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Risk Factor Cause Inadequate sunlight exposure Residing in cold climates Residing in northern latitudes Wearing sun protective clothing Wearing winter protective clothing Inadequate dietary intake Vegetarian diet Vegan diet Malabsorption syndromes Crohn’s disease Celiac disease Ethnic minorities, particularly those with darker skin pigmentation, have higher incidence of vitamin D deficiency. Screening for vitamin D deficiency118 “I” Recommendation: There is insufficient evidence to recommend screening asymptomatic non -pregnant adults in the general population for vitamin D deficiency. Vitamin D for the primary prevention of falls121 “D” Recommendation: Evidence suggests against the use of vitamin D at any dose for the primary prevention of falls. Vitamin D and calcium for primary prevention of fractures122 Postmenopauasal women for vitamin D doses less than 400 IU or calcium doses less than 1000 mg “D” Recommendation. Evidence suggests against the use of vitamin D at low doses for fracture prevention in postmenopausal women. Postmenopauasal women for vitamin D doses greater than 400 IU or calcium doses greater than 1000 mg “I” Recommendation. There is insufficient evidence to recommend the use of vitamin D at higher doses for fracture prevention in postmenopausal women. Men and premenopausal women “I” Recommendation. There is insufficient evidence to recommend the use of vitamin D at any dose for fracture prevention in men and premenopausal women. Population Recommended Daily Allowance Age 0–12 months 10 mcg (400 IU) 1–13 years 15 mcg (600 IU) 14–70 years 15 mcg (600 IU) >71 years 20 mcg (800 IU) Special populations Pregnancy 15 mcg (600 IU) Lactation 15 mcg (600 IU) Bariatric surgery 75 mcg (3000 IU), titrate to serum level of >30 ng/mL Abbreviation: IU, International Units.
Clinical Recommendation Evidence Rating Comments Patients with COVID-19 infection demonstrate reduced morbidity, but not mortality, when supplemented with vitamin D. B Meta-analyses showing decreased severity of illness from COVID-19 infection with vitamin D supplementation.38–40 Avoid vitamin D doses of 100 mcg (4000 IU) per day or higher as well as intermittent high dose regimens due to increased risk of falls in the elderly. B Several randomized controlled trials demonstrate that high dose regimens can increase the risk of falls.44–46 Based on a single RCT there is suggestion that the optimal dose may be 1600 to 3200IU daily.46 In patients with vitamin D deficiency and fibromyalgia, supplement with vitamin D3 doses of 50000 international units weekly to improve pain. B Findings are generally consistent however, the included studies are lower quality clinical trials.63,64 In patients with dementia, correct known hypovitaminosis D. C Based on expert consensus despite a lack of clear evidence of benefit.51,52 For patients with symptomatic depression, supplement with vitamin D3 37.5 mcg daily to reduce depressive symptoms. B Two RCTs testing different doses of vitamin D in patients with clinically significant depressive symptoms showed consistent findings of improved symptoms.57,58 For patients with prediabetes, supplement with vitamin D3 1000 IU per day or greater to reduce progression to T2DM B Meta-analysis results showing benefit in higher dose (>1000 IU) subgroup.70 Conflicting RCT results from recent study may be due to novel vitamin D formulation.71 For pediatric and adult patients with persistent atopic dermatitis, consider supplementing with vitamin D3 25 to 50 mcg daily to reduce AD symptoms in addition to standard emollient care. B Based on meta-analyses, limited by small sample sizes, showing reductions in AD severity scoring measures with vitamin D supplementation of 25 to 50 mcg daily.75,76,81,82 For pregnant patients with known hypovitaminosis D, supplement with vitamin D3 25 to 50mcg per day. Consider supplementing all pregnant patients with vitamin D3 25 to 50mcg per day. B Based on a meta-analysis demonstrating decreased fetal mortality and expert consensus despite lack of clear evidence of benefit for other pregnancy conditions.98,100 For human milk-fed infants in the first year of life, supplement 10 mcg of vitamin D3 daily to prevent vitamin D deficiency and rickets C Based on consensus opinion, not substantiated by most recent Cochrane review.106,107 Abbreviations: RCT, randomized controlled trials; IU, International Units.
- Table 1.
The United States Food and Drug Administration (FDA) Updated Units for Dosing Equivalents of Vitamin D
Old Units (International Units [IU]) New Units (Micrograms [mcg]) 400 IU 10 mcg 800 IU 20 mcg 1000 IU 25 mcg 2000 IU 50 mcg 5000 IU 125 mcg 50,000 IU 1250 mcg
