• Cholecalciferol = Vitamin D3; regulates calcium and phosphate in body; required for bone and teeth health

Deficiency

• Test in patients with bone disease (osteomalacia or Pagets) or patients with musculoskeletal symptoms (bone, joint and muscle pain and hyperalgesia, or widespread pain)

  • < 25 deficiency

  • 25-50 insufficient

  • > 50 sufficient

• Deficiency associated with rickets, osteomalacia, CVD, weight gain, diabetes, infectious disease, dementia and all cause mortality but evidence for supplementation limited (consequence rather than a cause?)

At risk groups

• Pregnant and breastfeeding

• Infants/children aged <5 years

• Aged >65 years

• People with low/no sun exposure

• People who have darker skin

Supplementation recommended for all at risk groups

• 0-6 months: e.g. Healthy start vitamin or Abidec drops)

• 6 months - 5 years: 280 IU (vitamin drops: but don't need until <500ml infant formula/day. Breast-fed infants from 1M if mother has not taken supplements in pregnancy)

• Adults: 400 IU = 10 mcg (standard combinations of calcium & Vit D e.g. Adcal-D3)

• Pregnancy: Healthy Start or Pregnacare vitamin tablets)

Management options for deficiency

• Rapid treatment: Cholecalciferol 25,000 U/ml (e.g. InVita D3 oral solution) twice weekly for 6 weeks

• Plenachol 20,000 2OD for 1week, Dekristol 20,000 caps, 2 daily (14 caps), Desunin 800U for 1-3 months, Fultium D3 800

Resources

• Vitamin D (NHS Choices), Vitamin D: increasing supplement use in at-risk groups (NICE, 2014), Comparison of licensed Vitamin D preparations in UK (Lambeth)