II. Indications: Vitamin D Supplementation or Replacement
- Vitamin D Deficiency
- Osteoporosis Prevention
- Children and adolescents consuming <1 Liter (34 oz) Vitamin D Fortified milk daily
- Additional groups that may benefit from Vitamin D Supplementation (empirically without serum levels)
- Pregnancy
- Impaired Glucose Tolerance
- Age >74 years
- Demay (2024) J Clin Endocrinol Metab 109(8): 1907-47 [PubMed]
III. Contraindications: Vitamin D Supplementation
- Granulomatous disease (e.g. Tuberculosis, Sarcoidosis)
- Metastatic bone disease
- Williams Syndrome
IV. Physiology: General
- See Serum Calcium for Calcium Metabolism
- Vitamin D2 (Ergocalciferol) and D3 (Cholecalciferol) are fat soluble
- Although termed a Vitamin, it is actually a steroid Hormone
- Vitamin D acts at both cellular receptors as well as nuclear receptors (directly affecting DNA Transcription)
- Sources
- Vitamin D is synthesized in skin after exposed to sun (ultraviolet light)
- Also may be ingested and absorbed from Small Intestine
- Vitamin D circulates in blood as Calcifediol (Calcidiol, 25-hydroxyvitamin D3)
- Active form is Calcitriol (1,25 Hydroxycholecalciferol)
V. Physiology: Synthesis
- See Serum Calcium for Calcium Metabolism
- Images
- Step 1a: Start with 7-Dehydrocholesterol (Cholesterol precursor)
- Skin exposure to sunlight or other ultraviolet light (290-315 nm of UV-B radiation)
- This pathway represents 90% of Vitamin D synthesis in humans
- Sun Exposure resulting in light pink skin (1 minimal erythema dose) = 20,000 IU (500 mcg) Oral Vitamin D
- Step 1b: Start with Dietary Vitamin D2 or D3
- Proceed to step 2 (bypasses sunlight-mediated synthesis pathway)
- Typically represents only 10% of Vitamin D source (unless specifically supplemented)
- Step 2: Cholecalciferol (Vitamin D3)
- Metabolized in liver by Vitamin D3-25 hydroxylase to 25-HYdroxycholecalciferol
- Step 3: Calcidiol (25-hydroxycholecalciferol, or 25-hydroxyvitamin D3)
- Metabolized in Kidney by 25-OH-D3-1a hydroxylase to 1, 25 Hydroxycholecalciferol (Calcitriol)
- Triggered by Parathyroid Hormone
- Step 4: Calcitriol (1, 25 Hydroxycholecalciferol)
- Calcitriol is the active form of Vitamin D)
VI. Pathophysiology
- Vitamin D Excess
-
Vitamin D Deficiency
- Risk Factors
- Homebound elderly
- Inhabitants of Northern States
-
Vitamin D Deficiency related conditions
- Children: Rickets
- Adults: Osteomalacia, Osteoporosis
- Risk Factors
VII. Signs: Vitamin D Deficiency
- See Vitamin D Deficiency
- Osteomalacia
- Muscular hypotonia
VIII. Signs: Vitamin D Toxicity (related to Hypercalcemia)
- Headache
- Metallic Taste
- Vascular calcinosis or nephrocalcinosis
- Pancreatitis
- Nausea or Vomiting
IX. Medications: Dietary and Supplement Sources
- Fish (Vitamin D3, most in fatty fish)
- Salmon (450 IU per 3 oz)
- Sardines
- Fish oils
- Tuna (150 IU per 3 oz)
- Egg yolk (40 IU or 1 mcg)
- Butter
- Liver and other organ meats
- Vitamin D Fortified Milk (USA) contains 100 IU (2.5 mcg) per cup
- Fortified Orange Juice contains 80 to 120 IU (2 to 3 mcg) per cup
- Multi-Vitamin Contains 400 IU (10 mcg) Vitamin D per tablet
X. Dosing: General Recommended Intake (higher than current RDA)
- Children and Adolescents: 400 IU (10 mcg) per day
- Adults Age 18-50 years: 400-800 IU (10-20 mcg) per day
- Adults Age >50 years or Osteoporosis (higher levels are controversial)
- Southern regions: 800 IU (20 mcg) per day
- Northern climates: 1000-2000 IU (25-50 mcg) per day may be required
- Expect a 0.4 ng/ml increase for every 40 IU (1 mcg) daily of Vitamin D
- Expect 4 ng/ml increase from 400 IU (10 mcg) daily
- Expect 40 ng/ml increase from 4000 IU (100 mcg) daily
- Vitamin D is fat soluble and is best absorbed with fat in the meal
XI. Dosing: Supplementation in Infants and Children under age 2 years
- Indications
- See Vitamin D Deficiency for risk factors
- Breastfed Infants
- Children (and adolescents) consuming <1 Liter (34 oz) Vitamin D Fortified milk daily
- Supplements with daily dose of 1 drop (equivalent to 400 IU or 10 mcg) for age under 2 years
- Carlson Baby D Drops
- Supplements with daily dose of 1 ml (equivalent to 400 IU or 10 mcg) for age under 2 years
- Enfamil Poly-Vi-Sol Multivitamin Supplement drops
- Enfamil Poly-Vi-Sol Vitamins A, C and D with Iron
- Sunlight Vitamins Just D Infant Vitamin Drops
- Twinlab Infant Care Multivitamin Drops with DHA
- References
XII. Dosing: Children with Vitamin D Deficiency (Rickets)
- Ergocalciferol (D2, Calciferol)
- Dose: 25-125 mcg (1-5000 IU) PO/IM for 6-12 weeks
- Cholecalciferol (D3, 40,000 IU/mg)
- Option 1: 125-250 mcg (5-10,000 IU) PO for 3 months
- Option 2: 15,000 mcg (600,000 IU) divided qid x1 day
- Dihydrotachysterol (DHT, 120,000 IU/mg)
- Option 1: 500 mcg (0.5 mg) for single dose or
- Option 2: 13-50 mcg PO per day until resolved
- References
XIII. Dosing: Adults with Vitamin D Deficiency
- Mild (Serum 25-hydroxyvitamin D 8-15 ng/ml)
- Calcium 1200 to 1500 mg orally daily
- Vitamin D
- Option 1: Vitamin D 50,000 IU PO weekly for 8 weeks (repeat another course if Vitamin D <30 ng/ml)
- Option 2: Vitamin D 1000 IU daily per every 10 ng/ml shortfall in addition to maintenance for 6 weeks
- Example: Vitamin D 10 ng/ml
- Take 2000 IU (50 mcg) replacement in addition to 1000 IU (25 mcg) maintenance daily
- Example: Vitamin D 10 ng/ml
- Option 3: Vitamin D 20-25 IU/kg IV daily (Parenteral for hospitalized patients)
- Maintenance after acute replacement: Vitamin D 800-1000 IU (20-25 mcg) PO daily
- Severe (Serum 25-hydroxyvitamin D <8 ng/ml)
- Vitamin D 50,000 IU (1250 mcg) orally daily for 1-3 weeks
- Then maintain as mild deficiency doses above
- Monitoring Vitamin D level at 6-8 weeks after starting therapy
- Goal 25-Hydroxyvitamin D >30-40 ng/ml
- Storage of Vitamin D does not start until 40 ng/ml
XIV. Efficacy: Vitamin D in Osteoporosis Prevention
- Dutch Study of 348 women over age 70 years
- Given Vitamin D 400 IU (10 mcg) or Placebo
- Vitamin D Group had greater BMD at 2 years
- Greater femoral neck Bone Mineral Density
- Placebo group had decreased Bone Mineral Density
- No change in femoral trachanter or distal radius BMD
- Ooms (1995) J Clin Endocrinol Metab 80:1052-8 [PubMed]
- Vitamin D does not reduce Fracture risk in adults over age 50 years (even in Vitamin D Deficiency)
XV. Efficacy: Conditions for which Vitamin D has no proven benefit
- Cardiovascular disease primary prevention (no proven benefit)
- Cancer primary prevention (no proven benefit)
Images: Related links to external sites (from Bing)
Related Studies
| vitamin d (on 12/21/2022 at Medicaid.Gov Survey of pharmacy drug pricing) | ||
| VITAMIN D2 1.25 MG(50,000 UNIT) | Generic | $0.13 each |
Ontology: Cholecalciferol (C0008318)
| Definition (NCI_NCI-GLOSS) | A nutrient that the body needs in small amounts to function and stay healthy. Cholecalciferol helps the body use calcium and phosphorus to make strong bones and teeth. It is fat-soluble (can dissolve in fats and oils) and is found in fatty fish, egg yolks, and dairy products. Skin exposed to sunshine can also make cholecalciferol. Not enough cholecalciferol can cause a bone disease called rickets. It is being studied in the prevention and treatment of some types of cancer. |
| Definition (NCI_CRCH) | Vitamin D synthesized from ergosterol in yeast and plants. |
| Definition (NCI) | A steroid hormone produced in the skin when exposed to ultraviolet light or obtained from dietary sources. The active form of cholecalciferol, 1,25-dihydroxycholecalciferol (calcitriol) plays an important role in maintaining blood calcium and phosphorus levels and mineralization of bone. The activated form of cholecalciferol binds to vitamin D receptors and modulates gene expression. This leads to an increase in serum calcium concentrations by increasing intestinal absorption of phosphorus and calcium, promoting distal renal tubular reabsorption of calcium and increasing osteoclastic resorption. |
| Definition (CSP) | produced in human and other animal tissue by photoactivation (normally sunlight on skin) of 7-dehydrocholesterol. |
| Definition (MSH) | Derivative of 7-dehydroxycholesterol formed by ULTRAVIOLET RAYS breaking of the C9-C10 bond. It differs from ERGOCALCIFEROL in having a single bond between C22 and C23 and lacking a methyl group at C24. |
| Definition (PDQ) | A steroid hormone produced in the skin when exposed to ultraviolet light or obtained from dietary sources. The active form of cholecalciferol, 1,25-dihydroxycholecalciferol (calcitriol) plays an important role in maintaining blood calcium and phosphorus levels and mineralization of bone. The activated form of cholecalciferol binds to vitamin D receptors and modulates gene expression. This leads to an increase in serum calcium concentrations by increasing intestinal absorption of phosphorus and calcium, promoting distal renal tubular reabsorption of calcium and increasing osteoclastic resorption. Check for "http://www.cancer.gov/Search/ClinicalTrialsLink.aspx?id=39734&idtype=1" active clinical trials or "http://www.cancer.gov/Search/ClinicalTrialsLink.aspx?id=39734&idtype=1&closed=1" closed clinical trials using this agent. ("http://nciterms.nci.nih.gov:80/NCIBrowser/ConceptReport.jsp?dictionary=NCI_Thesaurus&code=C48194" NCI Thesaurus) |
| Concepts | Steroid (T110) , Vitamin (T127) , Pharmacologic Substance (T121) |
| MSH | D002762 |
| SnomedCT | 18414002, 108943009, 418425007, 126236008, 15211009 |
| LNC | LP15456-4, MTHU008559, LA18888-0 |
| English | Vitamin D 3, Vitamin D3, 9,10-Secocholesta-5,7,10(19)-trien-3-ol, (3beta,5Z,7E)-, vitamin D3, (3 beta,5Z,7E)-9,10-Secocholesta-5,7,10(19)-trien-3-ol, Calciol, (3beta,5Z,7E)-9,10-Secocholesta-5,7,10(19)-trien-3-ol, Vitamin D3 (substance), Vitamin D<sub>3</sub> (substance), Vitamin D<sub>3</sub>, VITAMIN D A 03, 9,10-Secocholesta-5,7,10(19)-trien-3-beta-ol, Delsterol, cholecalciferol, Colecalciferol preparation, calciferol, vitamin D3 (cholecalciferol) (medication), calciferol (medication), vitamins calciferol, vitamin D3 (cholecalciferol), Vtitamin D3, Vtitamin D<sub>3</sub>, Vtitamin D>3<, Cholecalciferol [Chemical/Ingredient], CHOLECALCIFEROL, vitamin d 3, vitamin d-3, d3 vitamin, vitamin d3, cholecalciferol (vit D3), D3, colecalciferol, Colecalciferol (product), Activated 7-dehydrocholesterol (substance), Activated 7-dehydrocholesterol preparation (product), 9,10-Secocholesta-5,7,10(19)-trien-3-ol, D3 - Cholecalciferol, VITD - Cholecalciferol, Vitamin D>3<, Cholecalciferol preparation (product), Cholecalciferol preparation, Colecalciferol, Vitamin D>3< (substance), Cholecalciferol preparation (substance), Activated 7-dehydrocholesterol preparation (substance), Activated 7-dehydrocholesterol preparation, Activated 7-dehydrocholesterol, Cholecalciferol |
| Swedish | Kolekalciferol |
| Czech | cholekalciferol |
| Finnish | Kolekalsiferoli |
| Russian | VITAMIN D3, KHOLEKAL'TSIFEROL, ВИТАМИН D3, ХОЛЕКАЛЬЦИФЕРОЛ |
| Spanish | vitamina D<sub>3</sub> (sustancia), vitamina D<sub>3</sub>, vitamina D3 (sustancia), colecalciferol (producto), preparado con colecalciferol (producto), colecalciferol, preparado con colecalciferol, 7-dehidrocolesterol activado (sustancia), preparado con 7-dehidrocolesterol activado, preparado con 7-dehidrocolesterol activado (producto), preparado de 7-dehidrocolesterol activado (producto), preparado de 7-dehidrocolesterol activado (sustancia), preparado de 7-dehidrocolesterol activado, preparado de colecalciferol (sustancia), vitamina D>3< (sustancia), vitamina D>3<, 7-dehidrocolesterol activado, vitamina D3, D3 - colecalciferol, Colecalciferol, Vitamina D 3 |
| Japanese | コレカルシフェロール, ビタミンD3, オレオビタミンD3 |
| Italian | Vitamina D 3, Vitamina D3, Colecalciferolo |
| German | VITAMIN D A 03, Cholecalciferol, Vitamin D3 |
| Croatian | KOLEKALCIFEROL |
| Polish | Cholekalcyferol, Witamina D3 |
| French | Cholécalciférol, Vitamine D3 |
| Portuguese | Colecalciferol, Vitamina D 3 |
Ontology: Dihydrotachysterol (C0012319)
| Definition (MSH) | A VITAMIN D that can be regarded as a reduction product of vitamin D2. |
| Concepts | Pharmacologic Substance (T121) , Steroid (T110) , Vitamin (T127) |
| MSH | D004097 |
| SnomedCT | 20237006, 126235007 |
| English | Dihydrotachysterin, Tachystin, dihydrotachysterol, 9,10-Secoergosta-5,7,22-trien-3-ol, (3beta,5E,7E,10alpha,22E)-, Dihydrotachysterol2 preparation, Dihydrotachysterol<sub>2</sub> preparation, dihydrotachysterol (medication), vitamins dihydrotachysterol, Dihydrotachysterol [Chemical/Ingredient], 9,10-Secoergosta-5,7,22-Trien-3-ol, (3Beta,5E,7E,10Alpha,22E)-, Dihydrotachysterol, DHT preparation, Dichysterol preparation, Dihydrotachysterol preparation, Dihydrotachysterol>2< preparation, Dihydrotachysterol (substance), Dihydrotachysterol preparation (product), Dihydrotachysterol preparation (substance), DIHYDROTACHYSTEROL |
| Swedish | Dihydrotakysterol |
| Czech | dihydrotachysterol |
| Finnish | Dihydrotakysteroli |
| Russian | DIGIDROTAKHISTEROL, DIGIDROTAKHISTERIN, TAKHISTIN, ДИГИДРОТАХИСТЕРИН, ДИГИДРОТАХИСТЕРОЛ, ТАХИСТИН |
| Japanese | ジヒドロタキステロール |
| Spanish | preparado con dihidrotaquisterol (producto), preparado con dihidrotaquisterol>2<, preparado con dihidrotaquisterol<sub>2</sub>, dihidrotaquisterol (producto), preparado con dihidrotaquisterol2, preparado con dihidrotaquisterol, dihidrotaquisterol (sustancia), dihidrotaquisterol, preparado de DHT, preparado de dicisterol, preparado de dihidrotacisterol (sustancia), Dihidrotaquisterol |
| Italian | Diidrotachisterina, Tacistina, Diidrotachisterolo |
| Polish | Dwuhydrotachysterol, Dihydrotachysterol |
| Portuguese | Di-Hidrotaquisterol |
| French | Dihydrotachystérol |
| German | Dihydrotachysterol |
Ontology: Ergocalciferol (C0014695)
| Definition (NCI_NCI-GLOSS) | A form of vitamin D that helps the body use calcium and phosphorus to make strong bones and teeth. It is fat-soluble (can dissolve in fats and oils) and is found in plants and yeast. It can be made in the body from another form of vitamin D when the body is exposed to the sun. Ergocalciferol is also made in the laboratory. It is used to prevent and to treat vitamin D deficiency. It is a type of dietary supplement. |
| Definition (NCI_CRCH) | Vitamin D synthesized from 7-dehydrocholesterol in the skin after exposure to UVB radiation. |
| Definition (NCI) | Vitamin D2, a fat-soluble vitamin important for many biochemical processes including the absorption and metabolism of calcium and phosphorus. In vivo, ergocalciferol is formed after sun (ultraviolet) irradiation of plant-derived ergosterol, another form of vitamin D. Ergocalciferol is the form of vitamin D usually found in vitamin supplements. (NCI04) |
| Concepts | Pharmacologic Substance (T121) , Vitamin (T127) , Organic Chemical (T109) |
| MSH | D004872 |
| SnomedCT | 23433006, 71516007, 30178006 |
| LNC | LP31696-5, LP15553-8, MTHU010601, LA18889-8 |
| English | D2, Vitamin, Vitamin D2, Vitamin D2 preparation, Vitamin D2 (substance), Vitamin D<sub>2</sub> (substance), Vitamin D<sub>2</sub> preparation, Vitamin D<sub>2</sub>, Ergocalciferol, ergocalciferol, calciferol, VITAMIN D A 02, 9,10-Secoergosta-5,7,10(19),22-tetraen-3-beta-ol, ergocalciferol (medication), vitamins ergocalciferol, vitamin D2 (ergocalciferol), vitamin D2 (ergocalciferol) (medication), ERGOCALCIFEROL, vitamin d2, ergocalciferol (vit D2), Vitamin D, (5Z,7E,22E)-(3S)-9,10-seco-5,7,10(19),22-ergostatetraen-3-ol, vitamin D2, Calciferol, Activated ergosterol preparation, Calciferol preparation, Ergocalciferol preparation, Viosterol preparation, Ergocalciferol product, Vitamin D>2< preparation, Vitamin D>2<, Ergocalciferol preparation (product), Vitamin D>2< (substance), Ergocalciferol preparation (substance), Vitamin D 2 |
| Spanish | preparado de ergocalciferol, Vitamina D 2, preparado de vitamina D<sub>2</sub>, vitamina D2 (sustancia), vitamina D<sub>2</sub> (sustancia), vitamina D<sub>2</sub>, preparado de vitamina D2, preparado con calciferol, ergocalciferol (producto), preparado con ergocalciferol (producto), ergocalciferol, vitamina D2, preparado con ergocalciferol, preparado de calciferol, preparado de ergocalciferol (producto), preparado de ergocalciferol (sustancia), preparado de ergosterol activado, preparado de viosterol, preparado de vitamina D>2<, vitamina D>2< (sustancia), vitamina D>2< |
| Portuguese | Vitamina D 2 |
| German | Vitamin D2, VITAMIN D A 02 |
| Croatian | VITAMIN D2 |
| Czech | vitamin D2, ergokalciferol |
Ontology: Vitamin D (C0042866)
| Definition (MEDLINEPLUS) |
Vitamin D helps your body absorb calcium, which your bones need to grow. A lack of vitamin D can lead to bone diseases such as osteoporosis or rickets. Vitamin D also has a role in your nerve, muscle, and immune systems. You can get vitamin D in three ways: through your skin, from your diet, and from supplements. Your body forms Vitamin D naturally after exposure to sunlight. However, too much sun exposure can lead to skin aging and skin cancer. So many people try to get their vitamin D from other sources. Vitamin D-rich foods include egg yolks, saltwater fish, and liver. Some other foods, like milk and cereal, often have added vitamin D. You can also take vitamin D supplements. Check with your health care provider to see how much you should take. People who might need extra vitamin D include
NIH: National Institutes of Health Office of Dietary Supplements |
| Definition (MSH) | A vitamin that includes both CHOLECALCIFEROLS and ERGOCALCIFEROLS, which have the common effect of preventing or curing RICKETS in animals. It can also be viewed as a hormone since it can be formed in SKIN by action of ULTRAVIOLET RAYS upon the precursors, 7-dehydrocholesterol and ERGOSTEROL, and acts on VITAMIN D RECEPTORS to regulate CALCIUM in opposition to PARATHYROID HORMONE. |
| Concepts | Pharmacologic Substance (T121) , Vitamin (T127) , Organic Chemical (T109) |
| MSH | D014807 |
| SnomedCT | 30178006, 11563006 |
| English | Vitamin D, vitamin D (medication), Vitamin D [Chemical/Ingredient], vitamin d preparations, d vitamin, vit d, vitamin-d, VITAMIN D, vitamin D, Oleovitamin D preparation, Vitamin D product, Vitamin D (substance), Vitamin D preparation (product), Vitamin D preparation, Vitamin D preparation, NOS, Vitamin D, NOS, Vitamin D preparation (substance) |
| Swedish | Vitamin D |
| Czech | vitamin D |
| Finnish | D-vitamiini |
| Russian | KAL'TSIFEROL, VITAMIN D, ВИТАМИН D, КАЛЬЦИФЕРОЛ |
| Spanish | preparado con vitamina D (producto), vitamina D (producto), preparado con vitamina D, calciferol, hormona calciotrópica, preparado de oleovitamina D, preparado de vitamina D (sustancia), vitamina D (sustancia), vitamina D, Vitamina D |
| Croatian | VITAMIN D |
| Polish | Kalcyferol, Witamina D |
| French | Vitamine D |
| German | Calciferole, Vitamin D |
| Italian | Vitamina D |
| Portuguese | Vitamina D |
