Vitamin D Dosing Recommendations for People With or at Risk for Osteoporosis

Patients with or at high risk for osteoporosis should take the lowest possible dosage of vitamin D₃ with the shortest possible interval (eg, 50,000 IU monthly vs 100,000 IU every 2 months), according to study findings published in Joint Bone Spine.

Researchers presented new data and practices relevant to vitamin D levels in the general population in France to establish optimal vitamin D status and frequency of intermittent supplement dosing, and make recommendations for appropriate supplementation.

Previous literature has recommended a minimum serum 25-hydroxyvitamin D (25(OH)D) level of ≥30 ng/mL for patients who have osteoporosis or who are at high risk because of health conditions or receiving treatment that may have deleterious bone effects, as well as patients who have chronic kidney disease or are prone to falls. For a general population of healthy individuals, the literature contends that a level of at least 20 ng/mL is sufficient, but should not exceed 60 ng/mL. Approximately 50% of individuals in the general French population have serum 25(OH)D levels <20 ng/mL.

The researchers recommend beginning supplementation with a loading phase consisting of 50,000 IU/wk of vitamin D₃ for 8 weeks in patients with levels <20 ng/mL and 50,000 IU/wk for 4 weeks in patients with levels between 20 and 30 ng/mL. Subsequently, long-term supplementation should be prescribed as 50,000 IU/mo.

Patients should be reassessed after 3 to 6 months of supplementation. If a patient’s level remains <30 ng/mL, dosing interval should be shortened or dosage should be increased to 80,000 or 100,000 IU monthly. If a patient’s level rises above 60 ng/mL, the researchers recommend lengthening the dosing interval.

“Should pharmaceutical forms suitable for daily supplementation become available,” the researchers said, “patients displaying good treatment adherence could take a daily dose determined based on the 25OHD level.”

Multiple authors disclosed relationships with the pharmaceutical industry. Please see original reference for a full list of authors’ disclosures.

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Reference

Souberbielle JC, Cormier C, Cavalier E, et al. Vitamin D supplementation in France in patients with or at risk for osteoporosis: recent data and new practices [published online April 30, 2019]. Joint Bone Spine. doi:10.1016/j.jbspin.2019.04.004