SUMMARY OF
RECOMMENDATIONS
Diagnostic procedure]

1.1. We recommend screening for vitamin D deficiency in individuals at risk for deficiency. We do not
recommend population screening for vitamin D deficiency in individuals who are not at risk (1| ).

1.2. We recommend using the serum circulating
25-hydroxyvitamin D [25(OH)D] level, measured by
a reliable assay, to evaluate vitamin D status in
patients who are at risk for vitamin D deficiency.

Vitamin D deficiency is defined as a 25(OH)D
below 20 ng/ml (50 nmol/liter) and vitamin D
insufficiency as a 25(OH) D of 21–29 ng/ml (52.5–
72.5) nmol/liter. We recommend against using the
serum 1,25-dihydroxyvitamin D [1,25(OH)2
D] assay
for this purpose and are in favor of using it only in
monitoring certain conditions, such as acquired and
inherited disorders of vitamin D and phosphate
metabolism (1| ).

2.0. Recommended dietary intakes of vitamin D
for patients at risk for vitamin D deficiency

2.1. We suggest that infants and children aged
0–1 yr require at least 400 IU/d (IU = 25 ng) of
vitamin D and children 1 yr and older require at
least 600 IU/d to maximize bone health. Whether
400 and 600 IU/d for children aged 0–1 yr and 1–18
yr, respectively, are enough to provide all the potential nonskeletal health benefits associated with
vitamin D to maximize bone health and muscle function is not known at this time. However, to raise the
blood level of 25(OH)D consistently above 30 ng/ml
(75 nmol/liter) may require at least 1000 IU/d of
vitamin D (2| ).

2.2. We suggest that adults aged 19–50 yr require
at least 600 IU/d of vitamin D to maximize bone
health and muscle function. It is unknown whether
600 IU/d is enough to provide all the potential
nonskeletal health benefits associated with vitamin
D. However, to raise the blood level of 25(OH)D
consistently above 30 ng/ml may require at least
1500–2000 IU/d of vitamin D (2| ).

2.3. We suggest that all adults aged 50–70 and 70+ yr
require at least 600 and 800 IU/d, respectively, of
vitamin D to maximize bone health and muscle
function. Whether 600 and 800 IU/d of vitamin D
are enough to provide all of the potential nonskeletal
health benefits associated with vitamin D is not
known at this time. Among those age 65 and older
we recommend 800 IU/d for the prevention of falls
and fractures. However, to raise the blood level of
25(OH)D above 30 ng/ml may require at least 1500–
2000 IU/d of supplemental vitamin D (2| ).

2.4. We suggest that pregnant and lactating women
require at least 600 IU/d of vitamin D and recognize
that at least 1500–2000 IU/d of vitamin D may be
needed to maintain a blood level of 25(OH)D above
30 ng/ml (2| ).

2.5. We suggest that obese children and adults and
children and adults on anticonvulsant medications,
glucocorticoids, antifungals such as ketoconazole, and
medications for AIDS be given at least two to three
times more vitamin D for their age group to satisfy
their body’s vitamin D requirement (2| ).

2.6. We suggest that the maintenance tolerable
upper limits (UL) of vitamin D, which is not to be
exceeded without medical supervision, should be
1000 IU/d for infants up to 6 months, 1500 IU/d for
infants from 6 months to 1 yr, at least 2500 IU/d for
children aged 1–3 yr, 3000 IU/d for children aged
4–8 yr, and 4000 IU/d for everyone over 8 yr.
However, higher levels of 2000 IU/d for children
0–1 yr, 4000 IU/d for children 1–18 yr, and 10,000
IU/d for children and adults 19 yr and older may be
needed to correct vitamin D deficiency (2| ).

3.0. Treatment and prevention strategies
3.1. We suggest using either vitamin D2
or vitamin
D3
for the treatment and prevention of vitamin D
deficiency (2| ).

Canadian Endocrine Society Guidelines. Ref-J CLINICAL ENDOCRINOL METAB: JULY 2011.

G.MOHAN.