10,000 IU of Vitamin D for 3 years found to help bone by two measurement methods – RCT Feb 2022

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Response to High Dose Vitamin D Supplementation is Specific to Imaging Modality and Skeletal Site

JMBR: https://doi.org/10.1002/jbm4.10615
Lauren A Burt PhD,Leigh Gabel PhD,Emma O Billington MD, FRCPC,David A Hanley MD, FRCPC,Steven K Boyd PhD
HR-pQCT: highlighted variables are statistically significant

DXA: highlighted variables are statistically significant

High-dose vitamin D supplementation (4,000 or 10,000 IU/day) in vitamin D-sufficient individuals results in a dose-dependent decrease in radius and tibia total bone mineral density (TtBMD), compared with 400 IU/day. This exploratory analysis examined whether the response to high dose vitamin D supplementation depends on imaging modality and skeletal site.

Participants were 55-70 years, not osteoporotic with serum 25(OH)D 30 - 125 nmol/L.
Participants’ radius and tibia were scanned on high-resolution peripheral quantitative computed tomography (HR-pQCT) to measure TtBMD, trabecular bone volume fraction (TbBV/TV), trabecular separation (TbSp), cortical thickness (CtTh), and finite element analysis (FEA) estimated failure load. Three-dimensional image registration was used.
Dual X-ray absorptiometry (DXA) scans of the hip, spine and radius measured areal BMD (aBMD) and trabecular bone score (TBS). Constrained linear mixed effects models determined treatment group-by-time and treatment group-by-time-by-sex interactions.

The treatment group-by-time interaction previously observed for radial TtBMD was observed at both ultra-distal (UD, p<0.001) and 33% (p<0.001) aBMD sites. However, the treatment group-by-time-by-sex interaction observed for radial TtBMD was not observed with aBMD at either the UD or 33% site, and the 4,000 and 400 groups did not differ. Registered radial FEA results mirrored TtBMD. An increase in TbSp and decrease in CtTh underpinned dose-dependent changes in radial BMD and strength. We observed no effects in DXA-based aBMD at the hip or spine, or TBS. At the tibia, we observed a time-by-treatment group effect for TbBV/TV.

Given that DXA measures at the radius did not detect sex-differences or differences between the 4,000 and 400 groups, HR-pQCT at the radius may be more sensitive for examining bone changes following vitamin D supplementation. Although DXA did not reveal treatment effects at the hip or spine, whether that is a true skeletal site difference, or a lack of modality sensitivity remains unclear.
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