Executive summary of vitamin D and calcium guidance

Prophylaxis and treatment for calcium and vitamin D for children and young people with neuromuscular disorders in UK. Information for GPs and paediatricians.

Indications: children at risk of vitamin D deficiency and long-term poor bone mineralisation:

  • Boys with Duchenne muscular dystrophy on corticosteroids
  • Children with neuromuscular conditions non-weight bearing 
  • Children/young people with mobility difficulties and reduced weight-bearing
  • Additional risk factors include obesity, reduced exposure to sunlight, dark skin colour

Recommendation to maintain Vitamin D level >75 nmol/l

Bioavailability of Vitamin D: 

  • Colecalciferol has a better bioavailability than Ergocalciferol and so Colecalciferol is favoured for management of insufficiency and maintenance.

Dosing:

Insufficiency Vitamin D <75 nmols/l Replenishment Dosage:

  • Colecalciferol 6000 units daily for 3 months
  • Repeat Vitamin D level, if normalised convert to maintenance

Colecalciferol in the above dosage can only be prescribed as a ‘special’

  • Colecalciferol ( brand name Vigantolettin ) 1000 units dispersible tablets can be obtained from specials Manufacturer UL Medicines Watford WD24 4YJ
  • OR Colecalciferol 3000 units /ml can be obtained from: Martindale & Aurum Pharmaceuticals Brentwood Essex CM14 4LZ
  • Other lower dose preparations as per Children’s BNF.

Sufficient Vitamin D >75 nmols/l Maintenance Dosage:

  • 2-8 years Colecalciferol  800 units daily 
  • 8 years – 12+ Colecalciferol 800-1000 units daily 

Calcium 

Calcium is less of a concern than vitamin D as it is present in many foods. However, children (particularly) boys will need more daily calcium as they enter puberty.  If you suspect a child needs additional calcium and they are already overweight/obese then calcium in the form of a supplement (usually one containing 500 mg/day) is the preferred option.  

Dubowitz Neuromuscular Service

Contact for further information: Neuromuscular SpR 020 7405 9200 Bleep 2012 OR neuromuscular CNSs 020 7405 9200 bleep 2123/0228

Ref: Neuromuscular Vitamin D Policy GOSH 2013