Endocrinologists Dr Zahra Ravat and Professor Zaki Hassan-Smith discuss key challenges in identifying and managing vitamin D deficiency in primary care, including interpretation of tests, when investigations are required, recommended treatment to correct levels and long-term management.
Learning objectives
This module will support your knowledge of how to manage challenges in vitamin D deficiency, including:
- Identifying which patients should be assessed for vitamin D deficiency and when testing is appropriate.
- Interpreting serum vitamin D levels and recognising deficiency, insufficiency and sufficiency thresholds.
- Recommending appropriate vitamin D supplementation, including first-line treatment, dosing regimens and maintenance dosages.
- Recognising when additional investigations or specialist referral are needed, especially in complex or refractory cases.
- Monitoring and follow-up, including checking serum calcium levels and repeat testing.
Authors: Zahra Ravat is NIHR Academic Clinical Fellow and Specialty Trainee in Endocrinology and Zaki Hassan-Smith is Honorary Consultant Endocrinologist and Clinical Associate Professor at Aston University and University Hospitals Birmingham NHS Foundation Trust
Published: 14.08.2025
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Reviews
Vitamin D deficiency remains a significant public health issue in the UK, largely driven by limited year?round sunlight exposure. National surveys consistently show that around half of UK adults have insufficient vitamin D levels during winter and spring, with deficiency particularly common in people with darker skin, those who cover their skin for cultural reasons, older adults, and individuals who are housebound or living in care settings. This makes vitamin D assessment and management a frequent part of routine clinical practice.\nFrom a medical management perspective, UK guidance emphasises targeted testing—reserved for symptomatic patients or those with conditions where vitamin D status affects treatment decisions, such as osteoporosis or prior to initiating potent antiresorptive therapy. When deficiency is confirmed, treatment typically follows a two?phase approach: an initial loading regimen of high?dose colecalciferol to correct deficiency, followed by maintenance supplementation to sustain adequate levels. Local NHS pathways guide the specific dosing schedules. Monitoring usually focuses on clinical response, with repeat vitamin D levels only when clinically indicated.\nReflecting on this topic has reinforced the importance of recognising at?risk groups, applying testing criteria appropriately, and following evidence?based treatment pathways. This learning has strengthened my confidence in managing vitamin D deficiency safely and consistently within UK primary care practice.
Excellent course very informative
Excellent