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Vitamin D loading dose was as effective as daily dosing (rickets in this case) – RCT July 2021

Low Dose Depot Oral Vitamin D3 Versus Daily Oral Vitamin D3 for Treating Nutritional Rickets: A Randomized Clinical Trial

Br J Nutr. 2021 Jul 19;1-18. doi: 10.1017/S0007114521002713
Ravneet Kaur Saluja 1, Pooja Dewan 1, Sunil Gomber 1, S V Madhu 2, Shuchi Bhatt 3, Piyush Gupta 1

Note; Radiological healing if Thatcher Score <1.5


For infants:  2,000 IU daily  or single dose of 60,000 IU
For 1-5 year:  4,000 IU daily  or single dose of 150,000 IU

Wonder why they call 60,000 IU or 150,000 IU low doses

Better than Daily has the following

31 items in BETTER THAN DAILY category

Non-daily (Bolus) is better:

  1. Better compliance for everyone
    • Fewer opportunities to forget.
    • If happen to forget, just take the pill days or weeks later
    • Fewer times to have to take a pill - for those who dislike doing so
  2. Non-daily is better the ~20% who have a poor Vitamin D Receptor
    • A high concentration gradient is one of 14 ways to get past Vitamin D Receptor limitations
    • So, while 80% get no extra benefit from non-daily dosing, 20% will get an extra benefit

Overview of Rickets and vitamin D contains the following summary

Rate of rickets is usually < 0.1% of births, unless dark skin, breastfed, preemie, twin, Mongolian, or Russian
Rate of rickets has greatly increased with the drop in vitamin D levels during the past 40 years
400 IU can prevent/treat most rickets Turkey gave vitamin D to EVERY child and eliminated Rickets
Can have rickets without a low serum level of vitamin D (~20% of the time)
Giving enough Vitamin D to the mother (before and after birth) PREVENTS most forms of Rickets
Rate of rickets in some countries varies from 10% to 70% (typically poor health overall)
Rickets has been more than doubling in many countries
Rickets is strongly associated with severe breathing problems (weak ribs)
Bowed legs is not the primary indication of rickets    (3 other indications of rickets are seen more often)
Rickets is typically due to low cellular Vitamin D - April 2024
Some Rickets is due to poor genes - Vitamin D needed lifelong – June 2020
Vitamin D and Rickets consensus took 80 years

Rickets category has 128 items

Loading Dose of Vitamin D category has the following

204 items in category
see also Overview Loading of vitamin D   Overview Toxicity of vitamin D
Better than Daily 1: Fewer chances to forget, 2) Gets past receptor barrier
Injection category has 62 items
It appears that over 1 million Vitamin D loading doses have been taken
Doses ranged from 100,000 to 600,000 IU over a period of a day to a month
No reports of serious adverse reactions
Many studies report on the benefits resulting from loading doses

TOP articles in Loading Dose of Vitamin D

Pages in both categories Infant/Child and Loading Dose:

 Download the PDF from VitaminDWiki

Objective: To compare the efficacy of daily versus low dose depot oral vitamin D3 for treating nutritional rickets.

Design: Randomized Controlled Trial.

Setting: Paediatrics department of a tertiary care hospital catering to semi-urban and rural population in Delhi, India.

Methods: We randomized 66 children aged 3 months to 5 years with nutritional rickets to receive either daily oral vitamin D3 drops (3-12 months: 2000 IU; >12 months-5y: 4000 IU; n=33) for 12 weeks duration, or a single oral depot dose of vitamin D3 granules (3-12 months: 60,000 IU; >12 months-5y: 150,000 IU; n=33).

Results: Participants in both groups had comparable demographic characteristics, laboratory features and radiological severity of rickets. 33 participants in each group received the assigned intervention and all were followed up till 12 weeks. At 12 weeks follow up, children in both groups showed a significant improvement in all biochemical parameters [serum calcium, phosphorus, alkaline phosphatase, parathormone and 25(OH) vitamin D levels] as well as radiological healing. At 12 weeks, the mean (SD) serum 25(OH) vitamin D levels (nmol/L) were statistically comparable in both groups [daily: 120.2 (83.2), depot: 108 (74), P=0.43] and 31 (94%) children in each group had radiological healing (Thacher score <1.5). Two children in each group persisted to have raised alkaline phosphatase and one child each in the daily group continued to have hypocalcemia and hypophosphatemia at 12 weeks.

Conclusion: Low dose oral depot vitamin D3 is an effective alternative to daily oral vitamin D3 for nutritional rickets.

Created by admin. Last Modification: Saturday December 23, 2023 20:04:04 GMT-0000 by admin. (Version 7)

Attached files

ID Name Comment Uploaded Size Downloads
15932 Rickets RCT.pdf admin 19 Jul, 2021 478.17 Kb 281
15931 Rickets RCT table.jpg admin 19 Jul, 2021 131.26 Kb 1274
15930 Rickets RCT.png admin 19 Jul, 2021 178.08 Kb 140