Hypovitaminosis D correction and high-sensitivity C-reactive protein levels in hypertensive adults.

CONTEXT: Hypovitaminosis D has been implicated as a possible risk factor for the development of cardiovascular disease. High-sensitivity C-reactive protein (hs-CRP) has been one of the most extensively studied biomarkers for cardiovascular inflammation as an indicator of disease and event risk, independent of traditional risk factors. To date, it is unclear if correction of hypovitaminosis D leads to a reduction of hs-CRP in human subjects. OBJECTIVES: To assess laboratory validity of 25-hydroxyvita-min D (25-OH-vitamin D) and hs-CRP measurements and to determine whether hs-CRP levels in adults with well-controlled hypertension and comorbid low vitamin D levels changed after hypovitaminosis D correction to a serum 25-OH-vitamin D level greater than 30 ng/mL. DESIGN: Prospective study using an unblinded design. RESULTS: One hundred eight subjects who were vitamin D insufficient or deficient completed this study. The mean 25-OH-vitamin D level was 20.07 ng/mL before treatment and 43.92 ng/mL after treatment. Posttreatment vitamin D levels were in the normal range for 91% of the subjects. No statistically significant changes in hs-CRP level were detected after the vitamin D treatment was administered and a posttreatment vitamin D level above 30 ng/mL was confirmed. CONCLUSION: We did not detect a statistically significant difference in hs-CRP after correction of hypovitaminosis D. Twelve weekly oral doses of 50,000 IU of ergocalciferol corrected the hypovitaminosis D in more than 90% of cases.

A telephone-based intervention for increasing the use of osteoporosis medication: a randomized controlled trial.

OBJECTIVE: To evaluate the effectiveness of a telephone-based "virtual" osteoporosis clinic in increasing the use of osteoporosis medication assessed at 1 year after receipt of a prescription. STUDY DESIGN: Randomized controlled trial. METHODS: Women 60 years and older with previously undiagnosed osteoporosis were randomized to evaluation and treatment by a dedicated telephone-based osteoporosis clinic with monthly telephone follow-up until medication was successfully started (intervention) or to usual care provided by their primary care physician (control). A successful outcome was defined as having filled a prescription for a 3-month supply of medication within 130 days, marking 1 year and 30 days since enrollment. RESULTS: A total of 235 women underwent randomization, and 211 received the allocation. Of 109 women in the telephone-based osteoporosis clinic group, 75 (68.8%) were using osteoporosis medication at 1 year compared with 46 of 102 women (45.1%) in the usual care group (P <.001). A poststudy questionnaire showed no significant differences between the groups in regard to knowledge about osteoporosis or attitude toward their osteoporosis care provider. The significant increase in osteoporosis medication use with the telephone intervention occurred at the same time that an independent health maintenance organization-wide program promoting osteoporosis treatment seemed to improve overall rates of use. CONCLUSIONS: The use of osteoporosis medication among women with newly diagnosed osteoporosis may be significantly improved by a simple intervention based on monthly telephone follow-up. Overall use of osteoporosis medication in this trial may have been increased by a systemwide initiative to improve osteoporosis care conducted concurrently with the trial. (ClinicalTrials.gov Identifier: NCT00145067.).