Reply to Meshkini et al.

Zittermann, Armin; Berthold, Heiner K.; Pilz, Stefan

doi:10.1038/s41430-021-00929-y

Cited by 4 publications

(1 citation statement)

References 9 publications

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“…The FGF23 increment was also higher if baseline 25(OH) D concentrations were low (<20ng/mL) and in patients with endstage kidney/heart failure. A limitation of this meta-analysis was the inclusion of studies that measured different forms of FGF23, but the majority of which measured iFGF23 (18 of 23 studies) [41,47].…”

Section: Vitamin D Megadoses Bolus and Compensatory Mechanismsmentioning

confidence: 99%

Doses and Schemes for Correcting Vitamin D Deficiency: An Update

2024

Food Nutr J

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Vitamin D deficiency is a global problem and vitamin D supplements are used to enhance vitamin D status. There is, however, no agreement on the appropriate dosage and replacement schedule. Current guidelines often recommend doses of 800 IU to 1,000 IU of vitamin D per day in patients at risk for vitamin D deficiency, but in some situations, rapid correction with higher daily doses or single or intermittent dosing schedules are needed. The administration of vitamin D several-fold higher than the current recommended intake was previously suggested, based on its efficacy in correcting rapidly insufficient serum levels of 25(OH)D and its relative safety. Recent clinical trials have, however, shown that very high intermittent dosing schedules have resulted in unfavorable health outcomes.The purpose of this article is to review the mechanism associated with the toxicities of very high intermittent dosing schedules, and to address the proper correction of vitamin D deficiency. Key points• Doses of 800 IU to 1,000 IU of vitamin D per day are recommended in patients at risk for vitamin D deficiency • Rapid correction schemes for vitamin D deficiency have included high daily doses; as well as single or intermittent megadose boluses administered at variable time intervals• Vitamin D in high daily doses or intermittent megadose boluses can be chosen for a few weeks until adequate 25(OH)D levels are reached. In the case of intermittent administration, it is recommended that individual doses do not exceed 50,000 IU weekly• Very high intermittent vitamin D megadose boluses can cause adverse events and must be avoided

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Section: Vitamin D Megadoses Bolus and Compensatory Mechanismsmentioning

confidence: 99%

Doses and Schemes for Correcting Vitamin D Deficiency: An Update

2024

Food Nutr J

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Role of vitamin D supplementation in the management of musculoskeletal diseases: update from an European Society of Clinical and Economical Aspects of Osteoporosis, Osteoarthritis and Musculoskeletal Diseases (ESCEO) working group

et al. 2022

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Vitamin D is a key component for optimal growth and for calcium–phosphate homeostasis. Skin photosynthesis is the main source of vitamin D. Limited sun exposure and insufficient dietary vitamin D supply justify vitamin D supplementation in certain age groups. In older adults, recommended doses for vitamin D supplementation vary between 200 and 2000 IU/day, to achieve a goal of circulating 25-hydroxyvitamin D (calcifediol) of at least 50 nmol/L. The target level depends on the population being supplemented, the assessed system, and the outcome. Several recent large randomized trials with oral vitamin D regimens varying between 2000 and 100,000 IU/month and mostly conducted in vitamin D-replete and healthy individuals have failed to detect any efficacy of these approaches for the prevention of fracture and falls. Considering the well-recognized major musculoskeletal disorders associated with severe vitamin D deficiency and taking into account a possible biphasic effects of vitamin D on fracture and fall risks, an European Society for Clinical and Economic Aspects of Osteoporosis, Osteoarthritis and Musculoskeletal Diseases (ESCEO) working group convened, carefully reviewed, and analyzed the meta-analyses of randomized controlled trials on the effects of vitamin D on fracture risk, falls or osteoarthritis, and came to the conclusion that 1000 IU daily should be recommended in patients at increased risk of vitamin D deficiency. The group also addressed the identification of patients possibly benefitting from a vitamin D loading dose to achieve early 25-hydroxyvitamin D therapeutic level or from calcifediol administration.

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