Effects of Weekly Supplementation of Cholecalciferol and Calcifediol Among the Oldest-Old People: Findings From a Randomized Pragmatic Clinical Trial.

Carmelinda Ruggiero,Vittorio Bini,Elisa Zengarini,Luca Parretti,Virginia Boccardi,Patrizia Mecocci,Maria Lapenna,Alberto Falorni,Marta Baroni,Annalisa Brozzetti,Pierluigi Antinolfi

doi:10.3390/nu11112778

Carmelinda Ruggiero, Vittorio Bini + Show 9 more

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https://doi.org/10.3390/nu11112778

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Abstract

Vitamin D inadequacy is pervasive in the oldest-old. Many vitamin D metabolites are available for supplementation, their effects on the recovery of adequate serum levels remain unknown. We investigate the effects of supplementation with cholecalciferol (D3) and calcifediol (25D3) on serum levels of 25(OH)D, 1-25(OH)D, bone and inflammatory markers, ultimately identifying clinical predictors of successful treatment. Sixty-seven oldest-old individuals were randomized to weekly administration of 150 mcg of 25D3 or D3, from hospital admission to 7 months after discharge. Supplementation of 25D3 and D3 were associated with increasing serum levels of 25(OH)D (p < 0.001) and 1-25(OH)D (p = 0.01). Participants on 25D3 experienced a steeper rise than those on D3 (group*time interaction p = 0.01), after adjustment for intact parathyroid hormone (iPTH) levels the differences disappeared (intervention*iPTH interaction p = 0.04). Vitamin D supplementation was associated with a decreasing trend of iPTH and C-reactive protein (CRP) (p < 0.001). Polypharmacy and low handgrip strength were predictors of failure of intervention, independent of vitamin D metabolites. In conclusion, D3 and 25D3 supplementation significantly increase vitamin D serum levels in the oldest-old individuals, with a tendency of 25D3 to show a faster recovery of acceptable iPTH levels than D3. Polypharmacy and low muscle strength weaken the recovery of adequate vitamin D serum levels.

Highlights

Low serum levels of vitamin D are pervasive in older people, especially among those with fragility fractures [1]
Serum levels of 25(OH)D ≤ 10–12 ng/mL identifies a vitamin D deficiency, which is extremely risky for bone and muscle health in the general population, even moreso in seniors, who are at risk of falls and fractures [3]
Participants showed cognitive functions at MiniMental State Examination (MMSE) substantially preserved, they reported independence in activities of daily living (ADL) and ability to perform several instrumental activities of daily living (IADL), they appeared clinically vulnerable at the CSHA scale (4 versus 4; p = 0.9)

Summary

Introduction

Low serum levels of vitamin D are pervasive in older people, especially among those with fragility fractures [1]. Falls and fractures are causally related to low serum 25-hydroxyvitamin D [25(OH)D], leading to decreased intestinal calcium absorption, increased intact parathyroid hormone (iPTH). ~40% for vertebral fracture in the oldest-old people, especially women [2]. Serum levels of 25(OH)D ≤ 10–12 ng/mL identifies a vitamin D deficiency, which is extremely risky for bone and muscle health in the general population, even moreso in seniors, who are at risk of falls and fractures [3]. Serum levels of 25(OH)D ≥ 20 ng/mL are likely adequate in the general population [4], but a threshold of 25(OH)D > 30 ng/mL is advisable for individuals at high risk for fracture, especially if anti-fracture treatment is used [5]. Studies point to 25(OH)D between 22–30 ng/mL as the optimal therapeutic range with respect to fall prevention in seniors who had a prior fall, while 25(OH)D concentrations below 20–22 ng/mL (53 nmol/L) and above 45–50 ng/mL (112–125 nmol/L) are associated with increased risk of falling [6]

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