High-dose oral vitamin D3 supplementation in the elderly

Bacon, Catherine J.; Gamble, Greg; Horne, Anne; Scott, M. A.; Reid, Ian R.

doi:10.1007/s00198-008-0814-9

Cited by 158 publications

(148 citation statements)

References 46 publications

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“…A loading dose may be required in those with levels <50 nmol/L and a loading dose of 500 000 IU vitamin D3 has been shown to rapidly normalise 25(OH)D levels in frail elder persons [23]. Nevertheless, there is no evidence of the effect of loading doses on falls and fracture efficacy.…”

Section: An Overview Of Evidencementioning

confidence: 96%

Vitamin D, bones and muscle: myth versus reality

et al. 2017

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ObjectivesEvidence regarding the efficacy and dosing of vitamin D on fall and fracture prevention, with or without calcium, is characterised by uncertainty.MethodsA panel of experts was organised at the First Australasian Conference on Sarcopenia and Frailty in Melbourne, Australia, in November 2016 to provide an interpretation of the current evidence and to give their opinions regarding the supplementation of vitamin D in three hypothetical cases.Results and ConclusionThe authors conclude that (i) target serum 25(OH)D concentration should be 50 to 60 nmol/L year round, with a conservative upper limit <100 nmol/L; (ii) change in serum concentrations at any given dose is highly variable among individuals; (iii) dosing interval may need to be <2 months to have a continuous benefit; (iv) a loading dose can raise levels to target quickly, but there is no evidence yet that this has any positive effect on falls or fracture outcomes; and (v) a maintenance dose of 1000 IU/day, or given as an equivalent dose weekly or monthly, is sufficient for most individuals.

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Section: An Overview Of Evidencementioning

confidence: 96%

Vitamin D, bones and muscle: myth versus reality

et al. 2017

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“…Several other studies of large bolus D3 doses of up to 12.5 mg have not adequately studied the changes in serum calcium in the first week after dose administration. [49][50][51] Furthermore, the recent finding of an increased risk of falls and fractures among older women following annual oral bolus doses of 12.5 mg vitamin D3 has heightened concern about the potential harms of single-dose regimens. 50 In summary, vitamin D3 doses up to 7.5 mg do not appear to produce disturbances in calcium homeostasis in non-pregnant adults.…”

Section: -Hydroxyvitamin D ([25(oh)d]mentioning

confidence: 99%

Vitamin D supplementation during pregnancy: safety considerations in the design and interpretation of clinical trials

Roth

2011

J Perinatol

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Maternal-child health benefits of optimizing vitamin D status during pregnancy may include a reduced risk of pre-eclampsia, improved fetal growth and beneficial effects on infant immune function. These hypotheses require evaluation by randomized controlled antenatal vitamin D supplementation trials using doses that are high enough to elevate serum 25-hydroxyvitamin D concentrations into the range believed to be associated with improved health outcomes. Such doses may be considerably higher than the current recommended dietary allowance (600 IU day -1 ) or standard prenatal supplement dose (400 IU day -1 ), and may even be higher than the tolerable upper intake level (4000 IU day -1 ) advised by the Institute of Medicine (2010). A critical review of the published literature yielded limited data regarding the safety of antenatal vitamin D regimens. There have been no published reports of the teratogenic effects of vitamin D on humans. Some animal studies have suggested the potential for dosedependent fetal toxicities (for example, growth impairment, skeletal malformations and cardiovascular anomalies), but the relevance of these observations to humans is unknown. Antenatal vitamin D supplementation trials should incorporate a range of methods for objectively establishing maternal and fetal safety, and aim to identify the lowest doses of vitamin D required to achieve target outcomes.

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“…In this study, which measured 25(OH)D using liquid chromatography with mass spectroscopy (LC/MS) , the threshold was approximately 165 nM (equivalent to 66 ng/ml) using disability from joint pain as the outcome. monthly 50,000 [53] is required, though a recent randomized clinical trial has raised some concerns, showing an increase in falls rate among patients having 500,000 IU in yearly basis, when compared to placebo [54].…”

Section: Ai-associated Joint Pain and Vitamin D Status At 3 Monthsmentioning

confidence: 99%

Vitamin D threshold to prevent aromatase inhibitor-induced arthralgia: a prospective cohort study

Prieto-Alhambra

Javaid

Servitja

et al. 2010

Breast Cancer Res Treat

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Purpose: Aromatase inhibitor (AI) associated arthralgia limits adherence to therapy in breast cancer. The pathophysiology may involve vitamin D status. We wished to establish the optimal concentration of 25(OH)D that prevents or minimizes arthralgia. Methods:We used a prospective cohort of 290 women starting AI in whom baseline vitamin D was measured. All received daily vitamin D3 (800 IU) with calcium. Women with baseline 25(OH)D concentration <30 ng/ml also received 16,000 IU of D3 orally every two weeks. The primary outcome was incident or worsening joint pain derived from baseline and three month VAS for joint pain. Regression models were used to analyse the association between vitamin D concentrations at 3 months and pain adjusting for age, BMI, season when the sample was drawn, aromatase inhibitor (exemestane vs letrozole/anastrozole), prior tamoxifen therapy, baseline NTX, and previous fracture.Results: 90% of women had a 25(OH)D <30 ng/ml at baseline. After supplementation (daily 800 IU and additional additional 16,000 IU every two week), 50% of them still failed to reach adequate concentrations at three months. In the whole cohort, there was an increase in joint pain (mean 1.16 points SD 2.66; p<0.001) and the increase was significantly (p= 0.02) attenuated in those that reached concentrations of 25(OH)D of ≥40 ng/ml, with a lower risk of incident arthralgia (OR 0.12 ** [0.03 to 0.40]).Conclusion: A target concentration of 40ng/ml 25OHD may prevent development of AI arthralgia but higher loading doses are required to attain this level in women with deficiency at baseline.

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High-dose oral vitamin D3 supplementation in the elderly

Abstract: Large loading doses of vitamin D(3) 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.

Cited by 158 publications

References 46 publications

Vitamin D, bones and muscle: myth versus reality

Vitamin D, bones and muscle: myth versus reality

Vitamin D supplementation during pregnancy: safety considerations in the design and interpretation of clinical trials

Vitamin D threshold to prevent aromatase inhibitor-induced arthralgia: a prospective cohort study

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