Abstract
Vitamin D deficiency has become commonplace, especially in older people. Given the role it plays in bone health and falls prevention, as well as the growing evidence of its extra-skeletal actions, it is important to treat vitamin D deficiency adequately. Our practice has been 2 to 3 weeks of daily treatment with 50,000IU ergocalciferol as a loading dose. However, recent guidelines recommend half this total cumulative dose given over a period of 6 to 8 weeks. Rather than promptly following the guidelines and changing our practice, we opted to conduct a quality improvement project (QIP) looking at the effectiveness of our protocol for treating Vitamin D deficiency in older patients. In the initial project patients admitted to an acute geriatric ward and found to have vitamin D deficiency were prescribed a 2 weeks course of daily ergocalciferol. In the second project, patients with severe deficiency (<20 IU/ml) received 3 weeks of treatment. In all patients pre- and post-treatment vitamin D levels were done. In total 76 patients were included. Results: all patients demonstrated significant improvement. Post-treatment serum vitamin D levels returned to normal in 66%. The median change in vitamin D level was 265%. Importantly no side effects were noted and no patient reached toxic serum vitamin D levels. Conclusion: Our results show that doses higher than the current recommendations for treating vitamin D deficiency are needed to replenish depleted vitamin D stores in older people. Compared to recommended strategies which generally span over 6 to 8 weeks, our daily protocol provides rapid replacement over 2 to 3 weeks. It is effective and safe with no side-effects. The short course of daily treatment should also increase patient compliance