Vitamin D and Fracture risk new research.
Posted: Wed Nov 14, 2007 1:00 pm
If you keep your eyes on the Vitamin D news you will over the next few days see headlines like this one.
Vitamin D injection fails to prevent fractures in elderly people
This study reports that 300,000iu intramuscular vitamin D2 ergocalciferol injection does not improve the fracture risk of elderly people.
No protective effect was observed.
It would help me and keep people better informed, if when you see these headlines, if you could use the comments section where available, to explain why ergocalciferol should not be used as a vitamin supplement and why it is not effective for older people and how by using it, this research is fundamentally flawed.
The Case Against Ergocaciferol as a vitamin supplement. explains the research showing that it is NOT as effective as D3 in raising vitamin d status. 3000iu of Ergocalciferol is the equivalent of 1000iu of Vitamin D3, that's at best if it is absorbed/utilised at all.
But we also know from this study "Plasma 25-Hydroxyvitamin D Responses of Younger and Older Men to Three Weeks of Supplementation with 1800 IU/day of Vitamin D" published 1999, by Bess Dawson-Hughes (an acknowledged expert) shows clearly that older people do NOT absorb/utilize Vitamin D2 as well as younger people and concludes Concentrations of 25(OH)D3 did not change significantly in any group.
And here A comparison of the effects of alfacalcidol treatment and vitamin D2 supplementation on calcium absorption in elderly women with vertebral fractures.
Our study shows that vitamin D2 supplementation is ineffective in stimulating calcium absorption in elderly women
It is D3 that is required to improve the uptake of calcium from our food.
It is D3 that is improves muscle strength and muscle function so older people are less likely to sway and are more able to regain their balance should they start to tumble.
So in the first place the 300,000iu of vitaminD2 was actually only the equivalent of 100,000iu of Vitamin D3.
100,000iu spread over 12 months should be the equivalent (if it is absorbed, if it were converted to D3) of 277iu daily
We know from "The urgent need to recommend an intake of vitamin D that is effective" that 400iu/daily d3 raises status by 7-12nmol/L so 277iu could possibly make a difference of 4-7nmol/l. As older people have nmol/l status of 35nmol/l summer 23nmol/l winter so adding at best 7nmol/l is trivial, it is simply insignificant because to improve calcium uptake/muscle function we need to be near the 80nmol/l level and these people are still below half the level required.
Perhaps if they had provided the vitamin D as D3 and in daily oral doses the impact would have been greater as this study shows may be the case.
Efficacy of different doses and time intervals of oral vitamin D supplementation with or without calcium in elderly nursing home residents. is some research comparing daily, weekly, monthly oral intake of vitamin D3. They found that, although daily dosing was best, the difference between daily and weekly was insignificant but monthly intake produced significantly lower effects. While I cannot be certain this is the same for injection it is probably the same.
So if you want to repeat this experiment at home as see if your risk of fracture is less following the use of an effective amount of vitamin d please pay attention to the following points.
1)Use the form of vitamin D that is known to be absorbed best by older people. D3 CHOLECALCIFEROL
2)Take an effective amount of supplement either DAILY or Weekly, (it's fat soluble so best taken with food)
3)Understand that those who have spent their lives working with Vitamin D3 say 400iu/daily raises status by approximately 9nmol/l only.
4)Understand that the average 45yr old has a winter vitamin d status around 40nmol/l and older people (because they stay indoors more and have thinner skins with less cholesterol to convert to vitamin d) have winter levels around 23nmol/l
5)Do some simple mental arithmetic to work out how many iu's you are likely to need to raise your status to over 80nmol/l the level that maximises calcium uptake and improves muscle strength.
6) and remember Risk assessment for vitamin D shows all the research in the safety of vitamin d up to January 2007
(more has been done since with even higher amounts safely) and NO ADVERSE EVENTS occur or have occurred under 10,000iu/daily but even that is twice what anyone reading this would need.
Vitamin D injection fails to prevent fractures in elderly people
This study reports that 300,000iu intramuscular vitamin D2 ergocalciferol injection does not improve the fracture risk of elderly people.
No protective effect was observed.
It would help me and keep people better informed, if when you see these headlines, if you could use the comments section where available, to explain why ergocalciferol should not be used as a vitamin supplement and why it is not effective for older people and how by using it, this research is fundamentally flawed.
The Case Against Ergocaciferol as a vitamin supplement. explains the research showing that it is NOT as effective as D3 in raising vitamin d status. 3000iu of Ergocalciferol is the equivalent of 1000iu of Vitamin D3, that's at best if it is absorbed/utilised at all.
But we also know from this study "Plasma 25-Hydroxyvitamin D Responses of Younger and Older Men to Three Weeks of Supplementation with 1800 IU/day of Vitamin D" published 1999, by Bess Dawson-Hughes (an acknowledged expert) shows clearly that older people do NOT absorb/utilize Vitamin D2 as well as younger people and concludes Concentrations of 25(OH)D3 did not change significantly in any group.
And here A comparison of the effects of alfacalcidol treatment and vitamin D2 supplementation on calcium absorption in elderly women with vertebral fractures.
Our study shows that vitamin D2 supplementation is ineffective in stimulating calcium absorption in elderly women
It is D3 that is required to improve the uptake of calcium from our food.
It is D3 that is improves muscle strength and muscle function so older people are less likely to sway and are more able to regain their balance should they start to tumble.
So in the first place the 300,000iu of vitaminD2 was actually only the equivalent of 100,000iu of Vitamin D3.
100,000iu spread over 12 months should be the equivalent (if it is absorbed, if it were converted to D3) of 277iu daily
We know from "The urgent need to recommend an intake of vitamin D that is effective" that 400iu/daily d3 raises status by 7-12nmol/L so 277iu could possibly make a difference of 4-7nmol/l. As older people have nmol/l status of 35nmol/l summer 23nmol/l winter so adding at best 7nmol/l is trivial, it is simply insignificant because to improve calcium uptake/muscle function we need to be near the 80nmol/l level and these people are still below half the level required.
Perhaps if they had provided the vitamin D as D3 and in daily oral doses the impact would have been greater as this study shows may be the case.
Efficacy of different doses and time intervals of oral vitamin D supplementation with or without calcium in elderly nursing home residents. is some research comparing daily, weekly, monthly oral intake of vitamin D3. They found that, although daily dosing was best, the difference between daily and weekly was insignificant but monthly intake produced significantly lower effects. While I cannot be certain this is the same for injection it is probably the same.
So if you want to repeat this experiment at home as see if your risk of fracture is less following the use of an effective amount of vitamin d please pay attention to the following points.
1)Use the form of vitamin D that is known to be absorbed best by older people. D3 CHOLECALCIFEROL
2)Take an effective amount of supplement either DAILY or Weekly, (it's fat soluble so best taken with food)
3)Understand that those who have spent their lives working with Vitamin D3 say 400iu/daily raises status by approximately 9nmol/l only.
4)Understand that the average 45yr old has a winter vitamin d status around 40nmol/l and older people (because they stay indoors more and have thinner skins with less cholesterol to convert to vitamin d) have winter levels around 23nmol/l
5)Do some simple mental arithmetic to work out how many iu's you are likely to need to raise your status to over 80nmol/l the level that maximises calcium uptake and improves muscle strength.
6) and remember Risk assessment for vitamin D shows all the research in the safety of vitamin d up to January 2007
(more has been done since with even higher amounts safely) and NO ADVERSE EVENTS occur or have occurred under 10,000iu/daily but even that is twice what anyone reading this would need.