Vitamin D insufficiency: Evaluation of an oral standardized supplementation using 100,000 IU vials of cholecalciferol, depending on initial serum level of 25OH vitamin D

Joint Bone Spine, In Press, Corrected Proof, doi:10.1016/j.jbspin.2011.09.004
Véronique Rouillona, Geneviève Dubourgb, Jean-Bernard Gauvainc, Dominique Barond, Joëlle Glemarece, Grégoire Cormierf, Pascale Guillote, pascale.guillot at chu-nantes.fr
a Service de rhumatologie, centre hospitalier, BP 30071, 95503 Gonesse cedex, France
b Service de rhumatologie, hôpital Pitié Salpêtrière, 83, boulevard de l’Hôpital, 75013 Paris, France
c Service de court-séjour gériatrie, CHR d’Orléans, 1, rue Porte-Madeleine, 45000 Orléans, France
d Centre hospitalier Lannion-Trestel, 22660 Trévou-Tréguignec, France
e Service de rhumatologie, CHU Hôtel-Dieu, 3, place Alexis-Ricordeau, 44093 Nantes cedex 1, France
f Service de rhumatologie, CHD Vendée, boulevard S.-Moreau, 85925 La Roche-sur-Yon cedex 9, France

Accepted 21 September 2011. Available online 6 November 2011.

Objectives: There is no protocol of vitamin D supplementation used worldwide due to a great disparity of vitamin D supplements available in different countries. The aim of this study was to evaluate the efficiency of the protocol most often used in France to correct vitamin D deficiency defined by a serum 25-hydroxy vitamin D (25OHD) level of less than 30 ng/mL.

Methods: This was a pragmatic multicentric study of vitamin D supplementation in 257 osteopenic/osteoporotic, vitamin D deficient patients who received 100,000 UI vitamin D3 vials every two weeks according to their initial serum 25OHD level (four vials when 25OHD less than 10 ng/mL, three when 25OHD was 10–19 ng/mL, two when 25OHD was 20–29 ng/mL). Blood samples were obtained at baseline, one (M1), two (M2), and three months (M3), after the end of the supplementation protocol.

Results: At M1, 198/257 (77%) patients had a serum 25OHD level more than 30 ng/mL. Eighty-five percent of those with a BMI less than 25 kg/m2 had a 25OHD concentration more than 30 ng/mL, whereas only 66% of those with a BMI more than 25 had a level more than 30 ng/mL.

At M2 and M3, {60 days and 90 days} 25OHD levels decreased significantly with 55% and 46% having still a level more than 30 ng/mL respectively, without any significant difference according to the initial 25OHD level.

Conclusion: This protocol was effective in rising serum 25OHD of most vitamin D insufficient patients with a BMI less than 25 kg/m2, but not in overweight patients. As almost one half of our patients had a serum 25OHD level less than 30 ng/mL at M2, we suggest that regular doses should be started quite soon after this initial supplementation.
– – – – – –
Restock with average of 7,142 IU daily if 10-19 ng
Restock with average of 14,285 IU daily if <10 ng

They note that this DOES NOT restock (to 30 ng) in 30 day

• 15% of people with low BMI
• 34% of people with high BM

Unclear: The duration of re-stocking:
With M2 and M3 having vitamin D decreasing, we wonder if restocking stopped at M1

See also VitaminDWiki

• All items in Megadose/Loading dose 206 items
• Variety of vitamin D loading dose recommendations in the UK includes critique by VitaminDWiki
• Must balance co-factors when increasing vitamin D
• Vitamin D3 loading dose of 500,000 IU for elderly – Aug 2009
• Vitamin D loading dose guidelines - April 2010
  • IU LOADING dose to achieve 30ng (in ng and pounds) = 35 x (30-serum 25-OHD(3)) x body weight
• Many reasons why vitamin D deficiency has become epidemic
• 300,000 IU vitamin D helped seniors in many ways – May 2011