Vitamin D deficiency medical therapy: Difference between revisions
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(Created page with "__NOTOC__ {{Vitamin D deficiency}} {{CMG}} {{AE}} {{SSH}} ==Overview== The mainstay of therapy for vitamin D deficiency is vitamin D, either vitamin D2 (ergocalcifero...") |
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==Medical therapy== | ==Medical therapy== | ||
There are two major forms of [[vitamin D]]; ergocalciferol (vitamin D2), cholecalciferol (vitamin D3). Both of them are commonly used. However, 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 | There are two major forms of [[vitamin D]]; [[ergocalciferol]] (vitamin D2), [[cholecalciferol]] (vitamin D3). Both of them are commonly used. However, 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 of [[vitamin D]] deficiency.<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> | ||
* [[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> | * [[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> | ||
{| class="wikitable" | {| class="wikitable" | ||
! style="font-weight: bold;" | Age | ! style="font-weight: bold;" | Age | ||
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| 3000–6000 IU/d | | 3000–6000 IU/d | ||
|} | |} | ||
High risk patients include African American, obese, patients with malabsorption syndromes and who are on anticonvulsants. | * High risk patients include African American, [[Obesity|obese]], patients with [[malabsorption]] syndromes and who are on [[Anticonvulsant|anticonvulsants]]. | ||
* 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. | * 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. 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><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> | ||
* An alternative strategy for treatment, also known as | * 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> | ||
===Special circumstances=== | ===Special circumstances=== | ||
* 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> | * 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> | ||
==References== | ==References== | ||
Revision as of 01:50, 21 November 2017
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Sadaf Sharfaei M.D.[2]
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.
Medical therapy
There are two major forms of vitamin D; ergocalciferol (vitamin D2), cholecalciferol (vitamin D3). Both of them are commonly used. However, 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 of vitamin D deficiency.[1]
- 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.[2]
| Age | Loading dose | Alternative dose | Maintenance dose |
|---|---|---|---|
| 0-1 y | 2000 IU/d orally for 6 weeks | 50,000 IU/w orally for 6 weeks | 400-1000 IU/d |
| 1-18 y | 2000 IU/d orally for 6 weeks | 50,000 IU/w orally for 6 weeks | 600-1000 IU/d |
| Adults | 50,000 IU/w orally for 8 weeks | 6000 IU/d orally for 6 weeks | 1500–2000 IU/d |
| Nursing home residents | 50,000 IU/three times per week for 1 month | 100,000 IU of vitamin D every 4 months | |
| High risk patients* | 6000-10,000 IU/d | 3000–6000 IU/d |
- High risk patients include African American, obese, patients with malabsorption syndromes and who are on anticonvulsants.
- 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. 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.[3][4]
- 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.[5]
Special circumstances
- 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.[6]
References
- ↑ Tripkovic, L.; Lambert, H.; Hart, K.; Smith, C. P.; Bucca, G.; Penson, S.; Chope, G.; Hypponen, E.; Berry, J.; Vieth, R.; Lanham-New, S. (2012). "Comparison of vitamin D2 and vitamin D3 supplementation in raising serum 25-hydroxyvitamin D status: a systematic review and meta-analysis". American Journal of Clinical Nutrition. 95 (6): 1357–1364. doi:10.3945/ajcn.111.031070. ISSN 0002-9165.
- ↑ Holick, Michael F.; Binkley, Neil C.; Bischoff-Ferrari, Heike A.; Gordon, Catherine M.; Hanley, David A.; Heaney, Robert P.; Murad, M. Hassan; Weaver, Connie M. (2011). "Evaluation, Treatment, and Prevention of Vitamin D Deficiency: an Endocrine Society Clinical Practice Guideline". The Journal of Clinical Endocrinology & Metabolism. 96 (7): 1911–1930. doi:10.1210/jc.2011-0385. ISSN 0021-972X.
- ↑ Misra M, Pacaud D, Petryk A, Collett-Solberg PF, Kappy M (2008). "Vitamin D deficiency in children and its management: review of current knowledge and recommendations". Pediatrics. 122 (2): 398–417. doi:10.1542/peds.2007-1894. PMID 18676559.
- ↑ Lee, Ji Yeon; So, Tsz-Yin; Thackray, Jennifer (2013). "A Review on Vitamin D Deficiency Treatment in Pediatric Patients". The Journal of Pediatric Pharmacology and Therapeutics. 18 (4): 277–291. doi:10.5863/1551-6776-18.4.277. ISSN 1551-6776.
- ↑ Shah BR, Finberg L (1994). "Single-day therapy for nutritional vitamin D-deficiency rickets: a preferred method". J. Pediatr. 125 (3): 487–90. PMID 8071764.
- ↑ Drezner MK (2004). "Treatment of anticonvulsant drug-induced bone disease". Epilepsy Behav. 5 Suppl 2: S41–7. doi:10.1016/j.yebeh.2003.11.028. PMID 15123011.