Effect of a Single ‘Megadose’ Intramuscular Vitamin D (600,000 IU) Injection on Vitamin D Concentrations and Bone Mineral Density Following Biliopancreatic Diversion Surgery
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Vitamin D (VitD) deficiency is common following biliopancreatic diversion (BPD). We conducted a prospective open-label study to evaluate the efficacy of a single intramuscular injection with 600,000 IU of cholecalciferol in an arachis oil depot formulation (VitD3, Arachitol Solvay Pharmacia) as an adjunct to regular oral VitD supplementation (Citrical+D) for a period of 12 months following BPD surgery.
Some 29 patients who had undergone BPD during 2000–2005 were recruited and received a single injection of 600,000 IU of cholecalciferol. Venous blood VitD, parathyroid hormone (PTH), alkaline phosphatase (ALP), ionised calcium and urinary N-telopeptide (NTX) were assessed at baseline and at 1.5, 3, 6, 9 and 12 months post-injection. Bone mineral density (BMD) was determined at baseline and 12 months post-injection.
VitD concentrations (mean ± SD) were significantly increased from baseline values (61.5 ± 18.8 nmol/L) at 1.5 months (92.4 ± 21.5, p < 0.001), 3 months (100.5 ± 24.4, p < 0.001) and 6 months (79.1 ± 20.9, p = 0.014) post-injection, with non-significant elevations at 9 months (73.3 ± 15.1, p = 0.248) and 12 months (73.4 ± 17.3, p = 0.278). The proportion of patients with ‘normalised’ VitD levels was significantly higher at all post-injection time points (range, 93–100%) compared with baseline (71.4%; p < 0.01). Ionised calcium and ALP remained within normal levels at baseline and all follow-up time points, although ionised calcium decreased by 3.4% (p = 0.015) and ALP increased by 14.6% (p = 0.021) at 12 months compared with baseline. No significant change in PTH, NTX or BMD was observed.
Intramuscular cholecalciferol injection, as an adjunct to oral supplementation, appears a safe and effective method to increase and maintain VitD levels after BPD.
KeywordsVitamin D Bone mineral density Biliopancreatic diversion surgery
We are grateful to all the patients who participated in this study. We also thank Mercy Hospital Pathology (Perth, Western Australia) and SKG Radiology (Perth, Western Australia) for blood and urine analysis, respectively.
Conflicts of Interest Statement
Dr. Leon Cohen received payment for original treatment of the patients in this study, but did not seek financial payment for any aspect relating to this study. All other authors report no conflicts of interest.
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