Large Vitamin D loading doses recomended (Italy, goal 40-60 ng) - 2011

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 Siena

English 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.

📄 Download the Italian PDF from Vitamin D Life

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