scholarly journals Vitamin D Dosing: Basic Principles and a Brief Algorithm (2021 Update)

Nutrients ◽  
2021 ◽  
Vol 13 (12) ◽  
pp. 4415
Author(s):  
Andrius Bleizgys
Keyword(s):  
Vitamin D ◽  
High Risk ◽  
Vitamin D Supplementation ◽  
Basic Principles ◽  
Vitamin D Levels ◽  
25 Hydroxy Vitamin D ◽  
The Right

Nowadays, in modern societies, many people can be at high risk to have low vitamin D levels. Therefore, testing of serum 25-hydroxy-vitamin D (25OH-D) levels should be performed before prescribing them vitamin D supplementation. However, in some cases the 25OH-D level assessment is not available at the right moment, e.g., due to mandatory quarantine of COVID-19 outpatients. Therefore, such patients could be advised to start taking moderate vitamin D doses (e.g., 4000 IU/day for adults), and their 25-OH-D levels could be checked later. The proposed algorithm also comprises vitamin D dosing principles when baseline 25OH-D levels are known.

Demographic Characteristics, Risk Factors, and Presenting Features of Children with Symptomatic Nutritional Rickets: A French Series

2020 ◽  
Vol 93 (5) ◽  
pp. 304-312
Author(s):  
Claire Flot ◽  
Valérie Porquet-Bordes ◽  
Justine Bacchetta ◽  
Anya Rothenbuhler ◽  
Anne Lienhardt-Roussie ◽  
...  
Keyword(s):  
Risk Factors ◽  
Vitamin D ◽  
Pediatric Population ◽  
Vitamin D Supplementation ◽  
Demographic Characteristics ◽  
Total Serum ◽  
Nutritional Rickets ◽  
Total Serum Calcium ◽  
Vitamin D Levels ◽  
25 Hydroxy Vitamin D

<b><i>Aim:</i></b> To describe the demographic characteristics, risk factors, and presenting features of children with symptomatic nutritional rickets in France. <b><i>Methods:</i></b> This is a retrospective study of 38 children diagnosed with nutritional rickets from 1998 to 2019. <b><i>Results:</i></b> We observed a higher frequency of rickets in males (74 vs. 26%), in young children (median age at diagnosis: 23 months; 82% were younger than 5 years), and in children with a non-Caucasian ethnic background (89%). Most children were exclusively breastfed (78%) without adequate vitamin D supplementation (89%). The most common presentations were bowed legs (63%), hypocalcemic seizures (21%), and growth retardation (11%). Approximately half (62%) of the children were hypocalcemic. The children presenting with hypocalcemic seizures were significantly younger (0.8 vs. 2.2 years; <i>p</i> = 0.041) and had lower total serum calcium levels (1.44 vs. 2.17 mmol/L; <i>p</i> &#x3c; 0.0001), higher phosphatemia (1.43 vs. 1.23 mmol/L; <i>p</i> = 0.020), and lower 25-hydroxy vitamin D levels (3 vs. 7 ng/mL; <i>p</i> = 0.020) but similar parathyroid hormone levels (357 vs. 289 ng/mL; <i>p</i> = 0.940) compared to rickets cases who did not experience hypocalcemic seizures. A dilated cardiomyopathy was detected in 14% of the children who had undergone echocardiography. <b><i>Conclusion:</i></b> Nutritional rickets remains endemic in the pediatric population and its most severe forms can have life-threatening sequelae. Health practitioners need to be cognizant of these facts to raise awareness and screen high-risk populations.

scholarly journals Inflammatory activity and vitamin D levels in an MS population treated with rituximab

2019 ◽  
Vol 5 (1) ◽  
pp. 205521731982659 ◽  
Author(s):  
Johan Linden ◽  
Gabriel Granåsen ◽  
Jonatan Salzer ◽  
Anders Svenningsson ◽  
Peter Sundström
Keyword(s):  
Multiple Sclerosis ◽  
Vitamin D ◽  
Magnetic Resonance ◽  
Vitamin D Supplementation ◽  
Inflammatory Activity ◽  
T2 Lesions ◽  
Vitamin D Levels ◽  
25 Hydroxy Vitamin D ◽  
Multiple Sclerosis Patients

Background Most multiple sclerosis patients on disease-modifying treatment at Umeå University Hospital are treated with rituximab and the prevalence of vitamin D supplementation has increased over time. Follow-up studies of these off-label treatments are needed. Objective To study inflammatory activity and adverse effects in rituximab-treated multiple sclerosis patients, and associations with 25-hydroxy-vitamin D levels. Methods Retrospectively collected data on repeated estimates of relapses, disability, side effects, magnetic resonance imaging, laboratory measures including 25-hydroxy-vitamin D levels and self-perceived health. Results In 272 multiple sclerosis patients with a mean follow-up of 43 months, we identified seven possible relapses during active rituximab treatment. On magnetic resonance imaging examination, new T2 lesions were seen in 1.3% (10 out of 792 scans), and 0.25% (two out of 785 scans) showed contrast enhancement. Adjusted 25-hydroxy-vitamin D levels in samples drawn close to all magnetic resonance images with new T2 lesions were lower compared to the remainder (62 vs. 81 nmol/l; P = 0.030). Levels of 25-hydroxy-vitamin D were associated with self-perceived health ( r = 0.18, P = 0.041, n = 130) and C-reactive protein ( r = –0.13, P = 0.042) but not with the risk of side effects. Conclusion The inflammatory activity in this rituximab-treated multiple sclerosis population that increasingly used vitamin D supplementation was extremely low. Higher 25-hydroxy-vitamin D levels were associated with beneficial outcomes.

scholarly journals Characterizing the Assessment and Management of Vitamin D Levels in Patients with Osteoporosis in Clinical Practice: A Chart Review Initiative

2015 ◽  
Vol 2015 ◽  
pp. 1-7
Author(s):  
Jonathan D. Adachi ◽  
Jacques P. Brown ◽  
George Ioannidis
Keyword(s):  
Vitamin D ◽  
Clinical Practice ◽  
Bone Health ◽  
Chart Review ◽  
Serum Vitamin ◽  
Vitamin D Supplementation ◽  
Serum Vitamin D ◽  
Vitamin D Levels ◽  
25 Hydroxy Vitamin D ◽  
Vitamin D Supplements

Though vitamin D is important for bone health, little is known about the monitoring and management of vitamin D levels in patients with osteoporosis in clinical practice—a deficit this chart review initiative aimed to remedy. A total of 52 physicians completed profiles for 983 patients being treated for osteoporosis between November 2008 and April 2009. Information collected included demographics; fracture risk factors; availability and level of serum vitamin D measurements; and information on osteoporosis medications and calcium and vitamin D supplementation. Physicians also evaluated patients’ current regimens and detailed proposed changes, if applicable. Nearly 85% of patients were prescribed calcium and vitamin D supplements. Serum 25-hydroxy vitamin D levels were available for 73% of patients. Of these patients, approximately 50% had levels less than 80 nmol/L, which contrasts with the 37% thought to have “unsatisfactory” vitamin D levels based on physician perceptions. Physicians felt 26% of patients would benefit from additional vitamin D supplementation. However, no changes to the osteoporosis regimen were suggested for 48% of patients perceived to have “unsatisfactory” vitamin D levels. The results underscore the importance of considering vitamin D status when looking to optimize bone health.

scholarly journals The effect of vitamin D supplementation on survival in patients with colorectal cancer: systematic review and meta-analysis of randomised controlled trials

2020 ◽  
Vol 123 (11) ◽  
pp. 1705-1712 ◽  
Author(s):  
Peter G. Vaughan-Shaw ◽  
Louis F. Buijs ◽  
James P. Blackmur ◽  
Evi Theodoratou ◽  
Lina Zgaga ◽  
...  
Keyword(s):  
Colorectal Cancer ◽  
Vitamin D ◽  
High Risk ◽  
Meta Analysis ◽  
Vitamin D Supplementation ◽  
Risk Of Bias ◽  
Survival Outcomes ◽  
Vitamin D Levels ◽  
Randomised Controlled ◽  
Incident Cases

Abstract Background Low circulating vitamin D levels are associated with poor colorectal cancer (CRC) survival. We assess whether vitamin D supplementation improves CRC survival outcomes. Methods PubMed and Web of Science were searched. Randomised controlled trial (RCTs) of vitamin D supplementation reporting CRC mortality were included. RCTs with high risk of bias were excluded from analysis. Random-effects meta-analysis models calculated estimates of survival benefit with supplementation. The review is registered on PROSPERO, registration number: CRD42020173397. Results Seven RCTs (n = 957 CRC cases) were identified: three trials included patients with CRC at outset, and four population trials reported survival in incident cases. Two RCTs were excluded from meta-analysis (high risk of bias; no hazard ratio (HR)). While trials varied in inclusion criteria, intervention dose and outcomes, meta-analysis found a 30% reduction in adverse CRC outcomes with supplementation (n = 815, HR = 0.70; 95% confidence interval (CI): 0.48–0.93). A beneficial effect was seen in trials of CRC patients (progression-free survival, HR = 0.65; 95% CI: 0.36–0.94), with suggestive effect in incident CRC cases from population trials (CRC-specific survival, HR = 0.76; 95% CI: 0.39–1.13). No heterogeneity or publication bias was noted. Conclusions Meta-analysis demonstrates a clinically meaningful benefit of vitamin D supplementation on CRC survival outcomes. Further well-designed, adequately powered RCTs are needed to fully evaluate benefit of supplementation in augmenting ‘real-life’ follow-up and adjuvant chemotherapy regimens, as well as determining optimal dosing.

Successful public health action to reduce the incidence of symptomatic vitamin D deficiency

2012 ◽  
Vol 97 (11) ◽  
pp. 952-954 ◽  
Author(s):  
Robert John Moy ◽  
Eleanor McGee ◽  
Geoff D Debelle ◽  
Ian Mather ◽  
Nicholas J Shaw
Keyword(s):  
Vitamin D ◽  
High Risk ◽  
Vitamin D Deficiency ◽  
Incidence Rate ◽  
Uptake Rate ◽  
Public Awareness ◽  
Vitamin D Supplementation ◽  
Minority Population ◽  
Vitamin Supplement ◽  
Vitamin D Levels

BackgroundIn response to a resurgence of symptomatic cases of vitamin D deficiency in a high-risk predominantly ethnic minority population, a programme of universal rather than targeted vitamin D supplementation was begun with a public awareness campaign about the importance of vitamin D.ObjectiveTo evaluate the effectiveness of this programme in reducing case numbers.MethodsCases of symptomatic vitamin D deficiency in children under 5 years resident in a primary care trust catchment area presenting at local hospitals were identified through laboratory records of low vitamin D levels which were cross-checked against medical records to confirm the diagnosis. Comparisons were made of the case incidence rate, level of public knowledge and vitamin supplement uptake rate at the onset of the programme in 2005 and 4 years later.ResultsThe number of cases of symptomatic vitamin D deficiency in those under 5 years fell by 59% (case incidence rate falling from 120/100 000 to 49/100 000) despite the supplement uptake rate rising only to 17%. Public awareness of vitamin D deficiency rose to near universal levels.ConclusionsA programme of universal rather than targeted Healthy Start vitamin D supplementation for pregnant and lactating women and young children has led to a substantial decrease in cases of symptomatic vitamin D deficiency in a high-risk population. Supplementation was also started at a younger age than in the national programme. This approach has implications for the delivery of vitamin D supplementation programmes in similar populations.

scholarly journals Calcium and vitamin D supplementation in children with frequently relapsing and steroid-dependent nephrotic syndrome

2012 ◽  
Vol 52 (1) ◽  
pp. 16
Author(s):  
Ayi Dilla Septarini ◽  
Taralan Tambunan ◽  
Pustika Amalia
Keyword(s):  
Bone Mineral Density ◽  
Vitamin D ◽  
Bone Mineral ◽  
Vitamin D Supplementation ◽  
Ionized Calcium ◽  
Mineral Density ◽  
Vitamin D Levels ◽  
Before And After ◽  
25 Hydroxy Vitamin D ◽  
Serum Ionized Calcium

Background Children with frequently relapsing and steroiddependentnephrotic syndrome (FRNS/SDNS) are at riskfor osteoporosis due to impaired metabolism of calcium andvitamin D.Objective To determine the effect of calcium and vitamin Dsupplementation on bone mineral density, serum ionized calciumlevels and serum 25-hydroxy-vitamin D levels in children withFRNS and SDNS.Methods A clinical trial with a before and after design wasperformed. Subjects were SDNS or FRNS pediatric patients 2: 5years of age. Subjects received 800 mg elemental calcium and 400IU vitamin D supplementation for 8 weeks. Serum ionized calcium,serum 25-hydroxy-vitamin D [25(0H)D], and bone mineral density(BMD) were determined before and after the supplementation.Results Of the 30 subjects, 28 completed the study. However,only 20 subjects underwent BMD determination before and aftersupplementation. Of the 28 subjects, 22 had hypocalcemia and 26had low vitamin D levels. Osteopenia was found in 14/20 subjects andosteoporosis was in 2/20 subjects. After 8 weeks of supplementation,mean serum ionized calcium increased from low [1.15 mmol/L (SDO.oJ)] to normal [1.18 mmol/L (SD 0.04)] (P< 0.001) levels, butmean serum 25(0H)D only increased from vitamin D deficiencycategory [20 ng/mL (SD 7 .7)] to vitamin D insufficiency category[25.5 ng/mL (7.7)] (P=0.010). Mean z-score BMD increased from-1.1 (SD 0.9) to -0.7 (SD 0.2) after supplementation (P<0.001).Conclusion Calcium vitamin D supplementation effectively increasedserum ionized calcium, serum 25 (OH)D, and BMD in subjectswith FRNS and SDNS. [Paediatr lndones. 2012;52:16-21].

scholarly journals Resolution of statin-induced myalgia by correcting vitamin D deficiency: a case report

2015 ◽  
Vol 9 (1) ◽  
pp. 21-26 ◽  
Author(s):  
Luca Gallelli ◽  
Andzelika Michniewicz ◽  
Antonio Siniscalchi ◽  
Giovambattista De Sarro
Keyword(s):  
Vitamin D ◽  
Vitamin D3 ◽  
High Performance ◽  
Plasma Lipids ◽  
Plasma Lipid ◽  
Good Control ◽  
Vitamin D Supplementation ◽  
Vitamin D Levels ◽  
25 Hydroxy Vitamin D ◽  
Pain Improvement

The onset of myalgia is a well-known side effect of cholesterol-lowering statins. Recent studiesa dvanced the hypothesis that reduced vitamin D levels may play a role in the onset of myalgia in statin users and potentially a vitamin D supplementation may be useful in these cases, as suggested by the present case report.A 52-year-old man with a history of smoke and successfully controlled hypertension presented with chest pain and asthenia. He was diagnosed with stable angina pectoris and discharged on atorvastatin. Due to the onset of myalgia, the dosage of atorvastatin was reduced (from 40 mg daily to 20 mg daily) and then atorvastatin was switched to rosuvastatin without symptoms improvement. Switching from rosuvastatin to ezetimibe resulted in pain improvement, but also in plasma lipids increase beyond the normal range. Ezetimibe was switched to rosuvastatin+ analgesic; in the meanwhile a high-performance liquid chromatography (HPLC) analysis showed low levels of 25-hydroxy-vitamin D and 1-25-dihydroxy-vitamin D. Therefore, vitamin D3 was added to rosuvastatin, resulting in pain improvement, decrease of plasma lipids and progressive discontinuation of analgesics. During the follow-up, rosuvastatin was switched to atorvastatin + vitamin D3, with a good control of plasma lipid levels and without the onset of myalgia.

scholarly journals Vitamin D as Modulator of Drug Concentrations: A Study on Two Italian Cohorts of People Living with HIV Administered with Efavirenz

Nutrients ◽  
2021 ◽  
Vol 13 (10) ◽  
pp. 3571
Author(s):  
Jessica Cusato ◽  
Massimo Tempestilli ◽  
Andrea Calcagno ◽  
Alessandra Vergori ◽  
Pierluca Piselli ◽  
...  
Keyword(s):  
Vitamin D ◽  
Drug Exposure ◽  
Plasma Concentrations ◽  
Vitamin D Supplementation ◽  
People Living With Hiv ◽  
Inverse Association ◽  
Drug Concentrations ◽  
Vitamin D Levels ◽  
Different Seasons ◽  
25 Hydroxy Vitamin D

To date, vitamin D seems to have a significant role in affecting the prevention and immunomodulation in COVID-19 disease. Nevertheless, it is important to highlight that this pro-hormone has other several activities, such as affecting drug concentrations, since it regulates the expression of cytochrome P450 (CYP) genes. Efavirenz (EFV) pharmacokinetics is influenced by CYPs, but no data are available in the literature concerning the association among vitamin D levels, seasonality (which affects vitamin D concentrations) and EFV plasma levels. For this reason, the aim of this study was to evaluate the effect of 25-hydroxy vitamin D (25(OH)D3) levels on EFV plasma concentrations in different seasons. We quantified 25(OH)D3 by using chemiluminescence immunoassay, whereas EFV plasma concentrations were quantified with the HPLC–PDA method. A total of 316 patients were enrolled in Turin and Rome. Overall, 25(OH)D3levels resulted in being inversely correlated with EFV concentrations. Some patients with EFV levels higher than 4000 ng/mL showed a deficient 25(OH)D3 concentration in Turin and Rome cohorts and together. EFV concentrations were different in patients without vitamin D supplementation, whereas, for vitamin D-administered individuals, no difference in EFV exposure was present. Concerning seasonality, EFV concentrations were associated with 25(OH)D3 deficiency only in winter and in spring, whereas a significant influence was highlighted for 25(OH)D3 stratification for deficient, insufficient and sufficient values in winter, spring and summer. A strong and inverse association between 25(OH)D3and EFV plasma concentrations was suggested. These data suggest that vitamin D is able to affect drug exposure in different seasons; thus, the achievement of the clinical outcome could be improved by also considering this pro-hormone.

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