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The effect of vitamin D on calcium absorption in older women
J Christopher Gallagher1, Vinod Yalamanchili, Lynette M Smith
1Bone Metabolism Unit, Creighton University Medical Center, 601 North 30th Street, Suite 6718, Omaha, Nebraska 68131, USA. jcg@creighton.edu
Context:
Vitamin D is often recommended for use with calcium supplements to increase absorption. There are no systematic studies of vitamin D on calcium absorption that indicate what dose should be recommended.
Objective:
Our objective was to study the effect of increasing doses of vitamin D3 on calcium absorption.
Design And Setting:
We conducted a randomized double-blind placebo-controlled trial at Creighton University Medical Center, Omaha, NE.
Participants:
Participants included 163 postmenopausal Caucasian women with vitamin D insufficiency, defined as a serum 25-hydroxyvitamin D (25OHD) below 20 ng/ml (50 nmol/liter).
Intervention:
Participants were randomized to receive one of the vitamin D3 doses, 400, 800, 1600, 2400, 3200, 4000, or 4800 IU/d, or placebo for 1 yr. Calcium intake was increased to 1200-1400 mg daily by giving daily calcium citrate.
Main Outcome:
We evaluated the change in calcium absorption on vitamin D.
Results:
Mean serum 25OHD increased from baseline 15.6 ng/ml (39 nmol/liter) to 46.5 ng/ml (112 nmol/liter) in subjects randomized to the highest dose of vitamin D (4800 IU). Calcium absorption was more significantly related to serum 25OHD (R2=0.50; P=0.001) than dose (R2=0.47; P=0.033). Calcium absorption of a 100-mg dose increased from 52-58% (6 mg) over a serum 25OHD range of 20-66 ng/ml (50-165 nmol/liter).
Conclusions:
There was no evidence of a threshold for reduced calcium absorption in the serum 25OHD range of 10-66 ng/ml (25-165 nmol/liter). The increase in absorbed calcium of 6% on high doses of vitamin D is so small that the same amount could be obtained from half a glass of milk (100 ml) or 100 mg elemental calcium. The results challenge assumptions about the value of adding vitamin D to increase calcium absorption except when serum 25OHD is very low that is less than 10 ng/ml (25 nmol/liter).
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