International Guidelines and Recommendations

Recommendations for at risk groups
  • The Food Safety Authority of Ireland (FSAI) in 2014 recommended that all babies living in Ireland should be given a vitamin D only supplement providing 5 μg (200 IU) daily vitamin D from birth to 12 months1
  • It is expected that the vitamin D needs of other ‘at-risk’ groups, such as pregnant women and children aged 12 months to four years, will be addressed by the FSAI at a later date1
  • The National Osteoporosis Society in the UK (NOS) has identified the following adult groups at risk of vitamin D deficiency:2
  • All pregnant and breastfeeding women, especially teenagers and young women
  • Older people, aged 65 years and over
  • People who have low or no exposure to the sun, for example those who cover their skin for cultural reasons, who are housebound or who are confined indoors for long periods
  • People who have darker skin, for example people of African, African-Caribbean or South Asian origin, because their bodies are not able to make as much vitamin D
Recommendations on screening

The Endocrine Society 'Clinical Practice Guideline on Evaluation, treatment and prevention of vitamin D deficiency' lists indications for 25(OH)D measurement (candidates for screening):3

Indications for 25(OH)D measurement include:​

Rickets
Osteomalacia
Osteoporosis
Chronic kidney disease
Hepatic failure
Malabsorption syndromes
Cystic fibrosis
Inflammatory bowel disease
Crohn’s disease
Bariatric surgery
Radiation enteritis
Hyperparathyroidism
Medications
Antiseizure medications
Glucocorticoids
AIDS medications
Antifungals, e.g. ketoconazole
Cholestyramine
Obese children and adults (BMI 30 kg/m2)
Granuloma-forming disorders
Sarcoidosis
Tuberculosis
Histoplasmosis
Coccidiomycosis
Berylliosis
Some lymphomas

 

The Endocrine Society suggests that all adults who are vitamin D deficient i.e. <50nmol/L be treated with 50,000 IU of vitamin D once a week for 8 weeks to achieve a blood level of 25(OH)D above 50nmol/L, followed by maintenance therapy of 1500-2000 IU/day.3

Recommendations on treatment of vitamin D deficiency

National Osteoporosis Society (NOS) recommendations for treatment of vitamin D deficiency:2

1. Loading regimens for treatment of deficiency up to a total of approximately 300,000 IU over several weeks.

 

2. Maintenance regimens may be considered one month after loading with doses equivalent to 800 to 2000 IU daily (occasionally up to 4,000 IU daily), given either daily or intermittently at a higher equivalent dose.

  • The American Geriatrics Society Consensus Statement on Vitamin D for the Prevention of Falls and their Consequences recommends a minimum dose of 1000 IU vitamin D per day4
     
  • The Scientific Advisory Council of Osteoporosis Canada states that in many adults over 50 years, supplementation at greater than 1000 IU vitamin D3 daily may be required to achieve optimal vitamin D status (>75nmol/L)5
     
  • The American Academy of Paediatrics (AAP) recommends a minimum of 400 IU per day for infants, children and adolescents6
     
  • The Canadian Paediatric Society recommends 400 IU daily for the first year of life, increasing to 800 IU daily from all sources, in specific northern regions, during the months October through February7
     
  • The Evidence-Based Recommendations from the Cystic Fibrosis Foundation recommend an initial dose of 400-500 IU vitamin D3 per day from birth to 12 months, rising to 800-1000 IU vitamin D3 per day from 1-10 years of age, and to 800-2000 IU vitamin D3 per day for 10 years and over8

1. https://www.fsai.ie/faq/vitamin_d.html accessed 24th October 2017
2. National Osteoporosis Society. Vitamin D and Bone Health: A Practical Clinical Guideline for Patient Management. April 2013. V1.1.
3. Holick M et al. Evaluation, Treatment, and Prevention of Vitamin D Deficiency: an Endocrine Society Clinical Practice Guideline. J Clin Endocrinol Metab; July 2011; 96(7): 1911-30.
4. Recommendations Abstracted from the American Geriatrics Society Consensus Statement on Vitamin D for Prevention of Falls and Their Consequences. J Am Geriatr Soc 62: 147-152, 2014.
5. Hanley D et al. Vitamin D in adult health and disease: a review and guideline statement from Osteoporosis Canada (summary). CMAJ 2010, Sep 7; 182(12): 1315-1319.
6. Wagner C et al. Prevention of Rickets and Vitamin D Deficiency in Infants, Children, and Adolescents. Paediatrics Vol 122: No. 5 November 1, 2008, 1142-1152.
7.Godel J et al. Recommendations for Canadian mothers and infants. Paediatr Child Health 2007; 12(7): 583-9.
8. Tangpricha V et al. An Update on the Screening, Diagnosis, Management and Treatment of Vitamin D Deficiency in Individuals with Cystic Fibrosis: Evidence-Based Recommendations from the Cystic Fibrosis Foundation. J Clin Endocrinol Metab April 2012, 97(4): 1082-1093.