Nevertheless, it was hardly prescribed, possibly because of unawareness of its existence, or due to the lack of evidence-based dosing guidelines. This formulation is not patented, it is cheap to prepare, and can be used everywhere. We were fortunate to discover a formulation for solubilized cholecalciferol (50 000 IU/ml), which was developed by the Dutch Pharmacists Association (Formularium der Nederlandse Apothekers, FNA) 20 years ago, and which included a guideline for quality control. This forced us to look for alternatives to maintain patient care.

In 2006, the commercially available cholecalciferol tablets (Devaron 400 IU) were suddenly withdrawn from the market in The Netherlands. Usually, this is done with daily supplementation using tablets. In Europe, cholecalciferol (vitamin D 3) is mainly used to treat vitamin D deficiency.

In the USA, ergocalciferol (vitamin D 2) is recommended at a dose of 50 000 IU/week for 8 weeks, irrespective of the degree of vitamin D deficiency or body weight (1). However, there is no consensus on how to achieve this target rapidly. There is an emerging consensus that serum 25-OHD 3 levels of about 75 nmol/l are optimal for bone health and extraskeletal effects ( 6, 7). Consequently, improvements in the detection and treatment of vitamin D deficiency may have a major health impact. A rapidly growing body of evidence indicates that vitamin D deficiency may play a role in the development of common cancers, autoimmune diseases, infectious diseases, and cardiovascular diseases ( 1, 3, 5). However, vitamin D receptors are also present on a large variety of extraskeletal cell types, including cardiomyocytes, vascular endothelial cells, neurons, immune cells, and pancreatic β-cells. Vitamin D deficiency is well known for its musculoskeletal complications in children and adults ( 1, 3, 4). In Germany, for example, 57% of the 18–79-year-old residents are vitamin D deficient, and this is mainly explained by the lack of sufficient sunlight exposure and low dietary vitamin D (2). As a result, vitamin D deficiency, defined as a serum 25-hydroxyvitamin D 3 (25-OHD 3) level <50 nmol/l, is very common in Northern Europe. Vitamin D status is related to sunlight exposure and therefore depends on latitude (1).

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