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.
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 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