Vitamin D supplementation in the elderly: Review of safety and effectiveness of different regimes

Abstract

Vitamin D deficiency is common in the elderly, especially in countries where effective sunlight or exposure to sunlight is limited. Two regimes for vitamin D supplementation--low-dose daily oral administration and intermittent high-dose administration--were examined with regard to safety and effectiveness. Eleven papers reporting studies in 449 elderly subjects were reviewed. On low-dose continuous supplementation mean concentration of 25 hydroxyvitamin D (25(OH)D) ranged from 57 to 105 nmol/L compared to 55 to 87 nmol/L following high-dose supplementation. These mean values fall within the physiological range for young adults. Hypercalcemia occurred in only 3 subjects and was associated with a predisposing cause in 2 of 3 subjects. We suggest that low dose continuous supplementation (10 to 20 micrograms daily) is the regime of choice but high-dose intermittent supplementation (2.5 mg six monthly) may be suitable where compliance is poor.

Vitamin D and its Major Metabolites: Serum Levels after Graded Oral Dosing in Healthy Men

“…It is also known that treatment with vitamin D 3 raises serum levels of 25(OH)D [2,31], without a measurable effect on serum 1,25(OH) 2 D [12,15]. Our findings are concordant with these reports.…”

“…But the slope we found of serum 25(OH)D on vitamin D intake is, we believe, relevant. If we take as a no-observed-adverse-effect level (NOAEL) a serum 25(OH)D of 150 nmol/l (which is within the observed range for healthy young adults in summer) [31], the mean daily dose of vitamin D 3 needed to move a group of subjects weighing 70 kg from basal levels of 67 nmol/l to 150 nmol/l would be 127.4 mg, which is equivalent to 5096 IU/day. There is obviously no need ever to go that high for nutritional purposes.…”

25-Hydroxyvitamin D Response to Cholecalciferol Supplementation in Hemodialysis

“…Pharmacokinetic studies of vitamin D are important clinically to determine the best repletion regimen in patients on hemodialysis. The 25(OH)D response was more robust in our study than in previous reports in healthy subjects (17,18) or other reports in dialysis subjects (13,14). Differences in study design could account for some of the findings, but the effects of CKD on vitamin D metabolism and racial differences in vitamin D metabolism likely played a substantial role.…”

Secondary Hyperparathyroidism in the Elderly: Means to Defining Hypovitaminosis D

“…In healthy elderly who are living in the community, the desirable level of 100 nmol/l should be achieved by regular sunshine exposure coupled with consumption of fortified milk and by low-dose vitamin D supplementation during winter months [35][36][37]. At the opposite end of the clinical spectrum, elderly patients who are housebound require vitamin D supplements (at least 800 IU/day) in conjunction with calcium supplements on a continuous basis without any need for supervision or concern about toxicity [38]. If evidence of vitamin D depletion persists then, and only then, would the stage be reached for evaluating the role of activated forms of vitamin D. …”