Vitamin D deficiency

Retesting serum 25-hydroxyvitamin D concentrations (e.g., after 2-3 months) is typical to assess effectiveness and adjust doses as needed. The optimal treatment target is debated, but many guidelines and experts recommend a goal of reaching and maintaining a serum 25-hydroxyvitamin D concentration of at least 30 nanograms/mL, particularly in older adults.[118]Vieth R. What is the optimal vitamin D status for health? Prog Biophys Mol Biol. 2006 Sep;92(1):26-32. https://www.sciencedirect.com/science/article/pii/S0079610706000216?via%3Dihub http://www.ncbi.nlm.nih.gov/pubmed/16766239?tool=bestpractice.com [119]Dawson-Hughes B, Mithal A, Bonjour JP, et al. IOF position statement: vitamin D recommendations for older adults. Osteoporos Int. 2010 Jul;21(7):1151-4. http://www.ncbi.nlm.nih.gov/pubmed/20422154?tool=bestpractice.com ​[83]American Geriatrics Society Workgroup on Vitamin D Supplementation for Older Adults. Recommendations abstracted from the American Geriatrics Society consensus statement on vitamin D for prevention of falls and their consequences. J Am Geriatr Soc. 2014 Jan;62(1):147-52. https://agsjournals.onlinelibrary.wiley.com/doi/epdf/10.1111/jgs.12631 http://www.ncbi.nlm.nih.gov/pubmed/24350602?tool=bestpractice.com ​[84]LeBoff MS, Greenspan SL, Insogna KL, et al. The clinician's guide to prevention and treatment of osteoporosis. Osteoporos Int. 2022 Oct;33(10):2049-102. https://pmc.ncbi.nlm.nih.gov/articles/PMC9546973 http://www.ncbi.nlm.nih.gov/pubmed/35478046?tool=bestpractice.com ​ The patient should then be started on daily maintenance vitamin D therapy. Once taking maintenance doses of vitamin D, the serum 25-hydroxyvitamin D level is typically 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.