Vitamin D supplementation protocols: loading, injection, etc – RCT

Created August 2014

Study Of Various Vitamin D3 Supplementation Protocols That Are Used In Community Practice For Treatment Of Hypovitaminosis D

Endo 2014 - Chicago: Poster Board, Session: SAT 0229-0266-Vitamin D Metabolism & Action

Pratibha Shahajirao Pawal, M.D, DM Endocrinology

T. N. Medical College & B.Y.L. Nair hospital, Mumbai, Mumbai

Pawal PS,Joshi AS,Lathia T,Mittal S,Sharma BR,Dalwadi PP,Bhagwat NM, Chadha MD, Varthakavi PK.

Introduction: Hypovitaminosis D is widely prevalent in India (70-90%). Different dosing protocols have been used for Vitamin D(VITD) supplementation; however there is no universally accepted regimen.

Objectives: Comparison of serial VITD concentrations attained with various VITD supplementation protocols in VITD deficient subjects.

Methods: 242 subjects were screened. 105 consenting subjects( age 20-60 years) with Hypovitaminosis D(VITD <16ng/ml) participated in the study and were randomized to receive 4 different supplemental regimens i.e. single dose 6lacIU orally, single dose 6lacIU intramuscular, 60000IU once weekly for 8 weeks and 2000IU daily for 8 weeks.

Outcome measures: Primary outcome measure was the serial serum VITD concentration attained. VITD, Parathyroid Hormone (PTH), calcium, phosphorus, alkaline phosphatase were monitored at baseline, 1,3,6,8 & 12 weeks of therapy.

Results: 66.5% subjects were found to be vitamin D deficient (<20ng/ml). Baseline VITD concentrations for Oral, IM, Weekly and Daily groups were 10.6±3.7; 9.7±4.5; 8.9±4.4 and 10.2±4.3 ng /ml respectively. VITD concentrations increased significantly in all groups at 3 weeks(P <0.001).

After 8 weeks, VITD concentrations for Oral, IM, Weekly and Daily groups were 34.6±9.4; 40.6±15.1 ; 40.2±13.9 and 24.7±7.7ng/ml respectively. VITD concentration decreased from 8 weeks to 12 weeks in all groups except in IM group which maintained steady increasing trend from 8wks to 12 wks.VITD level >100ng/ml was observed in 40% of subjects in oral group while none of other groups showed VITD >100ng/ml at all time points. All groups were compared with mean percentage increment in VITD concentration at different time points. Serum intact PTH was increased in only in 40% of subjects with VITD <16 ng/ml.

Conclusions:

  • Only IM mega dose group showed sustained increment of VITD concentration at 12 weeks without VITD toxicity or hypercalcaemia.

  • Only oral group had VITD levels >100 ng/ml(40%) without clinical manifestations of hypervitaminosisD .

  • Oral loading dose is adequate for maintaining VITD sufficiency only for duration of 3 months & need for resupplementation at 3 monthly interval.

  • Weekly group also showed decline in VITD sufficiency at 12 weeks indicates need for retesting and supplementation.

  • 2000IU daily is not adequate to achieve sufficiency in VITD deficient subjects.

Summary by VitaminDWiki
Dose 8 weeks
(end of dosing)		 12 weeks
600,000 IU oral 35 ng
600,000 IU injection 40 ng 40% > 100 ng
60,000 IU weekly 40 ng declined by 12 weeks
2,000 IU daily 25 ng

See also VitaminDWiki

VitaminDWiki pages in both categories Loading and Injection

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Overview Loading of vitamin D contains the following

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Tags: Injection Loading dose