitamin D deficiency in institutionalized older adults. J Am Geriatr Soc. May 1997;45(5):598-603. [Medline].

  40. Tangpricha V, Luo M, Fernández-Estívariz C, et al. Growth hormone favorably affects bone turnover and bone mineral density in patients with short bowel syndrome undergoing intestinal rehabilitation. J Parenter Enteral Nutr. Nov-Dec 2006;30:480-6. [Medline].

  41. Koutkia P, Lu Z, Chen TC, Holick MF. Treatment of vitamin D deficiency due to Crohn's disease with tanning bed ultraviolet B radiation. Gastroenterology. Dec 2001;121(6):1485-8. [Medline].

  42. Gartner LM, Greer FR. Prevention of rickets and vitamin D deficiency: new guidelines for vitamin D intake. Pediatrics. Apr 2003;111(4 Pt 1):908-10. [Medline]. [Full Text].

  43. Hollis BW, Wagner CL. Normal serum vitamin D levels. N Engl J Med. Feb 3 2005;352(5):515-6; author reply 515-6. [Medline].

  44. Chapuy MC, Preziosi P, Maamer M, et al. Prevalence of vitamin D insufficiency in an adult normal population. Osteoporos Int. 1997;7(5):439-43. [Medline].

  45. Holick MF. Vitamin D deficiency. N Engl J Med. Jul 19 2007;357(3):266-81. [Medline].

  46. Lu Z, Chen TC, Zhang A, et al. An evaluation of the vitamin D3 content in fish: is the vitamin D content adequate to satisfy the dietary requirement for vitamin D?. J Steroid Biochem Mol Biol. Mar 2007;103(3-5):642-4. [Medline].

  47. Holick MF, Shao Q, Liu WW, et al. The vitamin D content of fortified milk and infant formula. N Engl J Med. Apr 30 1992;326(18):1178-81. [Medline].

  48. Tangpricha V, Koutkia P, Rieke SM, et al. Fortification of orange juice with vitamin D: a novel approach for enhancing vitamin D nutritional health. Am J Clin Nutr. Jun 2003;77(6):1478-83. [Medline]. [Full Text].

  49. Bischoff H, Stahelin HB, Vogt P, et al. Immobility as a major cause of bone remodeling in residents of a long-stay geriatric ward. Calcif Tissue Int. Jun 1999;64(6):485-9. [Medline].

  50. Elidrissy AT, Sedrani SH, Lawson DE. Vitamin D deficiency in mothers of rachitic infants. Calcif Tissue Int. May 1984;36(3):266-8. [Medline].

  51. Heaney RP. Vitamin D, nutritional deficiency, and the medical paradigm. J Clin Endocrinol Metab. Nov 2003;88(11):5107-8. [Medline]. [Full Text].

  52. Holick MF. Vitamin D: a millenium perspective. J Cell Biochem. Feb 1 2003;88(2):296-307. [Medline].

  53. Malabanan A, Veronikis IE, Holick MF. Redefining vitamin D insufficiency. Lancet. Mar 14 1998;351(9105):805-6. [Medline].

  54. Suda T, Ueno Y, Fujii K, et al. Vitamin D and bone. J Cell Biochem. Feb 1 2003;88(2):259-66. [Medline].

  55. Tangpricha V, Luo M, Fernández-Estívariz C, et al. Growth hormone favorably affects bone turnover and bone mineral density in patients with short bowel syndrome undergoing intestinal rehabilitation. J Parenter Enteral Nutr. Nov-Dec 2006;30:480-6. [Medline].

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Keywords

vitamin D deficiency, D vitamin, vitamin D, vitamin D calcium, vitamin D3, low vitamin D, rickets, osteomalacia, vitamin D2, deficiency of vitamin D, cholecalciferol, ergocalciferol, nutritional rickets, fat soluble vitamins, elevated parathyroid hormone, PTH, secondary hyperparathyroidism, vitamin B2, calcium absorption, phosphorus absorption, bone mineralization, 25-hydroxyvitamin D, 1,25-dihydroxyvitamin D, 1,25(OH)2D, circulating 25(OH)D, osteoporosis, bone mineral density, cutaneous synthesis of vitamin D, cutaneous vitamin D production, vitamin D synthesis, melanin, vitamin D malabsorption, calcium absorption from the small intestine, vitamin D insufficiency

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Contributor Information and Disclosures

Author

Vin Tangpricha, MD, PhD, Associate Professor of Medicine, Division of Endocrinology, Metabolism and Lipids, Emory University School of Medicine
Vin Tangpricha, MD, PhD is a member of the following medical societies: American College of Clinical Endocrinologists, American College of Endocrinology, Endocrine Society, and Massachusetts Medical Society
Disclosure: NIH Grant/research funds Other

Coauthor(s)

Natasha B Khazai, MD, Instructor of Medicine, Division of Endocrinology, Emory University School of Medicine
Natasha B Khazai, MD is a member of the following medical societies: American Association of Clinical Endocrinologists and Endocrine Society
Disclosure: Nothing to disclose.

Medical Editor

Udaya M Kabadi, MD, Professor, Department of Medicine, University of Iowa College of Medicine
Disclosure: Nothing to disclose.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: eMedicine Salary Employment

Managing Editor

Romesh Khardori, MD, Chief, Division of Endocrinology, Metabolism and Molecular Medicine, Professor, Department of Internal Medicine, Southern Illinois University School of Medicine
Romesh Khardori, MD is a member of the following medical societies: American Association of Clinical Endocrinologists, American College of Physicians, American Diabetes Association, American Federation for Medical Research, American Medical Association, American Society of Andrology, Endocrine Society, and Illinois State Medical Society
Disclosure: Nothing to disclose.

CME Editor

Mark Cooper, MBBS, PhD, FRACP, Head, Diabetes & Metabolism Division, Baker Heart Research Institute, Professor of Medicine, Monash University
Disclosure: Nothing to disclose.

Chief Editor

George T Griffing, MD, Professor of Medicine, St Louis University School of Medicine
George T Griffing, MD is a member of the following medical societies: American Association for the Advancement of Science, American College of Medical Practice Executives, American College of Physician Executives, American College of Physicians, American Diabetes Association, American Federation for Medical Research, American Heart Association, Central Society for Clinical Research, Endocrine Society, International Society for Clinical Densitometry, and Southern Society for Clinical Investigation
Disclosure: Nothing to disclose.

 
 
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