title: Treatment of vitamin D deficiency: divergence between clinical practice and expert advice.
abstract: BACKGROUND
  Current recommendations for the treatment of vitamin D deficiency vary from calciferol 800 IU per day to loading doses of vitamin D followed by maintenance therapy of up to 2000 IU per day.
  
  
  OBJECTIVE
  To assess the preparations and doses of vitamin D used to load and maintain patients with serum 25-hydroxyvitamin D (25OHD) <25 nmol/l.
  
  
  METHODS
  We examined all requests for serum 25OHD over a 12-month period, from September 2009 to 2010 in southwest Scotland. We wrote to all 33 general practices asking whether they usually started replacement therapy with a loading dose and/or recommended over-the-counter maintenance preparations. We accessed the Emergency Care Summary for all patients with serum 25OHD <25 nmol/l to determine whether they had been prescribed maintenance therapy.
  
  
  RESULTS
  Serum 25OHD was requested in 1162 patients. Levels were <25 nmol/l in 282 (24%) patients, only 173 (61%) of whom were receiving vitamin D replacement therapy 3-15 months after diagnosis. Only four (1.4%) were prescribed a loading dose. One hundred and fifty-three (54%) were treated with cholecalciferol or ergocalciferol and 19 (7%) with alfacalcidol or calcitriol. The median dose of chole/ergocalciferol was 800 IU per day, usually in combination with 1200 mg calcium per day.
  
  
  CONCLUSIONS
  We have shown a divergence between clinical practice and even the most conservative expert advice for vitamin D replacement therapy. Possible explanations are conflicting advice on treatment and difficulty obtaining suitable vitamin D preparations, particularly high dose vitamin D and vitamin D without calcium, in the UK.
authors.affiliation: Department of Medicine, Dumfries and Galloway Royal Infirmary, Dumfriesshire, UK.
authors.forename: Mark
authors.initials: M
authors.lastname: Findlay
authors.forename: Julia
authors.initials: J
authors.lastname: Anderson
authors.forename: Susan
authors.initials: S
authors.lastname: Roberts
authors.forename: Alison
authors.initials: A
authors.lastname: Almond
authors.forename: Chris
authors.initials: C
authors.lastname: Isles
mesh_terms: D015652:25-Hydroxyvitamin D 2 / Q000008:administration & dosage / Q000097:blood / Q000172:deficiency; D000328:Adult; D000368:Aged; D050071:Bone Density Conservation Agents / Q000008:administration & dosage; D002117:Calcitriol / Q000008:administration & dosage / Q000172:deficiency; D002118:Calcium / Q000097:blood*; D002762:Cholecalciferol / Q000008:administration & dosage / Q000172:deficiency; D003625:Data Collection; D019587:Dietary Supplements; D004305:Dose-Response Relationship, Drug; D004339:Drug Compounding / Q000379:methods / Q000592:standards; D011307:Drug Prescriptions / Q000592:standards*; D004872:Ergocalciferols / Q000008:administration & dosage / Q000172:deficiency; D005260:Female; D006801:Humans; D008297:Male; D054539:Medication Therapy Management; D008660:Metabolism; D008875:Middle Aged; D004366:Nonprescription Drugs / Q000592:standards / Q000627:therapeutic use; D010818:Practice Patterns, Physicians' / Q000592:standards*; D015995:Prevalence; D012606:Scotland / Q000453:epidemiology; D014808:Vitamin D Deficiency / Q000097:blood / Q000188:drug therapy / Q000453:epidemiology
chemical_list: D050071:Bone Density Conservation Agents; D004872:Ergocalciferols; D004366:Nonprescription Drugs; D002762:Cholecalciferol; D015652:25-Hydroxyvitamin D 2; D002117:Calcitriol; D002118:Calcium