Clinical Practice in the Prevention, Diagnosis and Treatment of Vitamin D Deficiency: A Central and Eastern European Expert Consensus Statement
Central and Eastern European expert consensus · 2022 · international
Source and licence
- Authors
- Pawel Pludowski, Istvan Takacs, Mihail Boyanov et al.
- Title
- Clinical Practice in the Prevention, Diagnosis and Treatment of Vitamin D Deficiency: A Central and Eastern European Expert Consensus Statement
- Journal
- Nutrients, 2022
- Licence
- CC BY 4.0
- Changes
- Verbatim excerpts; formatting adapted
Full text retrieved 2026-10-27 from Europe PMC · PMC9002638
Licence statement of the original publication
Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/).
This page reproduces excerpts of the original publication; the original is authoritative. It has not been reviewed by a physician, does not state a recommendation of Medelix and does not replace medical advice. The guideline may have been updated since.
Open the original publication →Full text on Europe PMC
Recommendations
Verbatim, with grade of recommendation or strength of consensus where given.
3.1. Current Situation of Vitamin D Deficiency Diagnosis, Prevention and Treatment
- To ensure an adequate screening, prevention and treatment of vitamin D deficiency in the clinical practice, it is necessary to increase the awareness and improve education in the public and medical community.Moreover, national and international guidelines/recommendations should be precise regarding the risk groups that need to be screened, the adequate dosages for prevention and treatment of vitamin D deficiency, the treatment regimen as well as the follow-up to allow transfer into clinical practice.Consensus Voting Scale: 9 (strongly agree); Level of Agreement: 80%
3.2. Screening of Vitamin D Deficiency in Adults
- Screening of vitamin D deficiency should be considered in the following patients/individuals or conditions:Osteoporosis; Osteomalacia; Musculoskeletal pain; Chronic kidney disease; Hepatic failure; Malabsorption syndromes (e.g., cystic fibrosis, inflammatory bowel diseases, bariatric surgery, radiation enteritis); Hyperparathyroidism; Chronic treatment with medications that influence vitamin D metabolism (e.g., antiseizure medications, glucocorticoids, AIDS-medications, antifungal agents, cholestyramine); Chronic autoimmune diseases (e.g., multiple sclerosis, rheumatoid arthritis); Pregnant and lactating women; Institutionalized or hospitalized patients; Older adults (>65 years) in general; Older adults with history of falls or nontraumatic fractures; Granuloma-forming disorders (e.g., sarcoidosis, tuberculosis, histoplasmosis, berylliosis, coccidiomycosis); Obesity (BMI ≥ 30kg/m2); dark skin pigmentation.25(OH)D is recommended as a laboratory marker for the diagnosis of vitamin D deficiency. In patients with diagnosed vitamin D deficiency (25(OH)D < 20 ng/mL (<50 nmol/L)) and suspected related health issues, serum calcium, phosphate, alkaline phosphatase, parathyroid hormone (PTH), creatinine, and serum magnesium levels should be considered for evaluation; in particular in individuals with a 25(OH)D concentration of <10 ng/mL (<25 nmol/L).A 25(OH)D concentration of <20 ng/mL (<50 nmol/L) is considered as vitamin D deficiencyA 25(OH)D concentration of ≥20 ng/mL (≥50 nmol/L) and <30 ng/mL (<75 nmol/L) is considered as vitamin D insufficiencyA 25(OH)D concentration of 30–50 ng/mL (75–125 nmol/L) is considered as vitamin D sufficiencyA 25(OH)D concentration of >50–60 ng/mL (125–150 nmol/L) is considered as safe but not as a target levelA 25(OH)D concentration of >60–100 ng/mL (150–250 nmol/L) is considered as area of uncertainty with potential benefits or risks.A 25(OH)D concentration of >100 ng/mL (250 nmol/L) is considered as oversupply/vitamin D toxicityConsensus Voting Scale: 9 (strongly agree); Level of Agreement: 50%
3.3. Prevention of Vitamin D Deficiency in Adults
- In healthy adults without other risk factors, a supplementation of 800–2000 IU/day, for those who want to achieve a targeted/measured 25(OH)D concentration, should be considered during wintertime (mainly November-April) due to insufficient endogenous dermal vitamin D synthesis and depending on the body weight.Due to decreased skin synthesis in elderly (>65 years), a supplementation of 800–2000 IU/day is recommended throughout the year.In hospitalized/institutionalized individuals, a supplementation of 800–2000 IU/day is recommended throughout the year.Women planning a pregnancy should start or maintain the vitamin D supplementation as recommended for healthy adults without other risk factors (800–2000 IU/day). The vitamin D supplementation should be continued throughout pregnancy and lactation.In certain patients/individuals or conditions 2–3 times higher vitamin D dosages, without using vitamin D doses above the UL of 4000 IU/day, are recommended for prevention compared to healthy adults without other risk factors:Malabsorption (e.g., cystic fibrosis, inflammatory bowel diseases, bariatric surgery, radiation enteritis)Obesity (BMI ≥ 30 kg/m2)Dark skin pigmentationAs vitamin D metabolites are stored in fat and other tissues and gradually released into the blood circulation, a daily or weekly or monthly supplementation regimen is equally effective and safe, if monthly doses are not exceedingly high, for the prevention of vitamin D deficiency.A tailored approach for vitamin D administration, involving the patients’ preferences of the supplementation regimen (daily, weekly, monthly) might enhance the adherence to preventive vitamin D supplementation.For the prevention of vitamin D deficiency, the supplementation of oral cholecalciferol (vitamin D3) is recommended.Consensus Voting Scale: 9 (strongly agree); Level of Agreement: 30%
3.4. Treatment of Vitamin D Deficiency in Adults
- It is recommended to initiate a vitamin D deficiency treatment at a 25(OH)D concentration of <20 ng/mL (<50 nmol/L). At a concentration of <30 ng/mL (<75 nmol/L) a treatment may be considered.Individuals with diagnosed vitamin D deficiency can be initially treated with higher vitamin D dosages compared to the preventive dosages recommended for the general population, if a rapid correction of the 25(OH)D concentration is clinically indicated. As initial dose for the treatment of vitamin D deficiency in patients without other risk factors, a dosage of 6000 IU, equivalent to a daily dosage, is recommended.In certain individuals or conditions, higher vitamin D dosages, up to 10,000 IU, equivalent to a daily dosage, are recommended for treatment compared to healthy adults without other risk factors (Endocrine Society recommendation) [14]:-Malabsorption (e.g., cystic fibrosis, inflammatory bowel diseases, bariatric surgery, radiation enteritis)-Chronic treatment of medications that influence vitamin D metabolism (e.g., antiseizure medications, glucocorticoids, AIDS-medications, antifungal agents, cholestyramine)-Obesity (BMI ≥ 30 kg/m2)A treatment duration of 4–12 weeks is recommended, depending on the severity of vitamin D deficiency.A tailored approach for vitamin D administration, involving the patients’ preferences of the treatment regimen (daily, weekly, monthly) might enhance the adherence to the therapy.As soon as a 25(OH)D concentration of 30–50 ng/mL (75–125 nmol/L) is achieved, a maintenance dose of 800–2000 IU/day is recommended, that can also be used as an initial treatment dose if there is no requirement for a rapid correction of vitamin D deficiency.Approx. 6–12 weeks after start of the treatment, the effectiveness may be evaluated by measurement of the 25(OH)D concentration particularly in certain risk groups with e.g., malabsorption syndrome.For the treatment of vitamin D deficiency in adults, oral cholecalciferol (vitamin D3) is preferred.Calcifediol may be used instead of vitamin D in certain conditions, including obesity or malabsorption.Calcitriol and active vitamin D analogues may be considered in special patient groups.In certain risk groups (e.g., patients with severe malabsorption), parenteral vitamin D treatment can be considered.Consensus Voting Scale: 9 (strongly agree); Level of Agreement: 60%
3.5. Vitamin D in Musculoskeletal Disorders
- In osteoporosis patients, a supplementation of 800–2000 IU/day, with oral cholecalciferol (vitamin D3) is recommended in combination with calcium, if indicated.Vitamin D deficiency may impair the response to the osteoporosis treatment, thus screening of the 25(OH)D level and correction of vitamin D deficiency before starting the osteoporosis treatment with antiresorptive medications is recommended.In patients with an increased risk of falls or fractures, a supplementation of 800–2000 IU/day is recommended.Consensus Voting Scale: 9 (strongly agree); Level of Agreement: 30%
3.6. Extra-Skeletal Actions of Vitamin D in Adults
- Results from observational studies consider a low 25(OH)D concentration as a potential risk marker for several diseases such as cancer incidence and mortality, cardiovascular diseases, diabetes mellitus and its comorbidities, chronic autoimmune diseases, metabolic syndrome, acute respiratory tract infections, neurological diseases and total mortality.Results from meta-analyses of RCTs suggest that beyond musculoskeletal-effects, vitamin D supplementation may have beneficial extra-skeletal effects regarding acute respiratory tract infections and cancer mortality.In patients with or at risk of different types of cancer, certain cardiovascular diseases, diabetes mellitus and its comorbidities, chronic autoimmune diseases, certain neurological diseases and recurrent acute respiratory tract infections, a screening of vitamin D deficiency should be considered, and preventive vitamin D supplementation may be considered.Consensus Voting Scale: 9 (strongly agree); Level of Agreement: 60%
Abstract
Vitamin D deficiency has a high worldwide prevalence, but actions to improve this public health problem are challenged by the heterogeneity of nutritional and clinical vitamin D guidelines, with respect to the diagnosis and treatment of vitamin D deficiency. We aimed to address this issue by providing respective recommendations for adults, developed by a European expert panel, using the Delphi method to reach consensus. Increasing the awareness of vitamin D deficiency and efforts to harmonize vitamin D guidelines should be pursued. We argue against a general screening for vitamin D deficiency but suggest 25-hydroxyvitamin D (25(OH)D) testing in certain risk groups. We recommend a vitamin D supplementation dose of 800 to 2000 international units (IU) per day for adults who want to ensure a sufficient vitamin D status. These doses are also recommended for the treatment of vitamin D deficiency, but higher vitamin D doses (e.g., 6000 IU per day) may be used for the first 4 to 12 weeks of treatment if a rapid correction of vitamin D deficiency is clinically indicated before continuing, with a maintenance dose of 800 to 2000 IU per day. Treatment success may be evaluated after at least 6 to 12 weeks in certain risk groups (e.g., patients with malabsorption syndromes) by measurement of serum 25(OH)D, with the aim to target concentrations of 30 to 50 ng/mL (75 to 125 nmol/L).
Contents of the original publication
The section headings of the original.
- 1. Introduction
- 2. Consensus Development Process
- 3. Consensus Recommendations
- 3.1. Current Situation of Vitamin D Deficiency Diagnosis, Prevention and Treatment
- 3.2. Screening of Vitamin D Deficiency in Adults
- 3.3. Prevention of Vitamin D Deficiency in Adults
- 3.4. Treatment of Vitamin D Deficiency in Adults
- 3.5. Vitamin D in Musculoskeletal Disorders
- 3.6. Extra-Skeletal Actions of Vitamin D in Adults
- 3.7. Development of a Vitamin D Deficiency Screening and Treatment Algorithm
- 4. Strengths and Limitations
- 5. Conclusions
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