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Maintenance vitamin D3 dosage requirements in Chinese women with post menopausal osteoporosis living in the tropics.
Asia Pac J Clin Nutr 2017; 26(3):412-420AP

Abstract

BACKGROUND AND OBJECTIVES

Vitamin D3 (cholecalciferol) dose required to maintain sufficiency in non- Caucasian women with postmenopausal osteoporosis (PMO) inthe tropics has not been well studied. Some guidelines mandate 800-1000 IU vitamin D/day but the Endocrine Society (US) advocates 1500-2000 IU/day to maintain 25-hydroxyvitamin-D (25(OH)D) concentration at >75 nmol/L. We aimed to establish oral cholecalciferol dose required to maintain 25(OH)D concentration at >75 nmol/L in PMO Chinese Malaysian women, postulating lower dose requirements amongst light-skinned subjects in the tropics.

METHODS AND STUDY DESIGN

90 Chinese Malaysian PMO women in Kuala Lumpur, Malaysia (2°30'N) with baseline serum 25(OH)D levels >=50 nmol/L were recruited. Prior vitamin D supplements were discontinued and subjects randomized to oral cholecalciferol 25,000 IU/4-weekly (Group-A) or 50,000 IU/4-weekly (Group- B) for 16 weeks, administered under direct observation. Serum 25(OH)D, PTH, serum/urinary calcium were measured at baseline, 8 and 16 weeks.

RESULTS

Baseline characteristics, including osteoporosis severity, sun exposure (~3 hours/week), and serum 25(OH)D did not differ between treatment arms. After 16 weeks, 91% of women sufficient at baseline, remained sufficient on 25,000 IU/4-weekly compared with 97% on 50,000 IU/4-weekly with mean serum 25(OH)D 108.1±20.4 and 114.7±18.4 SD nmol/L respectively (p=0.273). At trial's end, 39% and 80% of insufficient women at baseline attained sufficiency in Group A and Group B (p=0.057). Neither dose was associated with hyperparathyroidism or toxicity.

CONCLUSIONS

Despite pretrial vitamin D supplementation and adequate sun exposure, 25.6% Chinese Malaysian PMO women were vitamin D insufficient indicating sunshine alone cannot ensure sufficiency in the tropics. Both ~900 IU/day and ~1800 IU/day cholecalciferol can safely maintain vitamin D sufficiency in >90% of Chinese Malaysian PMO women. Higher doses are required with baseline concentration <75 nmol/L.

Authors+Show Affiliations

Department of Medicine, University of Malaya, Lembah Pantai,59100 Kuala Lumpur,Malaysia. Email: yogesvenugopal@gmail.com; theyoges@hotmail.com.Department of Medicine, University of Malaya, Lembah Pantai,59100 Kuala Lumpur,Malaysia.Department of Medicine, University of Malaya, Lembah Pantai,59100 Kuala Lumpur,Malaysia.Department of Medicine, University of Malaya, Lembah Pantai,59100 Kuala Lumpur,Malaysia.Department of Medicine, University of Malaya, Lembah Pantai,59100 Kuala Lumpur,Malaysia.Department of Medicine, University of Malaya, Lembah Pantai,59100 Kuala Lumpur,Malaysia.Department of Medicine, University of Malaya, Lembah Pantai,59100 Kuala Lumpur,Malaysia.Department of Medicine, University of Malaya, Lembah Pantai,59100 Kuala Lumpur,Malaysia.Department of Medicine, University of Malaya, Lembah Pantai,59100 Kuala Lumpur,Malaysia.Department of Medicine, University of Malaya, Lembah Pantai,59100 Kuala Lumpur,Malaysia.Department of Medicine, University of Malaya, Lembah Pantai,59100 Kuala Lumpur,Malaysia.Department of Medicine, University of Malaya, Lembah Pantai,59100 Kuala Lumpur,Malaysia.Department of Medicine, University of Malaya, Lembah Pantai,59100 Kuala Lumpur,Malaysia.

Pub Type(s)

Journal Article
Randomized Controlled Trial

Language

eng

PubMed ID

28429905

Citation

Venugopal, Yogeswari, et al. "Maintenance Vitamin D3 Dosage Requirements in Chinese Women With Post Menopausal Osteoporosis Living in the Tropics." Asia Pacific Journal of Clinical Nutrition, vol. 26, no. 3, 2017, pp. 412-420.
Venugopal Y, Hatta SFWM, Musa N, et al. Maintenance vitamin D3 dosage requirements in Chinese women with post menopausal osteoporosis living in the tropics. Asia Pac J Clin Nutr. 2017;26(3):412-420.
Venugopal, Y., Hatta, S. F. W. M., Musa, N., Rahman, S. A., Ratnasingam, J., Paramasivam, S. S., ... Vethakkan, S. R. (2017). Maintenance vitamin D3 dosage requirements in Chinese women with post menopausal osteoporosis living in the tropics. Asia Pacific Journal of Clinical Nutrition, 26(3), pp. 412-420. doi:10.6133/apjcn.042016.10.
Venugopal Y, et al. Maintenance Vitamin D3 Dosage Requirements in Chinese Women With Post Menopausal Osteoporosis Living in the Tropics. Asia Pac J Clin Nutr. 2017;26(3):412-420. PubMed PMID: 28429905.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Maintenance vitamin D3 dosage requirements in Chinese women with post menopausal osteoporosis living in the tropics. AU - Venugopal,Yogeswari, AU - Hatta,Sharifah F Wan Muhamad, AU - Musa,Nurbazlin, AU - Rahman,Siti Abdul, AU - Ratnasingam,Jeyakantha, AU - Paramasivam,Sharmila Sunita, AU - Lim,Lee Ling, AU - Ibrahim,Luqman, AU - Choong,Karen, AU - Tan,Alexander Tb, AU - Chinna,Karuthan, AU - Chan,Siew Pheng, AU - Vethakkan,Shireene R, PY - 2017/4/22/entrez PY - 2017/4/22/pubmed PY - 2017/7/14/medline SP - 412 EP - 420 JF - Asia Pacific journal of clinical nutrition JO - Asia Pac J Clin Nutr VL - 26 IS - 3 N2 - BACKGROUND AND OBJECTIVES: Vitamin D3 (cholecalciferol) dose required to maintain sufficiency in non- Caucasian women with postmenopausal osteoporosis (PMO) inthe tropics has not been well studied. Some guidelines mandate 800-1000 IU vitamin D/day but the Endocrine Society (US) advocates 1500-2000 IU/day to maintain 25-hydroxyvitamin-D (25(OH)D) concentration at >75 nmol/L. We aimed to establish oral cholecalciferol dose required to maintain 25(OH)D concentration at >75 nmol/L in PMO Chinese Malaysian women, postulating lower dose requirements amongst light-skinned subjects in the tropics. METHODS AND STUDY DESIGN: 90 Chinese Malaysian PMO women in Kuala Lumpur, Malaysia (2°30'N) with baseline serum 25(OH)D levels >=50 nmol/L were recruited. Prior vitamin D supplements were discontinued and subjects randomized to oral cholecalciferol 25,000 IU/4-weekly (Group-A) or 50,000 IU/4-weekly (Group- B) for 16 weeks, administered under direct observation. Serum 25(OH)D, PTH, serum/urinary calcium were measured at baseline, 8 and 16 weeks. RESULTS: Baseline characteristics, including osteoporosis severity, sun exposure (~3 hours/week), and serum 25(OH)D did not differ between treatment arms. After 16 weeks, 91% of women sufficient at baseline, remained sufficient on 25,000 IU/4-weekly compared with 97% on 50,000 IU/4-weekly with mean serum 25(OH)D 108.1±20.4 and 114.7±18.4 SD nmol/L respectively (p=0.273). At trial's end, 39% and 80% of insufficient women at baseline attained sufficiency in Group A and Group B (p=0.057). Neither dose was associated with hyperparathyroidism or toxicity. CONCLUSIONS: Despite pretrial vitamin D supplementation and adequate sun exposure, 25.6% Chinese Malaysian PMO women were vitamin D insufficient indicating sunshine alone cannot ensure sufficiency in the tropics. Both ~900 IU/day and ~1800 IU/day cholecalciferol can safely maintain vitamin D sufficiency in >90% of Chinese Malaysian PMO women. Higher doses are required with baseline concentration <75 nmol/L. SN - 0964-7058 UR - https://www.unboundmedicine.com/medline/citation/28429905/Maintenance_vitamin_D3_dosage_requirements_in_Chinese_women_with_post_menopausal_osteoporosis_living_in_the_tropics_ L2 - http://apjcn.nhri.org.tw/server/APJCN/26/3/412.pdf DB - PRIME DP - Unbound Medicine ER -