International Guidelines and Recommendations
Recommendations for at risk groups
The Food Safety Authority of Ireland (FSAI) recommends that a daily 5µg vitamin D only supplement should be given to all healthy term breast-fed infants from birth to 12 months.1
Recently, following advice from EFSA (2014) there has been a change in EU legislation governing the composition of infant formula which will result in a significant increase in their vitamin D content. For this reason, the national policy on vitamin D supplementation for infants in Ireland is being revised to include an updated recommendation for vitamin D supplementation in formula fed infants and those who are fed a combination of breast milk and formula.1
- The Royal Osteoporosis Society in the UK (ROS) has identified the following adult groups at risk of vitamin D deficiency:2
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:
- Chronic kidney disease
- Hepatic failure
- Malabsorption syndromes
- Cystic fibrosis
- Inflammatory bowel disease
- Crohn’s disease
- Bariatric surgery
- Radiation enteritis
- Antiseizure medications
- AIDS medications
- Antifungals, e.g. ketoconazole
- Obese children and adults (BMI 30 kg/m2)
- Granuloma-forming disorders
- Some lymphomas
The Endocrine Society suggests that all adults who are vitamin D deficient 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 30 ng/ml (75nmol/l), followed by maintenance therapy of 1500–2000 IU/day.3
Recommendations on treatment of vitamin D deficiency
The Royal Osteoporosis Society (ROS) 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 recommends that those over 50 or younger adults at high risk (with osteoporosis, multiple fractures, or conditions affecting vitamin D absorption) should receive 800-2,000 IU daily.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 IUvitamin D3 per day from 1-10 years of age, and to 800-2000 IU vitamin D3 per day for 10 years and over8
1. Food Safety Authority of Ireland (FSAI) Update to 2007 Scientific Committee Report: Recommendations for a National Policy on Vitamin D Supplementation for Infants in Ireland, 2020
2. The Royal Osteoporosis Society (ROS). Vitamin D and Bone Health: A Practical Clinical Guideline for Patient Management. December 2018. V2.
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. The Scientific Advisory Council of Osteoporosis Canada, Calcium and Vitamin D, https://osteoporosis.ca/bone-health-osteoporosis/calcium-and-vitamin-d/. Accessed August 2020.
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, reaffirmed in January 2017.
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, reaffirmed in Winter 2017.