National Osteoporosis Society publishes new guidance on vitamin D
The National Osteoporosis Society has published a clinical guideline for health professionals on vitamin D prescribing and the management of bone heath in adults. The guideline provides up-to-date advice from clinicians and scientists with expertise in vitamin D and osteoporosis, using evidence from the 2010 Institute of Medicine report and the 2016 Scientific Advisory Committee on Nutrition Report on vitamin D and health, as well as more recently published scientific papers.
The new guideline recommends that measurement of plasma 25-hydroxy vitamin D is the best way of estimating vitamin D status. There is currently no universal consensus on the criteria for vitamin D deficiency, but the guidance proposes vitamin D thresholds that should be adopted by UK healthcare professionals, namely that 25-hydroxy vitamin D plasma levels <25nmol/L is deficient; 25–50nmol/L is inadequate in some people; and >50nmol/L is sufficient for almost the whole population. Vitamin D testing is recommended in patients with musculoskeletal symptoms that could be attributed to vitamin D deficiency, and in patients with bone disease or suspected bone disease that may be improved with vitamin D treatment. The guidance adds that routine vitamin D testing is unnecessary in most cases in patients with osteoporosis or fragility fracture, who may be co-prescribed vitamin D supplements with their oral antiresorptive treatment.
The guideline recommends oral vitamin D3 (cholecalciferol) as the treatment of choice in vitamin D deficiency, with a dosage equivalent to 800–2000IU daily (taken either daily or intermittently at higher doses) recommended as maintenance therapy (preceded by a loading regimen if necessary). Plasma calcium should be checked after one month but routine monitoring of plasma 25-hydroxy vitamin D is generally unnecessary. Adequate dietary calcium intake should be promoted for optimisation of bone health.