3, 28 Based on these concerns, the American Academy of Pediatrics recently recommended doubling the minimum daily intake for children and adolescents to 400 IU ( Table 4 29). 8, 26, 27 However, recent research suggests that current AI recommendations for children and adults may be too low to maintain optimal levels (above 30 ng per mL) for calcium absorption and parathyroid hormone suppression. The current daily AI is 200 IU for infants, children, and adults younger than 51 years 400 IU for adults 51 to 70 years of age and 600 IU for adults older than 70 years. To prevent vitamin D deficiency in persons with inadequate sun exposure, the Institute of Medicine has recommended adequate intake (AI) based on levels needed to maintain optimal bone health in all members of a healthy population. After vitamin D levels normalize, experts recommend maintenance dosages of cholecalciferol (vitamin D 3) at 800 to 1,000 IU per day from dietary and supplemental sources. In persons with vitamin D deficiency, treatment may include oral ergocalciferol (vitamin D 2) at 50,000 IU per week for eight weeks. Evidence shows that vitamin D supplementation of at least 700 to 800 IU per day reduces fracture and fall rates in adults. To prevent vitamin D deficiency, the American Academy of Pediatrics recommends that infants and children receive at least 400 IU per day from diet and supplements. The goal of treatment is to normalize vitamin D levels to relieve symptoms and decrease the risk of fractures, falls, and other adverse health outcomes. Deficiency is defined as a serum 25-hydroxyvitamin D level of less than 20 ng per mL (50 nmol per L), and insufficiency is defined as a serum 25-hydroxyvitamin D level of 20 to 30 ng per mL (50 to 75 nmol per L). A 25-hydroxyvitamin D level should be obtained in patients with suspected vitamin D deficiency. Common manifestations of vitamin D deficiency are symmetric low back pain, proximal muscle weakness, muscle aches, and throbbing bone pain elicited with pressure over the sternum or tibia. Vitamin D deficiency affects persons of all ages.
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