EVALUATION OF VITAMIN D REPLETION REGIMENS TO CORRECT VITAMIN D STATUS IN ADULTS

Endocr Pract. 2009; 15(2): 95–103., PMCID: PMC2683376, NIHMSID: NIHMS110700

Kara J. Pepper, MD,1 Suzanne E. Judd, MPH, PhD,2 Mark S. Nanes, MD, PhD,2,4 and Vin Tangpricha, MD, PhD, FACE2,3,4

1Division of General Internal Medicine, Emory University School of Medicine, Atlanta, Georgia

2Division of Endocrinology, Diabetes and Lipids, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia

3Division of Nutrition and Health Sciences Program, Graduate Division of Biological and Biomedical Sciences, Emory University School of Medicine, Atlanta, Georgia

4Staff Physician, Endocrinology, Department of Veterans Affairs Medical Center, Atlanta, Georgia

Address correspondence and reprint requests to Dr. Vin Tangpricha, Emory University School of Medicine, Division of Endocrinology, Diabetes and Lipids, WMRB 1301, 101 Woodruff Circle Northeast, Atlanta, GA 30322.

Objective

To determine the efficacy and safety of commonly prescribed regimens for the treatment of vitamin D insufficiency.

Methods

We performed a retrospective analysis of 306 consecutive patients who were prescribed ergocalciferol (vitamin D2) for correction of vitamin D insufficiency at the Atlanta Veterans Affairs Medical Center between February 2003 and May 2006. Serum levels of parathyroid hormone, 25-hydroxyvitamin D (25-OHD), and calcium were compared before and after treatment with ergocalciferol. Patients who did not have a 25-OHD determination (n = 41) were excluded from analysis. Vitamin D deficiency, insufficiency, and sufficiency were defined as a serum 25-OHD level of <20 ng/mL, 21 to 29 ng/mL, and ?30 ng/mL, respectively.

Results

We identified 36 discrete prescribing regimens. The 3 most common regimens were ergocalciferol 50,000 IU once weekly for 4 weeks followed by 50,000 IU once monthly for 5 months (n = 48); ergocalciferol 50,000 IU once monthly for 6 months (n = 80); and ergocalciferol 50,000 IU 3 times weekly for 6 weeks (n = 27) . Each of these 3 treatments significantly increased serum 25-OHD (P<.01), but vitamin D sufficiency was achieved in only 38%, 42%, and 82% of study subjects, respectively. Regimens with >600,000 IU of ergocalciferol given for a mean of 60 ± 40 days achieved sufficiency in 64% of cases, without vitamin D toxicity.

Conclusion

In this study, regimens that contained at least 600,000 IU of ergocalciferol appeared to be the most effective in achieving vitamin D sufficiency. Guidelines for the treatment of vitamin D insufficiency in healthy adults should be developed.

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Wonder why not replete with D3 instead of D2. It seems to be 3X more effective and have fewer side effects.