2000 IU of vitamin D and 600 mg of Calcium for 38 weeks for Osteoporosis (more D is needed) – July 2024

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Real-world effectiveness and safety of combined calcium 600 mg and cholecalciferol 2000 IU for treating vitamin d deficiency: Results from a nationwide study with focus in osteoporosis

Bone Reports https://doi.org/10.1016/j.bonr.2024.101796 Spain
Rosa Pinto Bonilla1; José Baeza Noci1; Clara Casado Blanco2; Guillermo Javier Valls Gumbau3; Rubén Juarez Fernández2; María Pascual-Pastor4; Blanca García Magamón5; Blanca Panero Lamothe6; Carmen Moragues Pastor7; Rafael izquierdo Aviñó; Eva García Aguilar9; Paula SazLeal9. On behalf of the DOSTEO research group*.

Introduction
Treatment of calcium (Ca) and vitamin D (VD) deficiency (VDD) is crucial for health, especially in bone conditions, such as low bone mineral density (BMD) and osteoporosis. Despite updates in clinical guideline recommendations, no studies have evaluated the efficacy and safety of administering 2000 IU of cholecalciferol combined with calcium. Thus, the main objective of this study was to evaluate VD levels following treatment with Ca 600 mg/ cholecalciferol 2000 IU in real-life clinical practice.

Methods
This multicenter, retrospective, observational study included 302 adult patients receiving Ca 600 mg/D3 2000 IU orodispersible tablets, daily for ≥24 weeks. The primary outcome was 25-hydroxivitamin D [25(OH)D] serum levels following treatment. Key secondary outcomes included changes in serum 25(OH)D levels and other bone metabolism (BM) parameters, safety and tolerability. The protocol was approved by a Research Ethics Committee.

Results
285 patients were evaluated (mean age [SD]: 67.4 [12.6] years old; 88.4 % women; basal serum 25(OH)D: 20.0 [8.6] ng/mL); 80.7 % reported previous history of osteoporosis/low BMD (osteopenia) and 37.2 % had received other Ca/VD prior to start study treatment. Median treatment duration was 38.5 weeks [range 24.0–82.4]. Overall, 94.4 % of patients increased serum 25(OH)D following treatment to a mean of 36.3 [11.8] ng/mL (p < 0.001 vs. baseline). Patients with basal VDD, significantly increased serum 25(OH)D to a mean over 30 ng/mL; no significant change found in repleted patients (basal 25(OH)D level ≥ 30 ng/mL). PTH was significantly reduced after treatment, with no clinically relevant effect on serum Ca or phosphate. Three non-serious treatment-emergent adverse events were reported. A post-hoc analysis on osteoporotic patients revealed virtually identical results in this population.

Conclusion
Treatment with Ca 600 mg/cholecalciferol 2000 IU for at least 24 weeks is effective and safe, especially in osteoporosis. Patients with VDD significantly increase plasma 25(OH)D to optimal range for bone health, with no clinically relevant changes on other bone metabolism parameters other than reducing secondary hyperparathyroidism. The magnitude of 25(OH)D increase directly correlates with the severity of VDD, with no effect in basally repleted patients.
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VitaminDWiki – Overview Osteoporosis and vitamin D contains

• FACT: Bones need Calcium (this has been known for a very long time)
• FACT: Vitamin D improves Calcium bioavailability (3X ?)
• FACT: Should not take > 750 mg of Calcium if taking lots of vitamin D (Calcium becomes too bio-available)
• FACT: Adding vitamin D via Sun, UV, or supplements increased vitamin D in the blood
• FACT: Vitamin D supplements are very low cost
• FACT: Many trials, studies. reviews, and meta-analysis agree: adding vitamin D reduces osteoporosis
• FACT: Toxic level of vitamin D is about 4X higher than the amount needed to reduce osteoporosis
• FACT: Co-factors help build bones.
• FACT: Vitamin D Receptor can restrict Vitamin D from getting to many tissues, such as bones
• It appears that to TREAT Osteoporosis:
•        Calcium OR vitamin D is ok
•        Calcium + vitamin D is good
•        Calcium + vitamin D + other co-factors is great
•        Low-cost Vitamin D Receptor activators sometimes may be helpful
• CONCLUSION: To PREVENT many diseases, including Osteoporosis, as well as TREAT Osteoporosis
• Category Osteoporosis has 220 items
• Category Bone Health has 313 items

Note: Osteoporosis causes bones to become fragile and prone to fracture
  Osteoarthritis is a disease where damage occurs to the joints at the end of the bones

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VitaminDWiki – Osteoporosis category contains

• 220 items in category - see also Overview Osteoporosis and vitamin D
• Overview Fractures and vitamin D
• Bone - Health 313 items
• VitaminDWiki pages with BONE MINERAL DENSITY or BMD in title 29+ pages
• Search VitaminDWiki for OSTEOPENIA 1740 items as of July 2020
• 13 articles are in both Osteroporosis and Vitamin D Receptor categories
• 10 articles are in both Osteroporosis and Meta-analysis categories
• 20X increase in vitamin D sold and 36 percent decrease in osteoporosis business in Australia – Nov 2013

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VitaminDWiki – Calcium hazards and bioavailability contains

• All items with Calcium in VitaminDWiki 226 items
• Calcium from food or supplements associated with more deaths (US Cohort of 31,000 people) – April 2019
• More Calcium absorbed with more vitamin D – 6.7% more with 4000 IU – RCT March 2014
• Decrease Calcium and Increase Magnesium when increasing vitamin D
• Calcium supplements proven to NOT reduce fractures, but are proven to INCREASE heart problems – July 2015
• More than 1.4 grams of Calcium increased male death rate by 1.4 X – Sept 2018
• 10,000 IU of Vitamin D is too much if you also take Calcium supplements – RCT Sept 2018
• Calcium Essential to Limit Osteoporosis but Avoid Excess, Say Europeans - Nov 2017
• Hypercalcemia can result from excess Vitamin D (if not reduce Ca or increase water) Oct 2016
• Must balance co-factors when increasing vitamin D 500 Ca, 500 Mg - which has the following concept graph

• More than 800 mg of Calcium increases Cardiovascular events by 85 %– Nov 2011

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VitaminDWiki – Bone - Health category contains

313 items in Bone - Health category
See also

• Overviews: Osteoporosis,  Fractures,  Rickets  Dental   Hair
• 16 articles are in both Bone and Magnesium categories
• 29 articles are in both Bone and Vitamin K2 categories
• 17 articles are in both Bone and Sports categories
• 8 articles are in both Bone and Meta-analysis categories
• 25 articles are in both Fractures and Meta-analysis categories
• Healthy bones need: Calcium, Vitamin D, Magnesium, Silicon, Vitamin K, and Boron – 2012
• VitaminDWiki pages with BONE MINERAL DENSITY or BMD in title 25 pages as of Feb 2023
• Hearing loss is associated with soft bones in ear
  • Perhaps prevented and treated by Vitamin D
• See also Overview of Rickets and Vitamin D   Overview Osteoporosis and vitamin D