European Journal of Nutrition

, Volume 49, Issue 5, pp 277–283 | Cite as

Is a lower dose of vitamin D supplementation enough to increase 25(OH)D status in a sunny country?

  • Giselle A. P. Pignotti
  • Patrícia S. Genaro
  • Marcelo M. Pinheiro
  • Vera L. Szejnfeld
  • Lígia A. Martini
Original Contribution

Abstract

Background

Calcium and vitamin D are essential nutrients for bone metabolism Vitamin D can either be obtained from dietary sources or cutaneous synthesis. The study was conducted in subtropic weather; therefore, some might believe that the levels of solar radiation would be sufficient in this area.

Aim of the study

To evaluate calcium and vitamin D supplementation in postmenopausal women with osteoporosis living in a sunny country.

Methods

A 3-month controlled clinical trial with 64 postmenopausal women with osteoporosis, mean age 62 ± 8 years. They were randomly assigned to either the supplement group, who received 1,200 mg of calcium carbonate and 400 IU (10 μg) of vitamin D3, or the control group. Dietary intake assessment was performed, bone mineral density and body composition were measured, and biochemical markers of bone metabolism were analyzed.

Results

Considering all participants at baseline, serum vitamin D was under 75 nmol/l in 91.4% of the participants. The concentration of serum 25(OH)D increased significantly (p = 0.023) after 3 months of supplementation from 46.67 ± 13.97 to 59.47 ± 17.50 nmol/l. However, the dose given was limited in effect, and 86.2% of the supplement group did not reach optimal levels of 25(OH)D. Parathyroid hormone was elevated in 22.4% of the study group. After the intervention period, mean parathyroid hormone tended to decrease in the supplement group (p = 0.063).

Conclusion

The dose given (400 IU/day) was not enough to achieve 25(OH)D concentration, considered optimal for bone health.

Keywords

Dietary intakes Serum 25-hydroxyvitamin D Vitamin D supplement Postmenopausal Osteoporosis 

Notes

Acknowledgment

Financial Support: CNPq no. 401883/2005-1 and CAPES.

References

  1. 1.
    Adami S, Viapiana O, Gatti D, Idolazzi L, Rossini M (2008) Relationship between serum parathyroid hormone, vitamin D sufficiency, age, and calcium intake. Bone 42:267–270CrossRefGoogle Scholar
  2. 2.
    Aguado P, Campo MT, Garcés MV, Gonzáez-Casaús ML, Bernad M, Gijón-Banos J et al (2000) Low vitamin D levels in outpatient postmenopausal women from a rheumatology clinic in Madrid, Spain: their relationship with bone mineral density. Osteoporos Int 11:739–744CrossRefGoogle Scholar
  3. 3.
    Barger-Lux MJ, Heaney RP, Dowell S, Chen TC, Holick MF (1998) Vitamin D and its major metabolites: serum levels after graded oral dosing in healthy men. Osteoporos Int 8:222–230CrossRefGoogle Scholar
  4. 4.
    Barnes MS, Robson PJ, Bonham MP, Strain JJ, Wallace JMW (2006) Effect of vitamin D supplementation on vitamin D status and bone turnover markers in young adults. Eur J Clin Nutr 60:727–733CrossRefGoogle Scholar
  5. 5.
    Bischoff-Ferrari HA, Willett WC, Wong JB, Stuck AE, Staehelin HB, Orav EJ, Kiel TADP, Henschkowski J (2009) Prevention of nonvertebral fractures with oral vitamin D and dose dependency a meta-analysis of randomized controlled trials. Arch Intern Med 169(6):551–561CrossRefGoogle Scholar
  6. 6.
    Bjorkman M, Sorva A, Tilvis R (2009) Responses of parathyroid hormone to vitamin D supplementation: a systematic review of clinical trials. Arch Gerontol Geriatr 48(2):160–166CrossRefGoogle Scholar
  7. 7.
    Bolland MJ, Barber PA, Doughty RN, Mason B, Horne A, Ames R, Gamble GD, Grey A, Reid IR (2008) Vascular events in healthy older women receiving calcium supplementation: randomized controlled trial. BMJ 336:262–266CrossRefGoogle Scholar
  8. 8.
    Calvo MS, Whiting SJ, Barton CN (2005) Vitamin D intake: a global perspective of current status. J Nutr 135:310–315Google Scholar
  9. 9.
    Cashman KD (2007) Diet, nutrition, and bone health. J Nutr 137:2507S–2512SGoogle Scholar
  10. 10.
    Cashman KD (2002) Calcium intake, calcium bioavailability and bone health. Br J Nutr 87(2):S169–S177CrossRefGoogle Scholar
  11. 11.
    Chapuy MC, Pamphile R, Paris E et al (2002) Combined calcium and vitamin D3 supplementation in elderly women: confirmation of reversal of secondary hyperparathyroidism and hip fracture risk: The Decalyos II Study. Osteoporos Int 13:257–264CrossRefGoogle Scholar
  12. 12.
    Cummings SR, Melton LJ (2002) Epidemiology and outcomes of osteoporotic fractures. Lancet 359:1761–1767CrossRefGoogle Scholar
  13. 13.
    Dawson-Hughes B, Heaney RP, Holick MF, Lips P, Meunier PJ, Vieth R (2005) Estimates of optimal vitamin status. Osteoporos Int 16:713–716CrossRefGoogle Scholar
  14. 14.
    Ferrari SI (2005) Osteoporosis: a complex disorder of aging with multiple genetic and environmental determinants. World Rev Nutr Diet 95:35–51CrossRefGoogle Scholar
  15. 15.
    Feskanich D, Willet WC, Colditz GA (2003) Calcium, vitamin D, milk consumption, and hip fractures: a prospective study among postmenopausal women. Am J Clin Nutr 77:504–511Google Scholar
  16. 16.
    Gannagé-Yared MH, Chemali R, Yaacoub N, Halaby G (2000) Hypovitaminosis D in a sunny country: relation to lifestyle and bone markers. J Bone Miner Res 15(9):1856–1862CrossRefGoogle Scholar
  17. 17.
    Grados F, Brazier M, Kamel S, Duver S, Heurtebize N, Maamer M, Mathieu M, Fardellone P (2003) Effects on bone mineral density of calcium and vitamin D supplementation in elderly women with vitamin D deficiency. Jt Bone Spine 70(3):203–208CrossRefGoogle Scholar
  18. 18.
    Holick MF (1999) Vitamin D. In: Shills M et al (eds) Modern nutrition in health and disease, 9th edn. Williams and Wilkins, BaltimoreGoogle Scholar
  19. 19.
    Holick MF (2007) Vitamin D deficiency. N Engl J Med 357:266–281CrossRefGoogle Scholar
  20. 20.
    Johnell O, Kanis J (2005) Epidemiology of osteoporotic fractures. Osteoporos Int 16(2):S3–S7CrossRefGoogle Scholar
  21. 21.
    Jones G, Horst R, Carter G, Makin HLJ (2007) Contemporary diagnosis and treatment of vitamin D-related disorders. J Bone Miner Res 22(2):v11–v15CrossRefGoogle Scholar
  22. 22.
    Levis S, Gomez A, Jimenez C, Veras L, Ma F, Lai S et al (2005) Vitamin D deficiency and seasonal variation in an adult south Florida population. J Clin Endocrinol Metab 90(3):1557–1562CrossRefGoogle Scholar
  23. 23.
    Levy-Costa RB, Sichieri R, Pontes NS, Monteiro CA (2005) Disponibilidade domiciliar de alimentos no Brasil: distribuição e evolução (1974–2003). Rev Saúde Pública 39(4):530–540CrossRefGoogle Scholar
  24. 24.
    Lips P (2001) Vitamin D deficiency and secondary hyperparathyroidism in the elderly: consequences for bone loss and fractures and therapeutic implications. Endocr Rev 22(4):477–501CrossRefGoogle Scholar
  25. 25.
    Lucas JA, Bolland MJ, Grey AB, Ames RW, Mason BH, Horne AM, Gamble GD, Reid IR (2005) Determinants of vitamin D status in older women living in a subtropical climate. Osteoporos Int 16(12):1641–1648CrossRefGoogle Scholar
  26. 26.
    Meddeb N, Sahli H, Chahed M, Abdelmoula J, Feki M, Salah H, Frini S et al (2005) Vitamin D deficiency in Tunisia. Osteoporos Int 16(2):180–183CrossRefGoogle Scholar
  27. 27.
    Mezquita-Raya P, Munoz-Torres M, Luna J, Luna V, Lopez-Rodriguez F, Torres-Vela E et al (2001) Relation between vitamin D insufficiency, bone density and bone metabolism in healthy postmenopausal women. J Bone Miner Res 16:1408–1414CrossRefGoogle Scholar
  28. 28.
    Moore CE, Murphy MM, Holick MF (2005) Vitamin D intakes by children and adults in the United States Differ among ethnic groups. J Nutr 135:2478–2485Google Scholar
  29. 29.
    Neuprez A, Bruyère O, Collette J, Reginster J (2007) Vitamin D inadequacy in Belgian postmenopausal osteoporotic women. PMC Public Health 7(147):64–73Google Scholar
  30. 30.
    Nieves JW (2005) Osteoporosis: the role of micronutrients. Am J Clin Nutr 81:1232S–1239SGoogle Scholar
  31. 31.
    NIH (2000) Consensus development program: consensus statements. Osteoporosis prevention, diagnosis, and therapy. 17(1), 27–29 March. Website: http://odp.od.nih.gov/consensus/cons/111/111intro.htm
  32. 32.
    Ovesen L, Andersen R, Jakobsen J (2003) Geographical differences in vitamin D status, with particular reference to European countries. Proc Nutr Soc 62:813–821CrossRefGoogle Scholar
  33. 33.
    Pinheiro MM, Schuch NJ, Genaro PS, Ciconelli RM, Ferraz MB, Martini LA (2009) Nutrient intakes related to osteoporotic fractures in men and women—The Brazilian Osteoporosis Study (BRAZOS). Nutr J 8:6. doi: 10.1186/1475-2891-8-6
  34. 34.
    Rapuri PB, Gallagher JC, Haynatzki G (2004) Effect of Vitamins D2 and D3 supplement use on serum 25OHD concentration in elderly women in summer and winter. Calcif Tissue Int 74:150–156CrossRefGoogle Scholar
  35. 35.
    Riggs BL, O’Fallon WM, Muhs J, O’Connor MK, Kumar R, Melton LJ (1998) Long-term effects of calcium supplementation on serum parathyroid hormone level, bone turnover, and bone loss in elderly women. J Bone Miner Res 13(2):168–174CrossRefGoogle Scholar
  36. 36.
    Sabbagh Z, Vatanparast H (2009) Is calcium supplementation a risk factor for cardiovascular diseases in older women? Nutr Rev 67(2):105–108CrossRefGoogle Scholar
  37. 37.
    Saraiva GL, Cendoroglo MS, Ramos LR, Araújo LMQ, Vieira JGH, Kunni I et al (2005) Influence of ultraviolet radiation on the production of 25 hydroxyvitamin D in the elderly population in the city of São Paulo (23°34′S), Brazil. Osteoporos Int 16:1649–1654CrossRefGoogle Scholar
  38. 38.
    Steingrimsdottir L, Gunnarsson O, Indridason OS, Franzson L, Sigurdsson G (2005) Relationship between serum parathyroid hormone levels, vitamin D sufficiency, and calcium intake. JAMA 194:2336–2341CrossRefGoogle Scholar
  39. 39.
    Talwar SA, Aloia JF, Pollack S, Yeh JK (2007) Dose response to vitamin D supplementation among postmenopausal African American women. Am J Clin Nutr 86:1657–1662Google Scholar
  40. 40.
    Trivedi DP, Doll R, Khaw KT (2003) Effect of four monthly oral vitamin D3 (cholecalciferol) supplementation on fractures and mortality in men and women living in the community: randomised double blind controlled trial. BMJ 326:469–474CrossRefGoogle Scholar
  41. 41.
    Van der Mei IAF, Ponsonby AL, Engelsen O, Pasco JA, McGrath JJ, Eyles DW et al (2007) The high prevalence of vitamin D insufficiency across Australian populations is only partly explained by season and latitude. Environ Health Perspect 115(8):1132–1139CrossRefGoogle Scholar
  42. 42.
    Vieth R (1999) Vitamin D supplementation, 25-hydroxyvitamin D concentrations, and safety. Am J Clin Nutr 69:842–856Google Scholar
  43. 43.
    Vieth R, Bischoff-Ferrari H, Boucher BJ, Dawson-Hughes B, Garland CF, Heaney RP, Holick MF, Hollis BW, Lamberg-Allardt C, McGrath JJ, Norman AW, Scragg R, Whiting SJ, Willett WC, Zittermann A (2007) The urgent need to recommend an intake of vitamin D that is effective. Am J Clin Nutr 85:649–650Google Scholar
  44. 44.
    Webb AR (2006) Who, what, where and when—influences on cutaneous vitamin D synthesis. Prog Biophys Mol Biol 92:17–25CrossRefGoogle Scholar
  45. 45.
    World Health Organization (WHO) (1994) Study group assessment of fracture risk and its application to screening for postmenopausal osteoporosis. WHO Technical Report Series 843, Geneva, SwitzerlandGoogle Scholar

Copyright information

© Springer-Verlag 2009

Authors and Affiliations

  • Giselle A. P. Pignotti
    • 1
    • 2
  • Patrícia S. Genaro
    • 1
    • 2
  • Marcelo M. Pinheiro
    • 2
  • Vera L. Szejnfeld
    • 2
  • Lígia A. Martini
    • 1
  1. 1.Nutrition Department, School of Public HealthUniversity of Sao PauloSão PauloBrazil
  2. 2.Rheumatology Department, Medical SchoolFederal University of Sao PauloSão PauloBrazil

Personalised recommendations