Review ArticleLarge, Single-Dose, Oral Vitamin D Supplementation in Adult Populations: A Systematic Review
Section snippets
INTRODUCTION
Vitamin D insufficiency is linked not only to bone disease 1., 2. but also to several nonskeletal conditions, including type 2 diabetes mellitus (DM) (3), cardiovascular disease 4., 5., 6., 7., chronic lung disease 8., 9., 10., 11., tuberculosis (TB) 12., 13., 14., and upper respiratory infections 15., 16.. Vitamin D status is determined by serum 25-hydroxyvitamin D (25[OH]D), the major circulating form of vitamin D (17). Controversy exists as to what serum concentration of 25(OH)D is
METHODS
We searched the terms “high dose vitamin D,” “single dose vitamin D,” “bolus vitamin D,” or “annual dose vitamin D” in PubMed for articles published through September 1, 2012. Limits were preset to manuscripts published in the English language. Titles and abstracts were reviewed. Review articles, cross-sectional studies, non-human studies, and responses to other articles were excluded. Manuscripts were also excluded if the studies: (1) did not use oral cholecalciferol or ergocalciferol, (2)
Study Design
The 30 studies that met eligibility criteria of this paper were published after 1990 and evaluated adult populations receiving single, oral vitamin D doses > 100,000 IU. Elderly populations were sampled in 14 studies 26., 27., 29., 30., 31., 32., 33., 34., 35., 36., 37., 38., 39., 40., and vitamin D-deficient adults were observed in 2 studies 41., 42.. Five studies evaluated cardiovascular risk factors (DM, insulin resistance, peripheral artery disease [PAD], and stroke history) 3., 43., 44., 45.
DISCUSSION
This systematic review demonstrated the consistent efficacy and safety of single, large, oral doses of vitamin D in adults. All studies evaluated report a significant increase in serum/plasma 25(OH)D concentration relative to baseline, which tended to peak between days 7 and 30 (Fig. 2). Mean serum/plasma 25(OH)D concentration surpassed IOM guidelines for vitamin D sufficiency (25[OH]D concentration > 20 ng/mL) in all but 1 study (53). However, the formulation and dose of vitamin D appeared to
CONCLUSION
In conclusion, a single vitamin D3 dose of ≥ 100,000 IU offers a consistently efficient means of improving shortterm vitamin D concentrations of > 20 ng/mL, although vitamin D3 doses of ≥ 300,000 IU are necessary to achieve 25(OH)D concentrations > 30 ng/mL and lowering of plasma PTH concentrations. Although generally safe, bolus doses of > 500,000 IU of vitamin D3 must be used with caution due to the potential for increased fracture risks, altered biochemical markers, and issues with tolerability,
DISCLOSURE
The authors have no multiplicity of interest to disclose.
ACKNOWLEDGMENT
Supported in part by the National Center for Advancing Translational Sciences of the National Institutes of Health, under Award Number UL1TR000454. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.
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