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Vitamin D

Checked: 01-03-2024 by Rob Adams Next Review: 01-03-2026

Vitamin D Deficiency in Adults

Guidelines

BNSSG Adult Vitamin D Prescribing Guidelines (updated Feb 2024) give a good overview on appropriate vitamin D testing and treatment including prescribing options.

The guidelines advise that Vitamin D levels should not be routinely checked in primary care unless symptoms are present.

Prescribing of vitamin D supplements should be reserved for patients at high risk or those with confirmed vitamin D deficiency (<25 nmol/litre). Other lower risk patients should be given dietary and lifestyle advice and encouraged to buy over the counter supplements. A patient leaflet can be found on the link above.

The guideline also covers the following scenarios:

Follow up testing of Vitamin D levels (not normally required)
When to check calcium levels
Vitamin D Deficiency in renal impairment
Vitamin D supplements when pregnant or breast feeding

Patient Leaflets

Patient information leaflet (BNSSG formulary) - give advice on safe sun exposure, dietary advice and oral supplements for adults.
Vitamins, minerals and supplements in pregnancy - NHS (www.nhs.uk) - includes advice for pregnant women on vitamin D supplements.

When to Seek Specialist Advice

Seek specialist advice prior to starting treatment for patients in the following scenarios:

Medical conditions which predisposes them to hypercalcaemia (e.g. granulomatous disease, metastatic bone disease, some lymphomas, primary hyperparathyroidism)
Active or history of renal stones
Severe liver disease or end-stage CKD
Gastrointestinal or malabsorption disorder likely to need intensive high-dose replacement
Pregnancy where laboratory tests confirm vitamin D insufficiency or deficiency

Vitamin D Deficiency in Children

Please see the Vitamin D Deficiency in Children page to link to the BRHC guidelines.

Prevention of Vitamin D Deficiency

CKS guidelines recommend that daily vitamin D supplements should be taken by adults who are aged 65 years old and those in at risk groups in addition to lifestyle measures (safe sunlight exposure and diet).

All other adults should also consider taking a daily supplement, particularly in the autumn and winter.

These supplements can be purchased and should not be prescribed and should contain 400 IU (10ug) of vitamin D.

Routine monitoring of serum 25-hydroxyvitamin D (25[OH]D) levels is not needed.

For full guidance see:

Scenario: Prevention | Management | Vitamin D deficiency in adults | CKS | NICE

Resources

Vitamin D deficiency in adults | Health topics A to Z | CKS | NICE

Vitamin D supplements in pregnancy: what’s the latest evidence? - Evidently Cochrane

Efforts are made to ensure the accuracy and agreement of these guidelines, including any content uploaded, referred to or linked to from the system. However, BNSSG ICB cannot guarantee this. This guidance does not override the individual responsibility of healthcare professionals to make decisions appropriate to the circumstances of the individual patient, in consultation with the patient and/or guardian or carer, in accordance with the mental capacity act, and informed by the summary of product characteristics of any drugs they are considering. Practitioners are required to perform their duties in accordance with the law and their regulators and nothing in this guidance should be interpreted in a way that would be inconsistent with compliance with those duties.

Information provided through Remedy is continually updated so please be aware any printed copies may quickly become out of date.