The Role of Vitamin D and the Treatment of Vitamin D Deficiency

Vitamin D deficiency

“There is widespread acknowledgement of the presence of vitamin D deficiency in the community and the pressing need to address this deficiency1“​

Prof Kevin Cashman, UCC, commenting on the results of the Irish NANS Study 2013.​

  • The North American Institute of Medicine (IOM)’s DRI Committee for Ca and vitamin D proposes a serum 25(OH)D concentration of 50nmol/L that would meet the needs of 97.5% of normal healthy persons1​
  • In agreement with the Scientific Advisory Committee on Nutrition (SACN)2​ report, the Royal Osteoporosis Society (ROS)3​ in the UK proposes vitamin D thresholds as follows:Plasma 25 (OH) D < 25 nmol/L is deficientPlasma 25 (OH) D of 25 – 50 nmol/L may be inadequate in some peoplePlasma 25 (OH) D > 50 nmol/L is sufficient for almost the whole population​
  • The Endocrine Society Clinical Practice Guideline defines vitamin D deficiency as 25(OH)D below 50nmol/L and vitamin D insufficiency below the range of 52.5-72.5nmol/L4
  • The American Geriatrics Society Consensus Statement on Vitamin D for the Prevention of Falls and their Consequences recommends that a serum 25(OH)D concentration of 75nmol/L should be a minimum goal to achieve in older adults, particularly in frail adults who are at greater risk of falls, injuries and fractures5​
  • The guideline statement from the Scientific Advisory Council of Osteoporosis Canada states that the optimal serum 25-hydroxyvitamin D (25OHD) level for bone health is uncertain, however ≥50 nmol/L is generally considered adequate for bone and overall health in healthy individuals.6​
  • The American Academy of Paediatrics (AAP) states that serum concentrations of 25(OH)D in infants and children should be at least 50nmol/L7 The Canadian Paediatric Society defines deficiency as serum 25(OH)D levels <25 nmol/l, insufficiency as 25-75nmol/L but highlights a range of 75-225nmol/L as optimal for parathyroid hormone production, minimisation of resorption from bone and stabilisation of intestinal calcium absorption8
  • The Evidence-Based Recommendations from the Cystic Fibrosis Foundation, published in JCEM 2012, recommend a minimum serum 25(OH)D level of 75nmol/L for people with cystic fibrosis9​

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Clinical Features of Vitamin D Deficiency

Osteomalacia and vitamin D deficiency treatment​

  • In young children, who have little mineral in their skeleton, vitamin D deficiency results in a variety of
    skeletal deformities classically known as rickets5​
  • In adults, the epiphyseal plates are closed and there is enough mineral in the skeleton to prevent skeletal deformities so that this mineralisation defect, known as osteomalacia, often goes undetected5​​
  • However osteomalacia causes a decrease in Bone Mineral Density (BMD) and is associated with isolated or generalised aches and pains in bones and muscles5​

Osteomalacia is softening or weakening of the bones due to a lack of vitamin D or due to a problem with the body’s ability to break down and absorb vitamin D.​

  • Vitamin D deficiency causes muscle weakness​
  • Affected children have difficulty standing and walking​
  • The elderly have increasing sway and more frequent falls, thereby increasing their risk of fracture5​​
References​
  1. Cashman K et al. Vitamin D status of Irish adults: findings from the National Adult Nutrition Survey. British Journal of
    Nutrition (2013), 109, 1248-1256.​
  2. Scientific Advisory Committee on Nutrition (SACN) Vitamin D and Health Report, 2016, P 1 – 285​
  3. The Royal Osteoporosis Society (ROS). Vitamin D and Bone Health: A Practical Clinical Guideline for Patient Management. December 2018. V2.​
  4. Holick M et al. Evaluation, Treatment, and Prevention of Vitamin D Deficiency: an Endocrine Society Clinical Practice Guideline. J Clin Endocrinol Metab; July 2011; 96(7): 1911-30.​
  5. Recommendations Abstracted from the American Geriatrics Society Consensus Statement on Vitamin D for Prevention of Falls and Their Consequences. J Am Geriatr Soc 62: 147-152, 2014.​
  6. Morin et al, Appendix 1 2023 Guideline Supplementary Tables in Clinical practice guideline for management of osteoporosis and fracture prevention in Canada: 2023 update, CMAJ October 10, 2023 195 (39) E1333-E1348.​
  7. Wagner C et al. Prevention of Rickets and Vitamin D Deficiency in Infants, Children, and Adolescents. Paediatrics Vol 122: No. 5 November 1, 2008, 1142-1152.​
  8. Godel J et al. Recommendations for Canadian mothers and infants. Paediatr Child Health 2007; 12(7): 583-9, Reaffirmed January 2017.​
  9. Tangpricha V et al. An Update on the Screening, Diagnosis, Management and Treatment of Vitamin D Deficiency in Individuals with Cystic Fibrosis: Evidence-Based Recommendations from the Cystic Fibrosis Foundation. J Clin Endocrinol Metab April 2012, 97(4): 1082-1093.​

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IE-ALT-385(2)a, Date of preparation: January 2026​

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