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 full guidance located on NHSGGC StaffNet / Clinical Info / Clinical Guideline Directory (link only active if accessing via NHS computer) and search for "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, on NHSGGC StaffNet / Clinical Info / Clinical Guideline Directory (link only active if accessing via NHS computer). Wherever possible, licensed products should be used in preference to unlicensed preparations. For available licensed colecalciferol preparations see table here.
For patients requiring a loading dose of 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.
Guideline reviewed and content updated June 2021.