Guidance On Vitamin D Deficiency/insufficiency printable pdf download

Guidance on Vitamin D Deficiency/Insufficiency – November 2011

(updated February 2012)

This guidance aims to provide general advice for clinicians in a community setting

including areas where clinical uncertainty remains.

Background Information

• Awareness of Vitamin D deficiency in the UK population has increased substantially in recent years

and there have been numerous articles published on the subject.

• There are different opinions regarding the ideal levels of vitamin D and the potential consequences

of deficiency and insufficiency.

• Vitamin D includes ergocalciferol (calciferol, vitamin D2) and colecalciferol (vitamin D3). The BNF

states the forms of colecalciferol and ergocalciferol should be considered bioequivalent and

interchangeable.

• The availability of licensed vitamin D products is limited and unlicensed products have variable

(and often substantial) costs.

• There are no national guidelines or recommendations on who to screen and how and when to treat

vitamin D deficiency/insufficiency.

• The evidence-base is not completely defined in relation to best management of vitamin D

deficiency states and the monitoring required following treatment.

• Population screening of Vitamin D levels is not currently recommended.

• Guidance is needed on how patients with possible suboptimal vitamin D status should be

investigated and managed.

Vitamin D deficiency

• Vitamin D deficiency develops when there is inadequate exposure to sunlight or a lack of vitamin D

in the diet and usually takes a long time to develop because of the slow release of the vitamin from

body stores.

• Prolonged vitamin D deficiency in infants and children results in rickets.

• In adults, vitamin D deficiency results in osteomalacia, the clinical symptoms of which include

skeletal pain and muscle weakness and pathological fractures.

• Evidence suggesting that vitamin D might protect against non-bone health outcomes (e.g. cancer,

heart disease, diabetes, multiple sclerosis) is insufficient, conflicting or inconclusive. More

randomised trials are needed.

• Current data is insufficient to clarify relationships between intake, biochemical status and chronic

illness outcome.

Vitamin D levels

• Opinions on the ideal level of vitamin D and optimal serum concentrations vary.

• For the purpose of this guideline the following definitions for vitamin D status measured by total

serum 25-hydroxyvitamin D (25-OHD) will be used although it should be noted that these

definitions originate from different populations to those in the UK and may not be directly applicable

to our climate:

Vitamin D levels <25 nmol/L probably indicate vitamin D deficiency.

Vitamin D levels 25-50 nmol/L probably indicates vitamin D insufficiency.

Vitamin D levels between 50 nmol/L and 75 nmol/L probably indicate suboptimal levels.

Vitamin D levels between 75 nmol/L and approximately 220 nmol/L probably indicate normal

vitamin D status

• Individual laboratory assays may vary in their definitions of thresholds for deficiency and

insufficiency. However, the above definitions are those which have been agreed locally and will be

used as intervention thresholds.

• Vitamin D status may be reported separately as 25-hydroxyvitamin D2 and 25-hydroxyvitamin D3.

The two values should added together to obtain the total serum 25-hydroxyvitamin D (25-OHD).

All patients, where appropriate, should receive lifestyle advice to help to meet their vitamin D

requirements (see Lifestyle Advice section page 5).

Risk Factors for reduced Vitamin D levels

Groups at high risk of vitamin D deficiency include:

• pregnant and breastfeeding women (including multiple, short interval pregnancies)

• young children (under the age of 5, particularly infants who are exclusively breast fed)

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Guidance On Vitamin D Deficiency/insufficiency

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