India · Deficiency · Rickets · Osteoporosis · Pregnancy · Paediatric · Shelcal · Calcirol · Uprise-D3 · Cholecalciferol
☀️ Vit D is fat-soluble — take with a fat-containing meal
🦴 Calcium carbonate: take with meals (needs acid for absorption)
🦴 Calcium citrate: can be taken on empty stomach — better for elderly / on PPIs
⚠️ Max single calcium dose: 500mg elemental (split doses)
⚠️ Vitamin D toxicity: levels >150 ng/mL — do not exceed upper safe limits
| Indication | Vitamin D3 dose | Calcium dose | Duration | Guideline |
|---|---|---|---|---|
| Vit D deficiency (<20 ng/mL) | 60,000 IU weekly × 8 weeks, then 60,000 IU monthly | 500–1000mg elemental/day | Recheck at 3 months | ICMR · Endocrine Society |
| Severe deficiency (<10 ng/mL) | 60,000 IU twice weekly × 6–8 weeks, then monthly | 1000mg/day | Recheck at 3 months | Endocrine Society |
| Maintenance (>30 ng/mL) | 1,000–2,000 IU daily or 60,000 IU monthly | 500–600mg/day | Ongoing | ICMR RDA |
| Nutritional rickets (child) | 60,000 IU weekly × 6–12 weeks (IAP) | 500mg elemental BD × 3 months | 6–12 weeks Vit D + 3m Ca | IAP rickets guidelines |
| Infant prophylaxis (breastfed) | 400 IU daily from day 15 until 2 years | From complementary feeds | Until 2 years | IAP · AAP |
| Osteoporosis (with bisphosphonate) | 800–1000 IU daily | 1000–1200mg elemental/day | Ongoing | IOF · BNF |
| Pregnancy — routine | 600–1000 IU/day or 60,000 IU monthly | 1200mg elemental/day | Throughout pregnancy + 6m postpartum | FOGSI · WHO |
| Pre-eclampsia prevention | 1000 IU/day | 1500–2000mg/day (WHO) | From 20 weeks if low intake | WHO · Cochrane |
India has a paradoxical vitamin D deficiency crisis — despite abundant sunshine, studies show that 70–90% of Indians have inadequate vitamin D levels (25-OH Vit D <20 ng/mL). The reasons are multifactorial: skin pigmentation (melanin reduces UV synthesis), traditional clothing covering most skin, indoor occupational lifestyles, air pollution blocking UV-B, and the near-complete absence of natural dietary vitamin D in vegetarian Indian diets (vitamin D3 is found almost exclusively in oily fish, eggs, and fortified dairy — all poorly represented in the Indian diet).
Unlike Western countries where daily supplementation (1000–2000 IU/day) is standard, Indian practice overwhelmingly uses high-dose intermittent therapy. The 60,000 IU cholecalciferol sachet or capsule (Calcirol, Uprise-D3, D-Rise) has become the de facto standard supplementation unit in India — prescribed weekly for deficiency loading and monthly for maintenance. This is supported by Indian endocrinology consensus and is practical for the Indian healthcare context where daily compliance is lower. The loading phase is 8 weekly doses (total 480,000 IU) followed by monthly maintenance.
In India, nutritional rickets is frequently calcium-deficiency rickets rather than vitamin D-deficiency rickets — an important distinction because treatment requires high-dose calcium supplementation alongside vitamin D. The IAP rickets guidelines recommend calcium 500 mg elemental twice daily for 3 months in addition to vitamin D 60,000 IU weekly for 6–12 weeks. Without adequate calcium, vitamin D loading alone is insufficient for radiological healing. Signs of calcium-deficiency rickets: hypocalcaemia, positive Trousseau and Chvostek signs, and a diet predominantly based on cereals with limited dairy.
Vitamin D toxicity (hypervitaminosis D) occurs when serum 25-OH Vit D exceeds 150 ng/mL, causing hypercalcaemia, hypercalciuria, nephrocalcinosis, and eventually renal failure. The upper tolerable intake limit (UL) for adults is 4,000 IU/day for chronic use; safe upper limit for short-term treatment in deficiency is higher. With standard Indian protocols (60,000 IU weekly × 8 weeks = 480,000 IU loading), toxicity is extremely rare in adults. However, caution is required in sarcoidosis, granulomatous diseases, primary hyperparathyroidism, and in patients already on calcitriol — these conditions cause excessive conversion of vitamin D to its active form.