scholarly journals Response of Severe Osteomalacia to High Dose Vitamin D3 Replacement in a Patient With Ulcerative Colitis and Liver Transplantation on Immunosuppressive Therapy

2021 ◽  
Vol 5 (Supplement_1) ◽  
pp. A219-A219
Author(s):  
Misbah Azmath ◽  
Faryal Sardar Mirza
Keyword(s):  
Ulcerative Colitis ◽  
Vitamin D ◽  
Liver Transplantation ◽  
Vitamin D Deficiency ◽  
Bone Disease ◽  
High Dose ◽  
Vitamin D Metabolism ◽  
Disease Case ◽  
25 Oh Vitamin D ◽  
High Dose Vitamin

Abstract Background: Bone disease is common in inflammatory bowel disease (IBD), more frequently in Crohn’s disease than ulcerative colitis (UC). We present the case of a patient with prior history of ulcerative colitis with severe 25 OH vitamin D deficiency and metabolic bone disease. Case: 67 year old male with h/o ulcerative colitis, colon cancer s/p proctocolectomy and ileostomy, chemo-radiation, h/o primary sclerosing cholangitis (PSC) and orthotopic liver transplantation (OLT) 20 years prior presented with presented with severe muscle aches, severe limitation in mobility and severe vitamin D deficiency. He had been on chronic prednisone and tacrolimus, mycophenolate. Three years after OLT, he had fragility fractures at different times in both hips requiring hip arthroplasty. Labs were significant for persistently elevated alkaline phosphatase (ALP) up to 1569 U/L for last 10 years, bone specific ALP at 423.6 mcg/L, Calcium 9 mg/dl, phosphorus 2 mg/dl, 25 OH vitamin D was 4 ng/ml, 1, 25-hydroxy vitamin D (25-OHD) was 34 ng/ml, PTH was 189 pg/ml, urine calcium/creatinine ratio was 50 mg/g and urine NTX at 223 nM BCE/mM. Celiac screen was negative and tacrolimus levels were within normal range. Patient had extensive workup by gastroenterology for elevated ALP including three liver biopsies which were unrevealing. A bone scan showed increased uptake in thoracic region and metaphyses of large joints. A diagnosis of osteomalacia and secondary hyperparathyroidism was made and he was started on high dose vitamin D gradually increased to 8000 units thrice a day. Within few weeks, he noted marked improvement in mobility, bone pain and need for pain medications. In few months, BSAP decreased to 144.9 mcg/l, NTX and PTH also improved. 25 OH has also increased slightly to 13. He continues on high dose vitamin D and 1200mg of calcium daily. Discussion: Our patient likely had severe osteomalacia due to prolonged vitamin D deficiency, caused by multiple etiologies. Firstly, poor absorption in UC might lower 25-OHD levels. Secondly CYP3A enzymes are involved in the metabolism of calcineurin inhibitor tacrolimus as well as vitamin D, this could result in enhanced vitamin D metabolism, which would explain persistently low vitamin D level despite replacement with such high doses. The significant improvement in his symptoms with supplementation resulting in increased mobility despite not having a normal vitamin D level suggest other pleiotropic effects of vitamin D on muscle and bone as well. Additionally effects of liver transplantation on vitamin D metabolism need to be explored further.

scholarly journals High-Dose versus Low-Dose Vitamin D Supplementation and Arterial Stiffness among Individuals with Prehypertension and Vitamin D Deficiency

2015 ◽  
Vol 2015 ◽  
pp. 1-7 ◽  
Author(s):  
Amanda Zaleski ◽  
Gregory Panza ◽  
Heather Swales ◽  
Pankaj Arora ◽  
Christopher Newton-Cheh ◽  
...  
Keyword(s):  
Vitamin D ◽  
Arterial Stiffness ◽  
Pulse Wave Velocity ◽  
Vitamin D Deficiency ◽  
Wave Velocity ◽  
Low Dose ◽  
Pulse Wave ◽  
Vitamin D Supplementation ◽  
High Dose ◽  
High Dose Vitamin

Introduction. Vitamin D deficiency is associated with the onset and progression of hypertension and cardiovascular disease (CVD). However, mechanisms underlying vitamin D deficiency-mediated increased risk of CVD remain unknown. We sought to examine the differential effect of high-dose versus low-dose vitamin D supplementation on markers of arterial stiffness among ~40 vitamin D deficient adults with prehypertension.Methods. Participants were randomized to high-dose (4000 IU/d) versus low-dose (400 IU/d) oral vitamin D3 for 6 months. 24 hr ambulatory blood pressure (BP), carotid-femoral pulse wave velocity, and pulse wave analyses were obtained at baseline and after 6 months of vitamin D supplementation.Results. There were no changes in resting BP or pulse wave velocity over 6 mo regardless of vitamin D dose (allp>0.202). High-dose vitamin D decreased augmentation index and pressure by 12.3 ± 5.3% (p=0.047) and 4.0 ± 1.5 mmHg (p=0.02), respectively. However, these decreases in arterial stiffness were not associated with increases in serum 25-hydroxyvitamin D over 6 mo (p=0.425).Conclusion. High-dose vitamin D supplementation appears to lower surrogate measures of arterial stiffness but not indices of central pulse wave velocity.Clinical Trial Registration. This trial is registered with www.clinicaltrials.gov (Unique Identifier:NCT01240512).

scholarly journals Vitamin D related genetic polymorphisms affect serological response to high-dose vitamin D supplementation in multiple sclerosis

PLoS ONE ◽  
2021 ◽  
Vol 16 (12) ◽  
pp. e0261097
Author(s):  
Max Mimpen ◽  
Linda Rolf ◽  
Geert Poelmans ◽  
Jody van den Ouweland ◽  
Raymond Hupperts ◽  
...  
Keyword(s):  
Multiple Sclerosis ◽  
Vitamin D ◽  
Risk Allele ◽  
Vitamin D Supplementation ◽  
High Dose ◽  
Clinical Consequence ◽  
Serological Response ◽  
Vitamin D Metabolism ◽  
Metabolism Enzymes ◽  
High Dose Vitamin

Introduction A poor 25-hydroxyvitamin D (25(OH)D) status is a much replicated risk factor for developing multiple sclerosis (MS), and several vitamin D-associated single nucleotide polymorphisms (SNPs) have been associated with a higher risk of MS. However, studies on the benefit of vitamin D supplementation in MS show inconclusive results. Here, we explore whether vitamin D-associated SNPs and MS risk alleles confound serological response to vitamin D supplementation. Methods 34 participants from the SOLARIUM study consented to genotyping, of which 26 had vitamin D data available. The SOLARIUM study randomised relapsing-remitting MS patients to placebo or 14,000 IU vitamin D3 for 48 weeks. Participants were categorised as either ‘carriers’ or ‘non-carriers’ of the risk allele for 4 SNPs: two related to D binding protein (DBP) and associated with lower 25(OH)D levels (rs4588 and rs7041), and two related to vitamin D metabolism enzymes CYP27B1 and CYP24A1 and associated with a higher risk of MS (rs12368653; rs2248359, respectively). 25(OH)D levels were determined at baseline and after 48 weeks. Results The DBP-related SNPs showed no difference in 25(OH)D status at baseline, but carriers of the rs7041 risk allele showed lower 25(OH)D-levels compared to non-carriers after 48 weeks of supplementation (median 224.2 vs. 332.0 nmol/L, p = 0.013). For CYP related SNPs, neither showed a difference at baseline, but carriers of the rs12368653 risk allele showed higher 25(OH)D-levels compared to non-carriers after 48 weeks of supplementation (median 304.1 vs. 152.0 nmol/L, p = 0.014). Discussion Vitamin D-related SNPs affect the serological response to high-dose vitamin D supplementation. The effects on more common doses of vitamin D, as well as the clinical consequence of this altered response, need to be investigated further.

Effect of high-dose vitamin D supplementation on radiographically detectable bone disease of very low birth weight infants

1989 ◽  
Vol 115 (5) ◽  
pp. 779-786 ◽  
Author(s):  
Jacquelyn R. Evans ◽  
Alexander C. Allen ◽  
Dora A. Stinson ◽  
David C. Hamilton ◽  
B. St. John Brown ◽  
...  
Keyword(s):  
Vitamin D ◽  
Birth Weight ◽  
Low Birth Weight ◽  
Bone Disease ◽  
Very Low Birth Weight ◽  
Vitamin D Supplementation ◽  
High Dose ◽  
Low Birth Weight Infants ◽  
High Dose Vitamin

scholarly journals MON-372 Treatment-Resistant Vitamin D Deficiency: Is It a Vitamin D Binding Protein Issue?

2020 ◽  
Vol 4 (Supplement_1) ◽  
Author(s):  
Sirisha Thambuluru ◽  
Imran Unal ◽  
Stuart Frank ◽  
Amy Warriner ◽  
Fernando Ovalle ◽  
...  
Keyword(s):  
Vitamin D ◽  
Alkaline Phosphatase ◽  
Vitamin D Deficiency ◽  
Binding Protein ◽  
High Dose ◽  
Vitamin D Metabolites ◽  
Vitamin D Binding Protein ◽  
Treatment Resistant ◽  
Vitamin D Levels ◽  
25 Oh Vitamin D

Abstract Introduction Vitamin D is present in free and bound forms; the bound form is complexed mainly to vitamin D binding protein (DBP). Vitamin D levels are affected by age, pregnancy, liver disease, obesity, and DBP mutations. We report a patient with treatment-resistant vitamin D deficiency suggestive of a DBP with abnormal vitamin D binding. Clinical Case A 58-year-old Pakistani male with a history of hypertension, sleep apnea and hypogonadism presented to endocrine clinic with symptoms including fatigue, generalized muscle cramps, and joint pain. Evaluation of common causes of fatigue, such as anemia, thyroid dysfunction and adrenal insufficiency were ruled out with CBC, thyroid hormone levels and ACTH stimulation test results all within normal ranges. A 25-OH vitamin D level was profoundly low (4.2 ng/ml; normal 30-100), and a 1,25-OH vitamin D level was undetectable (<8 pg/ml; normal 18-72), leading to a presumptive diagnosis of severe vitamin D deficiency. However, his calcium, phosphorus, alkaline phosphatase and kidney function were in the normal range. Furthermore, the absence of osteoporosis, fracture history, or kidney stones suggested adequate vitamin D action at target tissues; PTH levels were high-normal to minimally elevated, ranging 70-94 pg/ml (12-88pg/mL). Aggressive supplementation with vitamin D3 at 50,000 IU 3 times a week and 5,000 IU daily failed to normalize 25-OH vitamin D (ranged 4.6-10ng/ml; normal 30-100) and 1,25-OH vitamin D levels remained undetectable. Addition of calcitriol resulted in mild hypercalcemia and was discontinued. Malabsorption did not appear to be a contributing factor, as a negative tTG antibody (with normal IgA) excluded celiac disease. Vitamin D metabolites levels measured with mass spectrometry showed undetectable 25-OH vitamin D levels (D2 <4 ng/ml, D3 <2 ng/ml; total <6ng/ml; normal 20-50) and 1,25-OH vitamin D levels (<8 pg/ml). Urine N-telopeptide, 24-hour urine calcium (177mg; 100-240) and bone-specific alkaline phosphatase were all normal. Repeat testing over more than five years showed similar results. DBP levels of 269 ug/ml [104-477] excluded DBP deficiency. Clinical Lesson Vitamin D deficiency is increasingly part of routine testing in internal medicine and endocrinology clinics, as is repletion with high-dose vitamin D. However, in rare cases such as this, relying on 25-OH vitamin D levels can be misleading, and supplementation unnecessary or potentially harmful. Thus, treatment decisions should consider the full clinical context and further evaluation performed when warranted. This patient’s labs are suggestive of an abnormality in the DBP, supporting future examination using molecular testing.

scholarly journals HIGH DOSE VITAMIN D3 VS PLACEBO IN CRITICALLY ILL PATIENTS WITH VITAMIN D DEFICIENCY

CHEST Journal ◽  
2021 ◽  
Vol 160 (4) ◽  
pp. A1005
Author(s):  
Metri Haddaden ◽  
Ibrahim Haddad ◽  
Mohammad Darweesh ◽  
David Weisman
Keyword(s):  
Vitamin D ◽  
Vitamin D Deficiency ◽  
Critically Ill ◽  
Vitamin D3 ◽  
Critically Ill Patients ◽  
High Dose ◽  
High Dose Vitamin

scholarly journals High Dose Vitamin-D-substitution in patients with COVID-19: study protocol for a randomized, double blind, placebo controlled, multi-centre study- VitCov Trial

2021 ◽  
Author(s):  
Fabienne Jaun ◽  
Giorgia Lüthi-Corridori ◽  
Kristin Abig ◽  
Anja Makhdoomi ◽  
Philippe Haas ◽  
...  
Keyword(s):  
Vitamin D ◽  
Vitamin D Deficiency ◽  
Case Series ◽  
Vitamin D Supplementation ◽  
High Dose ◽  
Double Blind ◽  
Multi Centre Study ◽  
Treatment As Usual ◽  
Centre Study ◽  
High Dose Vitamin

Abstract BackgroundThe Coronavirus disease 19 (Covid-19) pandemic has caused more than a million deaths and new treatments are urgently needed. Factors associated with a worse Covid-19 prognosis include old age (> 65 years), ethnicity, male sex, obesity and people with comorbidities such as hypertension, diabetes, cardiovascular disease, and respiratory diseases. Further, vitamin D deficiency has been reported to be a predictor of poor prognosis in patients with acute respiratory failure due to Covid-19. Vitamin D deficiency is a modifiable risk factor, which - according to a recent clinical case series – has the prospect of reducing hospital stay, intensive care and fatal outcomes. Vitamin D has potent immunomodulatory property sand its supplementation might improve important outcomes in critically ill and vitamin D deficient Covid-19 patients. Despite the evidence that supports an association between vitamin D deficiency and Covid-19 severity, there is uncertainty about the direct link. The aim of the trial is therefore to assess if high dose vitamin D supplementation has a therapeutic effect in vitamin D deficient patients with Covid-19.MethodsRandomized, placebo-controlled double blind, multi-centre study trial to compare a high single dose of vitamin D (140’000 IU) followed by treatment as usual (TAU) (VitD + TAU) with treatment as usual only (placebo + TAU) in patients with Covid-19 and vitamin D deficiency.DiscussionVitamin D substitution in patients with Covid-19 and vitamin D deficiency should be investigated for efficacy and safety. The objective of the study is to test the hypothesis that patients with vitamin D deficiency suffering from Covid-19 treated under standardized conditions in hospital will recover faster when additionally treated with high dose vitamin D supplementation. Latest studies suggest, that vitamin D supplementation in patients with Covid-19 is highly recommended to positively influence the course of the disease. With this randomised controlled trial, a contribution to new treatment guidelines shall be made.Trial registration: clinicaltrials.gov: NCT04525820 and SNCTP: 2020 − 01401

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