Your doctor will tell you if you need this test. You may need to repeat the hydroxyvitamin D blood test during treatment of vitamin D deficiency. This will show your response to treatment.
Treatment and prevention of vitamin D deficiency includes increasing your intake of vitamin D. You likely will need supplements to raise your vitamin D level. That is because it is hard to get enough vitamin D soley from your diet, and excess sun exposure can cause skin cancer.
In supplements and fortified foods, vitamin D comes in two forms: D 2 and D 3. While some research studies suggest that vitamin D 2 may be less potent, either form can be effective at recommended doses. Vitamin D comes in pills, gelatin capsules, or a liquid for children, alone or in a multivitamin.
The oral dose is once daily or weekly. Children with rickets or at risk of this disease may get vitamin D injections shots a few times a year. The treatment dose of vitamin D depends on your age, how low your blood vitamin D level is, and what is causing the level to be low. Most often your doctor will lower the vitamin D dose after six to eight weeks of treatment.
Vitamin D treatment can improve bone, body composition how much lean muscle mass an individual has , and quality of life in patients with vitamin D deficiency. Vitamin D treatment is very safe. Patients with a chronic granuloma-forming disease and some patients with lymphoma who receive vitamin D treatment may get too much calcium in their blood or urine.
Careful monitoring of blood vitamin D levels will help check for this possible problem. However, individuals at risk of low vitamin D may need more than the RDA. Therefore, The Endocrine Society guidelines suggest intakes the amounts of vitamin D an individual should consume for at-risk people.
The table shows both sets of advice and the upper limit highest intake thought to be safe. For most people, there is no downside to taking vitamin D supplements. Getting too much vitamin D is uncommon at the recommended intake. An overdose of vitamin D is possible, though, when daily supplements exceed the suggested upper limits.
It is therefore important that you take the dose of vitamin D that your doctor recommends. Excess vitamin D can cause calcium deposits, nausea, vomiting, itching, increased thirst and urination, weakness, and kidney failure. To prevent vitamin D deficiency, make sure you get at least the RDA through supplements and the foods you eat.
Vitamin D supplementation of to IU per day reduces falls in older adults. Vitamin D supplementation of to IU per day reduces fractures in older adults. To prevent vitamin D deficiency, the recommended intake of vitamin D is IU per day for infants and children with inadequate sun exposure, and to IU per day for adults with inadequate sun exposure. Maintenance dosages of to 1, IU of vitamin D per day are recommended for adults with vitamin D deficiency, except in those with malabsorption syndromes.
In adults, vitamin D deficiency is defined as a serum hydroxyvitamin D level of less than 20 ng per mL 50 nmol per L , and insufficiency is defined as a serum hydroxyvitamin D level of 20 to 30 ng per mL 50 to 75 nmol per L.
There are two forms of vitamin D: vitamin D 2 ergocalciferol , which comes from irradiation of the yeast and plant sterol; ergosterol; and vitamin D 3 cholecalciferol which is obtained from oily fish and by skin synthesis.
There are few dietary sources that contain vitamin D 2 Table 1 1 ; therefore, it is difficult to maintain adequate levels of vitamin D from dietary sources alone.
Humans typically obtain 90 percent of vitamin D from sunlight. Information from reference 1. Vitamin D deficiency in adults was previously thought to be limited to older persons living in institutions, but recent evidence suggests otherwise. Risk factors for vitamin D deficiency are listed in Table 2. Medication use that alters vitamin D metabolism e.
Information from references 4 and 5. The interactions between parathyroid hormone, serum calcium, and vitamin D are outlined in Figure 1.
Without the presence of activated vitamin D, normal bone metabolism is altered so that only 10 percent of calcium and 60 percent of phosphorus is absorbed. Vitamin D deficiency causes bone to demineralize. In children, bones soften over time and become deformed, leading to growth retardation, enlargement of the epiphyses of the long bones, and leg deformities.
Because vitamin D receptors are present in skeletal muscle, deficiency may also lead to proximal muscle weakness; an increased risk of falls; global bone discomfort, often elicited with pressure over the sternum or tibia; and low back pain in older women. Bone discomfort or pain often throbbing in low back, pelvis, lower extremities. Information from references 1 , 4 , and 8 through In a randomized controlled trial RCT of nursing home residents, patients who received IU of vitamin D daily had a 72 percent reduction in falls compared with the placebo group.
The number needed to treat to prevent one fall was seven, and the impact was noted primarily in less active women. In adults 65 years and older, more than 90 percent of hip fractures are caused by falling, and the one-year mortality rate for persons with hip fractures is 20 percent. Clinical research suggests that the optimal daily dosage for adults in this age group is approximately to IU.
A meta-analysis of 12 RCTs followed more than 19, persons older than 60 years living in ambulatory and institutional settings. A vitamin D dosage of to IU per day reduced the relative risk of hip fracture by 26 percent and the relative risk of nonvertebral fracture by 23 percent, compared with calcium supplementation alone or placebo. No significant benefit in fracture reduction was observed at a dosage of IU per day. In an RCT of community-dwelling men and women 65 to 85 years of age, persons taking vitamin D had a statistically significant decrease in osteoporotic fractures, particularly in women.
Research suggests that suboptimal vitamin D levels are associated with increased risk of cardiovascular disease. There was a 62 percent higher risk of cardiovascular events in patients with hypertension whose hydroxyvitamin D level was less than 15 ng per mL 38 nmol per L , compared with those whose level was 15 ng per mL or greater. Clinical trials are needed to determine whether vitamin D supplementation has a role in preventing cardiovascular events.
Vitamin D receptors have a broad tissue distribution, which includes colorectal tissues. In vitro studies have reported that colon cancers are responsive to the antiproliferative effects of 1,dihydroxyvitamin D. Evidence from the Women's Health Initiative RCT suggests that a modest dosage of calcium 1, mg per day and vitamin D IU per day does not affect the risk of colorectal cancer in healthy women at average risk.
Vitamin D deficiency has been linked to depression and decreased cognitive function. The best indicator of vitamin D status is hydroxyvitamin D because it is the major circulating form of vitamin D; it reflects cutaneous and dietary contributions; and it is thought to be a precursor for 1,dihydroxyvitamin D, the most active vitamin D metabolite.
To prevent vitamin D deficiency in persons with inadequate sun exposure, the Institute of Medicine has recommended adequate intake AI based on levels needed to maintain optimal bone health in all members of a healthy population. The current daily AI is IU for infants, children, and adults younger than 51 years; IU for adults 51 to 70 years of age; and IU for adults older than 70 years. All breastfed infants unless they are weaned to a minimum of 1 L per day All infants who are not breastfed and who are ingesting less than 1 L per day of vitamin D—fortified formula or milk.
All children and adolescents who do not get regular sunlight exposure; who do not ingest a minimum of 1 L per day of vitamin D—fortified formula or milk; or who do not take a daily multivitamin supplement containing at least IU of vitamin D. Information from reference Vitamin D is a fat-soluble vitamin, and there are concerns about toxicity from excessive supplementation.
Widespread fortification of food and drink from the s to s in the United States and Europe led to reported cases of toxicity. Preventive Services Task Force states that dosages of vitamin D greatly exceeding the recommended AI should be taken with care.
To replenish serum hydroxyvitamin D levels in persons with vitamin D deficiency, one cost-effective regimen is oral ergocalciferol at 50, IU per week for eight weeks. Good article above, and add to my knowledge, once again thank you very much.
Best Regards MutiaraPublic. Manson should have noted that that policy has never been evaluated as to long term effects.
The most reasonably position seems to be expressed here …. Author information Abstract The IOM recommendations for vitamin D fail in a major way on logic, on science, and on effective public health guidance. Moreover, by failing to use a physiological referent, the IOM approach constitutes precisely the wrong model for development of nutritional policy.
The fact is most studies on vitamin d use only small amouts often the wrong type D2 instead of D3. ScienceDaily, 6 July One MUST get it from both sources….
I also had osteoporosis and very low bone density. Pay no attention of expert advice unless you want untreated osteoporosis. Number two, health care professions stand to loose billions of dollars of annual revenue if the vitamin D deficiency is corrected. In our modern society, many factors contribute to the likeihood that we do not have enough vitamin D: we do not go outside, sunblock, shirts, too hot , etc all of these inhibit vitamin D levels.
In my practice, patients that have had low vitamin D often have other nutritional issues as well, inclduing low iron, B12 deficiency, etc. It may be more benficial to have nutrient deficiencies evaluated versus multiple prescription medications to address just the symptoms, and not the underlying cause s. I also taken vitamin D off and on, after a blood test indicated that my vitamin D levels were low. I stopped taking vitamin D after reading mixed reviews.
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Get helpful tips and guidance for everything from fighting inflammation to finding the best diets for weight loss Stay on top of latest health news from Harvard Medical School. Recent Blog Articles. Calcium levels should be checked 1 month after the end of the treatment course.
Hypercalcaemia should raise suspicion that the patient has primary hyperparathyroidism; the patient should not take any more vitamin D and appropriate investigations should be instigated. It is up to the individual GP to decide which guideline they need to follow; however, it is clear that regular ongoing monitoring is not needed. Most people can buy vitamin D supplements over the counter and do not require routine monitoring.
People who have vitamin D insufficiency, and people with deficiency who have completed their loading dose, should take a maintenance dose of IU per day or IU, occasionally up to IU, for people with malabsorption disorders. Patients should be advised that the maintenance dose should be taken for life.
Exposure to the sun is a significant risk factor for melanoma, particularly if the patient has been sunburnt in the past, and there have been large public health campaigns to increase awareness of the need for sunscreen. Patients should be advised that sufficient vitamin D can be obtained by spending short periods of time in the sun without sunscreen during the summer months; 9 however, sunscreen is still advised for prolonged exposure.
People who are unable to expose their skin to the sun should be taking supplements all year round. Vitamin D toxicity is rare and is usually only seen in people who are taking very high doses for prolonged periods, but it is important that healthcare professionals are able to recognise the symptoms.
Symptoms include hypercalcaemia e. So far this article has concentrated on how GPs can treat patients with vitamin D deficiency or insufficiency, but many patients are willing to help themselves by making lifestyle changes. Information intended for UK healthcare professionals only. TRd Date of preparation: August