This guidance gives a summary of how to treat adults who are at risk of or who are known to have deficient / insufficient levels of vitamin D. It is based on the full NHSGGC guidance, Vitamin D Prevention and Treatment of Deficiency in Adults.
Deficiency of vitamin D can result in osteomalacia. The prime aim of vitamin D supplementation is to prevent this vitamin D deficiency syndrome and the long-term consequences of it i.e. osteoporosis and increased fracture risk.
In the asymptomatic general population there is no need to measure vitamin D levels, although supplementation may be considered. Refer to flowchart 1 from the NHSGGC guideline, Vitamin D Prevention and Treatment of Deficiency in Adults, for advice on supplementation in the general population.
Follow up measurements are rarely required – seek specialist advice before requesting.
Osteomalacia is clinically characterised by joint and bone pain, and is associated with abnormal biochemistry as follows:
For recommended treatments and dosage regimes in patients with, or at increased risk of, osteomalacia, osteoporosis or increased risk of fracture, please refer to flowchart 2 from the guideline, Vitamin D Prevention and Treatment of Deficiency in Adults. Wherever possible, licensed products should be used in preference to unlicensed preparations.
For patients requiring a loading dose of colecalciferol 300,000 units, this can be given as a single dose orally or intramuscularly (IM preparation is unlicensed), but may also be given using one of the following oral regimes (as per Royal Osteoporosis Society Guidance "Vitamin D and Bone Health"):
Where daily supplementation is recommended, the patient can be offered a weekly or twice weekly regime which provides approximately the same total daily dose if preferred.
From flowchart 2, if a combined calcium and vitamin D preparation is recommended then consult the NHSGGC Adult Formulary for choice.
Guideline reviewed: August 2023
Page last updated: December 2023
