Background Recent medical research has highlighted that vitamin D deficiency/insufficiency is a significant public health problem. A UK study found that more than 50% of the adult population had insufficiency and 16% had deficiency. [1] Low vitamin D levels have been linked to rickets, malignancies, cardiovascular disease, type 2 diabetes and some autoimmune diseases. [1] Therefore, appropriate management of Vitamin D deficiency/insufficiency is essential.

This increased awareness among prescribers of treating vitamin D deficiency was apparent in the Mater Misericordiae University Hospital (MMUH):

• Medicines Information enquiries regarding treatment of vitamin D deficiency had increased.

• Biochemistry assay numbers for vitamin D (25-hydroxy-vitamin D) had increased.

• Requests to the endocrinology service for guidance on the treatment of vitamin D deficiency had increased.

MMUH clinicians were experiencing difficulty treating patients with vitamin D deficiency/insufficiency as:

• There were no definitive guidelines for the treatment of vitamin D deficiency/insufficiency.

• There is no licenced preparation containing cholecalciferol or ergocalciferol as a single drug formulation in Ireland.

Guidance for MMUH clinicians was therefore necessary.

Purpose To develop a protocol for the treatment of vitamin D deficiency/insufficiency.

Materials and Methods Review of treatment algorithms for treatment of vitamin D deficiency/insufficiency in the literature.

Compilation of vitamin D products currently available in Ireland.

Liaison with MMUH clinical staff to ensure production of a protocol that is applicable to all disciplines.

Results A treatment algorithm was prepared detailing two specific guidelines for the treatment of:

• Vitamin D deficiency (serum 25-hydroxy-vitamin D <25 nmol/L)

• Vitamin D insufficiency (serum 25-hydroxy-vitamin D 25–50 nmol/L)

The protocol recommends vitamin D preparations, including one unlicensed preparation, which are available in the MMUH and accessible in the community.

The protocol also recognises the limitation of giving guidance on treating a condition that may be affected by numerous clinical scenarios or that may require input from specialist physicians. Where applicable, consultation with the relevant medical team(s) is recommended.

Conclusions MMUH patients diagnosed with vitamin D deficiency/insufficiency are treated in a standardised manner in accordance with available clinical evidence. The protocol ensures delays in treatment are minimised and physicians are aware of the particular considerations involved in the management of vitamin D deficiency/insufficiency.

No conflict of interest.