- Guidelines on prevention and treatment of vitamin D deficiency
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Guidelines on prevention and treatment of vitamin D deficiency
Linee guida su prevenzione e trattamento dell’ipovitaminosi D con colecalciferolo
S. Adami1, E. Romagnoli 2, V. Carnevale2, A. Scillitani3, A. Giusti4, M. Rossini1,
D. Gatti1, R. Nuti5, S. Minisola2
1Unità di Reumatologia, Dipartimento di Medicina, Università di Verona; 2Dipartimento di Medicina,
Università La Sapienza, Roma; 3Unità di Endocrinologia, Ospedale S. Giovanni Rotondo, Foggia;
4Ospedale Galliera, Genova, Italia; 5Dipartimento di Medicina, Università degli Studi di SienaEnglish SUMMARY
The Italian Society for Osteoporosis, Mineral Metabolism and Bone Diseases (SIOMMMS) has elaborated
the following guidelines about the definition, prevention and treatment of inadequate vitamin D status. The
highlights are presented here.
• Daily vitamin D allowance ranges from 1,500 IU (healthy adults) to 2,300 IU (elderly with low calcium
intake). Since the average Italian diet includes around 300 IU/day, subjects with no effective sun exposure
should be supplemented with 1,200-2,000 IU vitamin D per day.
• The serum 25-hydroxy-vitamin D [25(OH)D] levels represents the most accurate way to assess vitamin D
repletion, even though there are still no standardized assay methods.
• Conditions of “deficiency” and “insufficiency” are defined by the following ranges of 25(OH)D levels: less
than 20 ng/ml and 20-30 ng/ml, respectively.
• In Italy, approximately 50% of young healthy subjects have vitamin D insufficiency during the winter months.
The prevalence of deficiency increases with ageing, affecting almost all elderly subjects not on vitamin D
supplements.
• When a condition of deficiency has been identified, a cumulative dose of 300,000-1,000,000 IU, over 1-4 weeks is recommended.
• In subjects recently treated for deficiency-insufficiency, a maintenance dose of 800-2,000 IU/day (or weekly
equivalent) is recommended. In patients on daily doses over 1,000 IU, 25(OH)D levels should be checked
regularly (e.g. once every two years).
• The highest tolerated daily dose has been identified as 4,000 IU/day.
• Vitamin D supplementation should be carefully monitored in patients at higher risk of vitamin D intoxication
(granulomatosis) or with primary hyperparathyroidism.
• In pregnant women, vitamin D supplements should be given as in non-pregnant women, but bolus administration (i.e.: single dose >25,000 IU) should be avoided.
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Vitamin D Life – Loading Dose of Vitamin D category contains
200 items in category
see also Overview Loading of vitamin D Overview Toxicity of vitamin D
Better than Daily 1: Fewer chances to forget, 2) Gets past receptor barrier
Injection category has62 items
It appears that over 1 million Vitamin D loading doses have been taken
Doses ranged from 100,000 to 600,000 IU over a period of a day to a month
No reports of serious adverse reactions
Many studies report on the benefits resulting from loading dosesTOP articles in Loading Dose of Vitamin D
- Vitamin D loading dose of 30,000 IU twice a week is safe and effective – RCT July 2023
- Large dose Vitamin D before surgery was found to help by 35 studies
- Vitamin D is needed before most surgeries – many studies and RCTs
- 400,000 IU of vitamin D 3 days after COVID symptoms reduced 14 day mortality by 3X – Annweiler RCT May 2022
- High-dose Vitamin D safe for children (10,000 IU daily, 600,000 IU bolus) – meta-analysis April 2022
- Take lots of Vitamin D at first signs of COVID
- Rapid Vitamin D Delivery May Result in Better COVID Outcomes - Dec 9, 2021
- Vitamin D loading doses quickly and safely raise levels – meta-analysis Dec 2021
- Childhood cancers – give Vitamin D loading dose if low – Oct 2021
- French recommended 200,000 IU of Vitamin D to stop COVID-19 - Jan 2021
- Vitamin D loading dose was as effective as daily dosing (rickets in this case) – RCT July 2021
- Stoss (loading) dose of vitamin D resulted in bigger response at 30 days (again) – RCT April 2021
- Vitamin D loading dose (stoss therapy) proven to improve health
- Low trauma bone fractures in seniors – considering Vitamin D loading dose for all, without testing – Nov 2019
- Intensive Care (ICU) helped by Vitamin D – review of past and on-going studies – Dec 2018
- Vitamin D restoration then monthly was the most popular dosing by trials – Nov 2018
- Rickets virtually cured by 90,000 IU of Vitamin D along with daily Calcium – RCT Nov 2018
- Rapidly restore Vitamin D levels with 10,000 IU per kg for children in ICU – RCT 2024
- Reasons for Low Vitamin D and what to do
- Healthy in Seven Days - Loading dose of Vitamin D – book 2014
- Can get 50,000 IU Vitamin D anywhere on the globe
Vitamin D Life -
35 studies in both categories Loading Dose and Trauma/surgery This list is automatically updated
- Large dose Vitamin D before surgery was found to help by 35 studies
- Vitamin D is needed before most surgeries – many studies and RCTs
- Half as much AFIB after bypass if 600,000 IU of vitamin D before surgery – RCT April 2022
- ICU mortality reduced by non-oral vitamin D – meta-analysis May 2021
- Taking Vitamin D just before and after surgery helps (open-heart in this case) – RCT Feb 2021
- Half as many problems if take Vitamin D (300,000 IU) before thyroidectomy – RCT Jan 2021
- Fewer days in hospital if 300,000 IU of vitamin D before brain surgery - RCT Feb 2021
- ICU Vitamin D injection (300,000 IU) helped - RCT Feb 2021
- Those getting an injection of 300,000 IU Vitamin D got out of the ICU a week sooner – RCT Dec 2020
- ICU patients greatly helped by Vitamin D loading doses – if gut-friendly – Oct 2020
- Fewer days in ICU after 300,000 IU of vitamin D, but not 540,000 – meta-analysis Aug 2020
- 3X less Septic Shock in children with sepsis getting 150,000 IU of Vitamin D - RCT June 2020
- 100,000 IU daily of Vitamin D for 5 days increased Hemoglobin in Mechanically Ventilated adults – RCT Jan 2018
- Traumatic Brain Injury – 120,000 IU of Vitamin D resulted in 3 fewer days on ventilators – RCT March 2020
- Hip surgery with multiple doses of 50,000 IU of vitamin D weekly both before and after – RCT 2023
- Use of Vitamin D in a trauma surgery - Dr. Matthews on Facebook – Jan 2020
- Surgeries often deplete Vitamin D - 300,000 IU resulted in little response – Nov 2018
- 10 fewer days of ICU Mechanical Ventilation 300,000 IU injection of vitamin D – RCT March 2019
- Intensive Care (ICU) helped by Vitamin D – review of past and on-going studies – Dec 2018
- ICU adults getting 540,000 IU of Vitamin D were 2X more likely to be alive 30 days later – RCT June 2019
- Traumatic Brain Injury recovery helped by injection of 100,000 IU of Vitamin D – March 2019
- Rapidly restore Vitamin D levels with 10,000 IU per kg for children in ICU – RCT 2024
- Esophageal Cancer surgery helped by 300,000 IU of Vitamin D – RCT Sept 2018
- Severe sepsis may be prevented by 400,000 IU of vitamin D – RCT 2023
- Critically ill children – randomized clinical trial to give single doses of up to 400,000 IU of vitamin D – 2019
- Vitamin D loading doses reduce ICU mortality by 30 percent – meta-analysis April 2017
- Children in Intensive Care need Vitamin D loading dose of 10000 IU per kg (nearing a consensus) - Oct 2016
- Vitamin D Loading dose - 20,000 IU daily is not enough if obese, etc. (Cancer) great table and chart – Oct 2016
- Rapid Normalization of Vitamin D in Critically Ill Children (10,000 IU per kg) – clinical trial
- VITdAL-ICU - AMA RCT Sept 2014
- Critically ill need vitamin D – how much and which test to use is TBD – Nov 2014
- ICU survival increased with vitamin D single 540K IU loading dose - JAMA Sept 2014
- 540000 IU before ICU raised vitamin D by 25 ng in 2 days – March 2011
- Hip surgery followed by 100000 IU then 1000 IU of vitamin D daily – June 2010
- 600,000 IU intramuscular D3 helped BMD after pancreatic surgery – June 2010
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