Heterogeneity in serum 25-hydroxy-vitamin D response to cholecalciferol in elderly women with secondary hyperparathyroidism and vitamin D deficiency.
J Am Geriatr Soc
; 58(8): 1489-95, 2010 Aug.
Article
en En
| MEDLINE
| ID: mdl-20646099
ABSTRACT
OBJECTIVES:
To compare the effects on parathyroid hormone (PTH) and 25-hydroxy-vitamin D (25(OH)D) of two dosing regimens of cholecalciferol in women with secondary hyperparathyroidism (sHPTH) and hypovitaminosis D and to investigate variables affecting 25(OH)D response to cholecalciferol.DESIGN:
Randomized-controlled trial with 6-month follow-up.SETTING:
Two osteoporosis centers in northern Italy.PARTICIPANTS:
Sixty community-dwelling women aged 65 and older with sHPTH and hypovitaminosis D, creatinine clearance greater than 65 mL/min and without diseases or drugs known to influence bone and vitamin D metabolism. INTERVENTION Cholecalciferol 300,000 IU every 3 months, once at baseline and once at 3 months (intermittent D(3) group) or cholecalciferol 1,000 IU/day (daily D(3) group). MEASUREMENTS Serum PTH, 25(OH)D, calcium, bone-specific alkaline phosphatase, ß-C-terminal telopeptide of type I collagen, phosphate, 24-hour urinary calcium excretion.RESULTS:
The two groups had similar baseline characteristics. All participants had vitamin D deficiency [25(OH)D<20 ng/mL)], and 36 subjects (60%) had severe deficiency (<10 ng/mL), with no difference between the groups (severe deficiency intermittent D(3) group, n=18; daily D(3) group, n=18). After 3 and 6 months, both groups had a significant increase in 25(OH)D and a reduction in PTH. Mean absolute increase ± standard deviation of 25(OH)D at 6 months was higher in the intermittent D(3) group (22.7±11.8 ng/mL) than in the daily D(3) group (13.7±6.7 ng/mL, P<.001), with a higher proportion of participants in the intermittent D(3) group reaching desirable serum concentration of 25(OH)D≥30 ng/mL (55% in the intermittent D(3) group vs 20% in the daily D(3) group, P<.001). Mean percentage decrease of PTH in the two groups was comparable, and at 6 months, a similar proportion of participants reached normal PTH values. 25(OH)D response to cholecalciferol showed a wide variability. In a logistic regression analysis, body mass index and type of treatment appeared to be significantly associated with normalization of 25(OH)D values.CONCLUSION:
Cholecalciferol 300,000 IU every 3 months was more effective than 1,000 IU daily in correcting vitamin D deficiency, although the two groups achieved similar effects on PTH at 6 months. Only 55% of the higher-dose intermittent group reached desirable concentrations of 25(OH)D, suggesting that yet-higher doses will be required for adequate vitamin D repletion.
Texto completo:
1
Bases de datos:
MEDLINE
Asunto principal:
Deficiencia de Vitamina D
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Vitaminas
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Colecalciferol
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Hiperparatiroidismo Secundario
Tipo de estudio:
Clinical_trials
Límite:
Aged
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Female
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Humans
Idioma:
En
Revista:
J Am Geriatr Soc
Año:
2010
Tipo del documento:
Article
País de afiliación:
Italia