A randomized controlled trial of vitamin D dosing strategies after acute hip fracture: no advantage of loading doses over daily supplementation.
BMC Musculoskelet Disord. 2011 Jun 20;12:135.
Papaioannou A, Kennedy CC, Giangregorio L, Ioannidis G, Pritchard J, Hanley DA, Farrauto L, DeBeer J, Adachi JD.
McMaster University, HHSC, St. Peter's Hospital Juravinski Research Centre, 88 Maplewood Avenue Hamilton, ON L8M 1W9, Canada. papaioannou at hhsc.ca
There remains uncertainty regarding the appropriate therapeutic management of hip fracture patients. The primary aim of our study was to examine whether large loading doses in addition to daily vitamin D offered any advantage over a simple daily low-dose vitamin D regimen for increasing vitamin D levels.
In this randomized controlled study, patients over age 50 with an acute fragility hip fracture were enrolled from two hospital sites in Ontario, Canada. Participants were randomized to one of three loading dose groups: placebo; 50,000 IU vitamin D2; or 100,000 IU D2. Following a placebo/loading dose, all patients received a daily tablet of 1,000 IU vitamin D3 for 90 days. Serum 25-hydroxy vitamin D (25-OHD) was measured at baseline, discharge from acute care (approximately 4-weeks), and 3-months.
Sixty-five patients were enrolled in the study (44% male). An immediate rise in 25-OHD occurred in the 100,000 group, however there were no significant differences in 25-OHD between the placebo, 50,000 and 100,000 loading dose groups after
- 4-weeks (69.3, 84.5, 75.6 nmol/L, p = 0.15) and
- 3-months (86.7, 84.2, 73.3 nmol/L, p = 0.09), respectively.
At the end of the study, approximately 75% of the placebo and 50,000 groups had reached the target therapeutic range (75 nmol/L), and 44% of the 100,000 group.
In correcting vitamin D insufficiency/deficiency in elderly patients with hip fracture, our findings suggest that starting with a lower daily dose of Vitamin D3 achieved similar results as providing an additional large loading dose of Vitamin D2. At the end of the study, all three groups were equally effective in attaining improvement in 25-OHD levels. Given that a daily dose of 1,000 IU vitamin D3 (with or without a loading dose) resulted in at least 25% of patients having suboptimal vitamin D status, patients with acute hip fracture may benefit from a higher daily dose of vitamin D.
Clinical Trials # NCT00424619.
PMCID: PMC3134427, Free PMC Article
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Red = 0 IU loading dose
Blue = 50,000 IU vitamin D2 loading dose
Purple = 100,000 IU vitamin D2 loading dose
Authors note that the differences were not statistically significant, i.e., need to have more data to be confident of the results.
75% of the 0 IU loading dose
75% of the 50,000 IU vitamin D2 loading dose
44% of the 100,000 IU vitamin D2 loading dose
- That is, fewer people who received the highest loading dose of vitamin D2 had a blood level of 30 ng (75 nmol) than even those who received NO loading dose
- Again, the result differences were not large enough to be statistically significant. (p relatively high = 0.09 )
This study brings into question the effectiveness of prescription of Vitamin D2 injections as loading doses.
Other groups have success with loading doses of 100,000 to 600,000 IU of vitamin D3 after hip surgery
- All items D3 vs D2 41 items Feb 2012
- Overview Vitamin D3 not D2
- Vitamin D2 decreased vitamin D3 levels in the blood – Feb 2011 Random Controlled Trial
- All items Surgery and Trauma 57 items Feb 2012
- All items Loading Dose or Megadose 28 items Feb 2012
- Hip surgery followed by 100,000 IU then 1,000 IU of vitamin D daily – June 2010
- All items in the megadose/loading dose category 29 items March 2012
- Case against Vitamin D2 Veith 2006 4 pages file
- Dose Response Graphs Grimes 2010 - has the results of loading doses of D2 and D3
- below is the response to injection of D2 loading dose
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