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.

• 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.

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

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’Sufficient Vitamin D >75 nmols/l - maintenance dosage:

• 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
• two to eight years old - Colecalciferol  800 units daily 
• eight years to 12 plus - Colecalciferol 800-1000 units daily 

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.

Contact the Dubowitz Neuromuscular Service for further information

• Neuromuscular SpR - 020 7405 9200 - bleep 2012
• Neuromuscular CNSs - 020 7405 9200 bleep - 2123 or 0228