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Bone mineral density somewhat better with 3750 IU vs 600 IU Vitamin D (1 year, with Calcium) – RCT March 2017

Impact of Calcium and Two Doses of Vitamin D on Bone Metabolism in the Elderly: A Randomized Controlled Trial.

J Bone Miner Res. 2017 Mar 9. doi: 10.1002/jbmr.3122. [Epub ahead of print]
Rahme M1, Sharara SL1, Baddoura R2, Habib RH3, Halaby G4, Arabi A1, Singh RJ5, Kassem M6, Mahfoud Z7,8, Hoteit M1, Daher RT9, Bassil D1, El Ferkh K1, El-Hajj Fuleihan G1.

  • 1 Department of Internal Medicine, Division of Endocrinology, Calcium Metabolism and Osteoporosis Program, WHO Collaborating Center for Metabolic Bone Disorders, American University of Beirut Medical Center, Beirut, Lebanon.
  • 2 Department of Rheumatology, Hotel Dieu de France, Beirut, Lebanon.
  • 3 Department of Internal Medicine, American University of Beirut Medical Center, Beirut, Lebanon.
  • 4 Department of Endocrinology, Hotel Dieu de France, Beirut, Lebanon.
  • 5 Division of Clinical Biochemistry and Immunology, Mayo Clinic, Rochester, Minnesota, United States of America.
  • 6 Department of Endocrinology and Metabolism, University Hospital of Odense, Denmark.
  • 7 Department of Healthcare Policy and Research, Weill Cornell Medicine, NY, USA.
  • 8 Weill Cornell Medicine, Doha, Qatar.
  • 9 Department of Pathology & Laboratory Medicine, American University of Beirut Medical Center, Beirut, Lebanon.

The optimal dose of vitamin D to optimize bone metabolism in the elderly is unclear. We tested the hypothesis a vitamin D, at a dose higher than recommended by the Institute of Medicine (IOM), has a beneficial effect on bone remodeling and mass. In this double blind trial we randomized 257 overweight elderly subjects to receive 1000 mg of elemental calcium citrate/day, and the daily equivalent of 3,750 IU/day or 600 IU/day of vitamin D3 for one year. The subjects' mean age was 71 ± 4 years, body mass index 30 ± 4 kg/m2 , 55% were women, and 222 completed the 12-months follow-up. Mean serum 25 hydroxy-vitamin D (25OHD) was 20 ng/ml, and rose to 26 ng/ml in the low dose, and 36ng/ml in the high dose arm, at one year (p < 0.05). Plasma parathyroid hormone, osteocalcin, and C-terminal telopeptide (Cross Laps) levels decreased significantly by 20-22% in both arms, but there were no differences between the two groups for any variable, at 6 or 12 months, with the exception of serum calcitriol that was higher in the high-dose group at 12 months.
Bone mineral density (BMD) increased significantly at total hip and lumbar spine, but not femoral neck, in both arms, while subtotal body BMD increased in the high-dose group only, at one year.
However, there were no significant differences in percent change BMD between the 2 arms at any skeletal site.
Subjects with serum 25OHD below 20 ng/ml and PTH level above 76 pg/ml, showed a trend for higher BMD increments at all skeletal sites, in the high-dose group, that reached significance at the hip.
Adverse events were comparable in the two study arms.
This controlled trial demonstrates little additional benefit in vitamin D supplementation at a dose exceeding the IOM recommendation of 600IU/day on BMD and bone markers, in overweight elderly individuals.

This article is protected by copyright. All rights reserved.

PMID: 28276596 DOI: 10.1002/jbmr.3122 Publisher rents PDF for $6

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