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| ==Overview== | | ==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.
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| ==Medical therapy== | | ==History and symptoms== |
| There are two major forms of vitamin D; ergocalciferol (vitamin D2), cholecalciferol (vitamin D3). 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. <ref name="TripkovicLambert2012">{{cite journal|last1=Tripkovic|first1=L.|last2=Lambert|first2=H.|last3=Hart|first3=K.|last4=Smith|first4=C. P.|last5=Bucca|first5=G.|last6=Penson|first6=S.|last7=Chope|first7=G.|last8=Hypponen|first8=E.|last9=Berry|first9=J.|last10=Vieth|first10=R.|last11=Lanham-New|first11=S.|title=Comparison of vitamin D2 and vitamin D3 supplementation in raising serum 25-hydroxyvitamin D status: a systematic review and meta-analysis|journal=American Journal of Clinical Nutrition|volume=95|issue=6|year=2012|pages=1357–1364|issn=0002-9165|doi=10.3945/ajcn.111.031070}}</ref>
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| * 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.<ref name="HolickBinkley2011">{{cite journal|last1=Holick|first1=Michael F.|last2=Binkley|first2=Neil C.|last3=Bischoff-Ferrari|first3=Heike A.|last4=Gordon|first4=Catherine M.|last5=Hanley|first5=David A.|last6=Heaney|first6=Robert P.|last7=Murad|first7=M. Hassan|last8=Weaver|first8=Connie M.|title=Evaluation, Treatment, and Prevention of Vitamin D Deficiency: an Endocrine Society Clinical Practice Guideline|journal=The Journal of Clinical Endocrinology & Metabolism|volume=96|issue=7|year=2011|pages=1911–1930|issn=0021-972X|doi=10.1210/jc.2011-0385}}</ref>
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| {| class="wikitable"
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| ! style="font-weight: bold;" | Age
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| ! style="font-weight: bold;" | Loading dose
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| ! style="font-weight: bold;" | Alternative dose
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| ! style="font-weight: bold;" | Maintenance dose
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| |-
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| | style="font-weight: bold;" | 0-1 y
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| | 2000 IU/d orally for 6 weeks
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| | 50,000 IU/w orally for 6 weeks
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| | 400-1000 IU/d
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| |-
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| | style="font-weight: bold;" | 1-18 y
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| | 2000 IU/d orally for 6 weeks
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| | 50,000 IU/w orally for 6 weeks
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| | 600-1000 IU/d
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| | style="font-weight: bold;" | Adults
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| | 50,000 IU/w orally for 8 weeks
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| | 6000 IU/d orally for 6 weeks
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| | 1500–2000 IU/d
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| |-
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| | style="font-weight: bold;" | Nursing home residents
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| | 50,000 IU/three times per week for 1 month
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| | 100,000 IU of vitamin D every 4 months
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| | style="font-weight: bold;" | High risk patients*
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| | 6000-10,000 IU/d
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| | 3000–6000 IU/d
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| |}
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| High risk patients include African American, obese, patients with malabsorption syndromes and who are on anticonvulsants.
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| * 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. <ref name="LeeSo2013">{{cite journal|last1=Lee|first1=Ji Yeon|last2=So|first2=Tsz-Yin|last3=Thackray|first3=Jennifer|title=A Review on Vitamin D Deficiency Treatment in Pediatric Patients|journal=The Journal of Pediatric Pharmacology and Therapeutics|volume=18|issue=4|year=2013|pages=277–291|issn=1551-6776|doi=10.5863/1551-6776-18.4.277}}</ref> 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. <ref name="pmid18676559">{{cite journal |vauthors=Misra M, Pacaud D, Petryk A, Collett-Solberg PF, Kappy M |title=Vitamin D deficiency in children and its management: review of current knowledge and recommendations |journal=Pediatrics |volume=122 |issue=2 |pages=398–417 |year=2008 |pmid=18676559 |doi=10.1542/peds.2007-1894 |url=}}</ref>
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| * 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. <ref name="pmid8071764">{{cite journal |vauthors=Shah BR, Finberg L |title=Single-day therapy for nutritional vitamin D-deficiency rickets: a preferred method |journal=J. Pediatr. |volume=125 |issue=3 |pages=487–90 |year=1994 |pmid=8071764 |doi= |url=}}</ref>
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| ===Special circumstances===
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| * 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. <ref name="pmid15123011">{{cite journal |vauthors=Drezner MK |title=Treatment of anticonvulsant drug-induced bone disease |journal=Epilepsy Behav |volume=5 Suppl 2 |issue= |pages=S41–7 |year=2004 |pmid=15123011 |doi=10.1016/j.yebeh.2003.11.028 |url=}}</ref>
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| ==References== | | ==References== |