Vitamin D Replacement

Objective: Monitor for and manage Vitamin D deficiency

Patient population: Individuals with known diagnosis of IBD and low serum 25-hydroxyvitamin D

Highlight Box Vitamin D deficiency is common among IBD patients. Restoring and maintaining appropriate levels of Vitamin D may help maintain remission.

Introduction

This care protocol provides a general guideline for monitoring and managing vitamin D deficiency in adults with inflammatory bowel disease. The availability of the listed options for vitamin D replacement may vary across organizations.

IBD Provider:

1. Check serum Vitamin D annually.

a. If 75-125nmol/l  - recommend 1000 - 2000 IU daily

b. 50-75 nmol/L – recommend 5000-10000 IU daily, or replace

c. Replace if <50 nmol/L

2. Re-assess vitamin D levels at 4 months, if vitamin D deficiency identified

3. Generate a vitamin D replacement Rx as per options for replacement below and give it to support staff

Support Staff:

4. Use letter templates for low vitamin D and send them to the patient and one to the patient’s GP.

5. Print bloodwork requisition to test vitamin D and calcium levels for the patient to complete in 4 months 

Table 1 Options for replacement

Type of Vitamin D	Availability	Dosage	Form	Route
Vitamin D3	OTC	400 IU, 1000 IU	Tablet	Oral
Vitamin D3 (D-VI-SOL)	OTC	400 IU/mL	Liquid	Oral
Vitamin D3 (DROPS)	OTC	600 or 1000 units/drop (5ml=180drops)	Liquid	Oral
Vitamin D3 (Euro-D)	Rx	10,000 IU	Capsule	Oral
Vitamin D3	Rx	2000-75,000 IU	Capsule/Tab	Oral
Vitamin D2 (OSTO-D2, D- FORTE)	Rx	50,000 IU	Capsule	Oral
Calcitriol (ROCALTROL)	Rx	0.25ug, 0.5ug	Capsul	Oral
Cholecalciferol (in sesame oil)	Rx	250,000 - 500,000 IU	Injection	Intramuscular

Table 4: Recommended Dose

Vitamin D level	Intramuscular**
50-75 nmol/L	250,000 IU x 1
<50 nmol/L	500,000 IU x 1

** not applicable to pediatrics

Note: Vitamin D3 may have a longer half-life than vitamin D2 and may be more potent, causing two- to threefold greater storage of vitamin D.

Other resources:

Vitamin D supplementation evidence https://www.rxfiles.ca/rxfiles/uploads/documents/Vitamin-D-Overview-QandA.pdf

Patient education: Vitamin D deficiency (Beyond the Basics) (freely accessible) https://www.uptodate.com/contents/vitamin-d-deficiency-beyond-the-basics#H13

Easy to read list of common foods reach in vitamin D https://osteoporosis.ca/bone-health-osteoporosis/calcium-and-vitamin-d/vitamin-d/

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