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 BoxVitamin 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 |
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/