Asked by audience members what she does about vitamin D in her own practice, Dr. Buckley said she generally tries to get patients into the 20-29 ng/mL range, while in African Americans and patients with known cardiovascular disease, she aims for 15 ng/mL or slightly more—“and I worry that might be too high sometimes.”
She reserves expedited supplementation—50,000 IU weekly for 8 weeks—mainly for vitamin D–deficient elderly patients at high risk for fracture or fall. There is no evidence to support supplementation in young or middle-aged patients, whose increased fracture risk is decades away.
Updated recommendations on vitamin D from the Institute of Medicine, due this spring, will likely recommend an increase in the currently recommended supplemental 400 IU/day for 50- to 70-year-olds not getting sufficient vitamin D from the sun. Dr. Buckley said she hopes the IOM will address the thorny issues of who should receive supplementation, and how quickly.
A related video is at www.youtube.com/InternalMedicineNews
Disclosures: Dr. Buckley reported having no relevant financial relationships.
The vitamin D assay is one of the most-ordered tests, despite questions about its reliability.
Source DR. BUCKLEYPASCAL/FOTOLIA.COM
This Month's Talk Back Question
What is your approach to advising patients about vitamin D and calcium supplementation?