Vitamin D deficiency

A repeat level of serum 25-hydroxyvitamin D is recommended 2 to 3 months after initiating therapy, to ensure that vitamin D deficiency has been treated. The goal is to reach and maintain a serum 25-hydroxyvitamin D level in children and adults of at least 75 nanomoles/L (30 nanograms/mL), with a preferred range of between 100-150 nanomoles/L (40-60 nanograms/mL).[2]Holick MF, Binkley NC, Bischoff-Ferrari HA, et al. Evaluation, treatment and prevention of vitamin D deficiency: an Endocrine Society clinical practice guideline. J Clin Endocrinol Metab. 2011 Jul;96(7):1911-30. https://academic.oup.com/jcem/article/96/7/1911/2833671 http://www.ncbi.nlm.nih.gov/pubmed/21646368?tool=bestpractice.com The patient should then be started on daily maintenance vitamin D therapy. Obese adults (BMI >30) require 2 to 3 times more vitamin D to maintain sufficiency. Once taking maintenance doses of vitamin D, the serum 25-hydroxyvitamin D level should be measured annually.

In addition to the above, patients with osteomalacia should have serum phosphate, calcium, creatinine, albumin, and parathyroid hormone levels measured on an annual basis. Bone density monitoring is also recommended. Similarly, patients with rickets require careful monitoring of serum calcium, phosphate, albumin, 25-hydroxyvitamin D, and alkaline phosphatase levels. Monitoring of the urine can detect changes in calcium and phosphorus. Abnormal fluctuations in serum or urine values may require adjustment to the dose of medication.