Monitoring
A patient's 25-hydroxyvitamin D levels should be checked approximately 2-3 months after initiating therapy. If undergoing long-term treatment, adults require ongoing annual monitoring for signs and symptoms of osteomalacia and over-treatment with vitamin D. Serum phosphate, calcium, creatinine, vitamin D, and PTH levels should be obtained annually, and 24-hour urinary calcium needs to be measured periodically. Bone density is also monitored.
For patients requiring high-dose calcitriol and phosphate treatment, serum calcium, phosphate, PTH level, and spot urine calcium: creatinine ratio should be checked every 3 months and medication doses adjusted accordingly. Additionally, a baseline renal ultrasound is recommended to evaluate for nephrocalcinosis or nephrolithiasis.[57]
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