High-dose oral vitamin D3 supplementation in the elderly
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- Bacon, C.J., Gamble, G.D., Horne, A.M. et al. Osteoporos Int (2009) 20: 1407. doi:10.1007/s00198-008-0814-9
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Daily dosing with vitamin D often fails to achieve optimal outcomes, and it is uncertain what the target level of 25-hydroxyvitamin D should be. This study found that large loading doses of vitamin D3 rapidly and safely normalize 25OHD levels, and that monthly dosing is similarly effective after 3–5 months. With baseline 25OHD > 50 nmol/L, vitamin D supplementation does not reduce PTH levels.
There is concern that vitamin D supplementation doses are frequently inadequate, and that compliance with daily medication is likely to be suboptimal.
This randomized double-blind trial compares responses to three high-dose vitamin D3 regimens and estimates optimal 25-hydroxyvitamin D (25OHD) levels, from changes in parathyroid hormone (PTH), and procollagen type I amino-terminal propeptide (P1NP) in relation to baseline 25OHD. Sixty-three elderly participants were randomized to three regimens of vitamin D supplementation: a 500,000-IU loading dose; the loading dose plus 50,000 IU/month; or 50,000 IU/month.
The Loading and Loading + Monthly groups showed increases in 25OHD of 58 ± 28 nmol/L from baseline to 1 month. Thereafter, levels gradually declined to plateaus of 69 ± 5 nmol/L and 91 ± 4 nmol/l, respectively. In the Monthly group, 25OHD reached a plateau of ~80 ± 20 nmol/L at 3–5 months. There were no changes in serum calcium concentrations. PTH and P1NP were only suppressed by vitamin D treatment in those with baseline 25OHD levels <50 and <30 nmol/L, respectively.
Large loading doses of vitamin D3 rapidly and safely normalize 25OHD levels in the frail elderly. Monthly dosing is similarly effective and safe, but takes 3–5 months for plateau 25OHD levels to be reached.