Endocrine Abstracts

Current strategies for prevention of vitamin D deficiency are primarily aimed at infants and young children to prevent rickets. In most countries this is based on recommendations to take a daily multivitamin supplement containing vitamin D often in a dose of 350–400 IU. There is variation in recommendations as to at risk groups who should receive supplementation and at what age these commence. In the UK this is currently delivered through the Healthy Start scheme with a recommended age of commencement at 6 months. The uptake of Healthy Start multivitamins is however quite poor which at best reaches 20% of the relevant age group. Some European countries advocate higher daily doses of 1000–1200 IU daily in infants up to age 18 months.

The concept of intermittent dosing to prevent vitamin D deficiency in this age group is not widely accepted with some concerns regarding vitamin D toxicity. Children with chronic disease are often at risk of vitamin D deficiency with different strategies being used to maintain acceptable vitamin D levels.

The treatment of vitamin D deficiency is again largely based on daily oral dosing for several weeks. Recommended dosage guidelines vary significantly internationally with little supporting evidence base and some variation in the threshold for defining vitamin D sufficiency. A significant issue in the UK is the use of unlicensed vitamin D preparations which are regarded as ‘special products’ and as such may attract significant prescribing costs. Newer licensed products are becoming available which may change this. The use of single or intermittent large doses or ‘stoss therapy’ although used in some countries are not routinely used although there is a reasonable evidence base for their efficacy and safety. A recent international consensus meeting on Rickets hosted by ESPE has produced recommendations on prevention and treatment of vitamin D deficiency in children.