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
Non-daily (Bolus) is better:
- Better compliance for everyone
- Fewer opportunities to forget.
- If happen to forget, just take the dose many days later
- Fewer times to have to take a pill - for those who dislike doing so
- Non-daily gets more vitamin D to the cells for 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
- Weekly Vitamin D better than daily – lower cost, less pill burden, perhaps 1.5X better response – meta-analysis Oct 2024
- Vitamin D given daily, weekly, or monthly has similar response (116 RCTs) – meta-analysis Aug 2023
- 44 percent of successful RCTs in VitaminDWiki used non-daily dosing - Nov 2020
- Monthly vitamin D dosing better for children than daily (again) - Oct 2023
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
Loading Dose of Vitamin D category has the following
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
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
- Vitamin D loading dose of 30,000 IU twice a week is safe and effective – RCT July 2023
- Large dose Vitamin D before surgery was found to help by 35 studies
- Vitamin D is needed before most surgeries – many studies and RCTs
- 400,000 IU of vitamin D 3 days after COVID symptoms reduced 14 day mortality by 3X – Annweiler RCT May 2022
- High-dose Vitamin D safe for children (10,000 IU daily, 600,000 IU bolus) – meta-analysis April 2022
- Take lots of Vitamin D at first signs of COVID
- Rapid Vitamin D Delivery May Result in Better COVID Outcomes - Dec 9, 2021
- Vitamin D loading doses quickly and safely raise levels – meta-analysis Dec 2021
- Childhood cancers – give Vitamin D loading dose if low – Oct 2021
- French recommended 200,000 IU of Vitamin D to stop COVID-19 - Jan 2021
- Vitamin D loading dose was as effective as daily dosing (rickets in this case) – RCT July 2021
- Stoss (loading) dose of vitamin D resulted in bigger response at 30 days (again) – RCT April 2021
- Vitamin D loading dose (stoss therapy) proven to improve health
- Low trauma bone fractures in seniors – considering Vitamin D loading dose for all, without testing – Nov 2019
- Intensive Care (ICU) helped by Vitamin D – review of past and on-going studies – Dec 2018
- Vitamin D restoration then monthly was the most popular dosing by trials – Nov 2018
- Rickets virtually cured by 90,000 IU of Vitamin D along with daily Calcium – RCT Nov 2018
- Rapidly restore Vitamin D levels with 10,000 IU per kg for children in ICU – RCT 2024
- Reasons for Low Vitamin D and what to do
- Healthy in Seven Days - Loading dose of Vitamin D – book 2014
- Can get 50,000 IU Vitamin D anywhere on the globe
Pages in both categories Infant/Child and Loading Dose:
- Growing pains reduced in 91% of children with a single dose of Vitamin D – July 2024
- High-dose Vitamin D safe for children (10,000 IU daily, 600,000 IU bolus) – meta-analysis April 2022
- Childhood cancers – give Vitamin D loading dose if low – Oct 2021
- Vitamin D loading dose was as effective as daily dosing (rickets in this case) – RCT July 2021
- 3X less Septic Shock in children with sepsis getting 150,000 IU of Vitamin D - RCT June 2020
- Child soccer players who were deficient were helped by a single 200,000 IU vitamin D dose – RCT May 2020
- Infant Vitamin D doubles 6 months after birth (can double in 2 weeks)– Oct 2019
- Vitamin D levels in children optimized with six Vitamin D biscuits – RCT Nov 2018
- 2X improved development by severely malnourished children with 2 loading doses of vitamin D – RCT May 2018
- 100,000 IU Vitamin D weekly for 4 weeks is safe and effective for children – May 2019
- Vitamin D loading dose of 300,000 IU for children – 3 weeks with capsules, biscuits, injection – RCT Aug 2018
- Critically ill children – randomized clinical trial to give single doses of up to 400,000 IU of vitamin D – 2019
- Childhood asthma problems eliminated for months by 600,000 IU of Vitamin D injection – June 2017
- Quick restoration of vitamin D in children – 10,000 IU per kg loading dose was not enough – Jan 2017
- Takes a year to restore children and youths to good levels of vitamin D without loading dose - RCT Dec 2016
- Children in Intensive Care need Vitamin D loading dose of 10000 IU per kg (nearing a consensus) - Oct 2016
- Newborn Vitamin D - single 50,000 IU is better than daily – RCT Sept 2016
- Pediatric trials of high dose vitamin D -163 are in a single online database – Feb 2016
- Rapid Normalization of Vitamin D in Critically Ill Children (10,000 IU per kg) – clinical trial
- Vitamin D loading doses of up to 400,000 IU OK for adolescents – meta-analysis Dec 2014
- Neonate loading dose of 30,000 IU vitamin D helped a lot – May 2014
- Recurrence of child pneumonia delayed by 100000 IU of vitamin D – RCT Oct 2010
- 600,000 IU of vitamin D2 every 4 months for decades in East Germany – 1987
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.
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