Vitamin D3 Replacement Research Articles

Vitamin D3 inhibits p38 MAPK and senescence-associated inflammatory mediator secretion by senescent fibroblasts that impacts immune responses during ageing.

Vitamin D3 replacement in older insufficient adults significantly improves their antigen-specific varicella zoster virus (VZV) cutaneous immunity. However, the mechanisms involved in this enhancement of cutaneous immunity are not known. Here, we show for the first time that vitamin D3 blocks the senescence-associated secretory phenotype (SASP) production by senescent fibroblasts by partially inhibiting the p38 MAPK pathway. Furthermore, transcriptomic analysis of skin biopsies from older subjects after vitamin D3 supplementation shows that vitamin D3 inhibits the same inflammatory pathways in response to saline as the specific p38 inhibitor, losmapimod, which also enhances immunity in the skin of older subjects. Vitamin D3 supplementation therefore may enhance immunity during ageing in part by blocking p38 MAPK signalling and in turn inhibit SASP production from senescent cells invivo.

The effect of vitamin D treatment on quality of life in patients with fibromyalgia

BackgroundFibromyalgia is a syndrome characterized by chronic widespread pain accompanied by fatigue, disrupted sleep quality, cognitive impairments, subjective soft tissue swelling, and somatic symptoms. There are conflicting results in the literature regarding the prevalence of vitamin D deficiency in fibromyalgia patients and the reduction of symptoms after supplementation.AimsOur study aims to evaluate the effectiveness and reliability of vitamin D supplementation in patients diagnosed with fibromyalgia.MethodsIn our cross-sectional clinical study, 180 female patients aged 18 to 65 diagnosed with fibromyalgia according to the 2010 American College of Rheumatology Diagnostic Criteria were included. Oral vitamin D3 replacement of 50,000 IU was administered for 12 weeks. Patients' Fibromyalgia Impact Questionnaire (FIQ)and Visual Analogue Scale (VAS) scores were evaluated before and after the study.ResultsSignificant differences were observed in the FIQ scores of the 180 fibromyalgia patients before and after vitamin D supplementation (p < 0.05). There was also a significant improvement in VAS scores (p < 0.01). A negative correlation between vitamin D and VAS as well as FIQ scores was found in the study.ConclusionWe determined that vitamin D deficiency is significantly more prevalent in patients diagnosed with fibromyalgia. Vitamin D supplementation was observed to have a positive effect on quality of life and reduction of pain.

Asymptomatic severe hypercalcaemia and renal impairment following vitamin-D replacement in a patient with miliary and CNS tuberculosis

Searchable abstracts of presentations at key conferences in endocrinology ISSN 1470-3947 (print) | ISSN 1479-6848 (online)

Vitamin D: A Factor affecting the Success of Type 1 Tympanoplasty.

Vitamin D (VD) plays role in wound healing and protection against infections. The relationship between plasma VD level and the outcomes of Type 1 tympanoplasty (T1T) has not been studied before. A total of 101 patients with chronic otitis media scheduled for T1T were divided into four groups in relation with their VD levels as severe insufficiency, insufficiency, mild-to-modest deficiency and optimal VD level groups. Graft success, hearing improvement and postoperative infection rates were compared among the groups in 12-month follow-up period. The graft success rate (P = 0.014) and air-bone gap gain (P = 0.004) were significantly higher, and postoperative infection rate was significantly lower (P < 0.001) in optimal VD level group. 25-OH VD deficiency should be considered as a factor for failure in T1T. VD replacement may increase success of tympanoplasty in patients with low preoperative serum VD levels.

Effectiveness of vitamin D2 compared with vitamin D3 replacement therapy in a primary healthcare setting: a retrospective cohort study.

Introduction: Vitamin D deficiency is a worldwide public health concern, which can lead to severe diseases, such as rickets in children and osteomalacia in adults. Most studies have compared equimolar unit-to-unit doses of vitamin D2 and D3.Objectives: The current study aimed to answer the research question: “How effective is vitamin D2 (600,000 U/1.5 ml) compared to vitamin D3 (300,000 U/1 ml) parenteral supplementation for raising serum vitamin D levels in adult patients treated in a primary health care setting?”Setting: Primary Health Care Corporation (PHCC) runs 28 health centers distributed throughout the State of Qatar and its capital city, Doha. Qatar is on the east coast of the Arabic peninsula, with very hot and sunny summers and a desert climate.Study design: This was a retrospective observational cohort study.Method: A total of 15,716 participants were recruited following ethical approval. They were identified by electronic medical records (EMR) describing the clinical encounters of individuals aged 18 to 60-years-old who attended a health center operated by the PHCC during the 3.5-year study period from January 1, 2017 to June 30, 2020. The PHCC EMR system uses SNOMED codes (a systematically organized computer-processable collection of medical terms providing codes, names, synonyms, and definitions implemented for clinical documentation and reporting). Four study groups were created depending on the type of vitamin D injection and the oral form of replacement therapy. The analysis scheme used the serum vitamin D level within the preceding 4 weeks (pretreatment), followed by administration of the treatment dose. The post-treatment serum testing value should have been available within a maximum of 12 weeks. The Statistical Package for Social Sciences (IBMSPSS; IBM Corp., Armonk, NY, USA) version 23 software was used for the statistical analysis.Results: Four treatment options were compared, including a vitamin D2 injection, a vitamin D3 injection, combined use of a vitamin D2 injection + a D2 tablet, and combined use of a vitamin D3 injection + a D2 tablet. All four treatment groups were associated with a statistically significant increase in serum vitamin D within a maximum of 12 weeks of follow-up. The vitamin D2 injection alone was associated with the lowest increase in serum concentration by a mean of 3.2 ng/ml. In contrast, the vitamin D3 injection alone or with a D2 tablet increased serum vitamin D by 6.1 and 5.6 ng/ml, respectively. Using the combination of a vitamin D2 injection and a tablet only added a marginal increase of 2.3 ng/ml in serum vitamin D on top of the 3.2 ng/ml increase attained after administering the D2 injection alone.Conclusion: Utilizing vitamin D3 in an injectable form is the best choice to restore severe vitamin D deficiency. Furthermore, it was superior to the injectable form of vitamin D2, even though vitamin D2 has double the molar units.

Antioxidant Effect of Thioredoxin and Vitamin D3 in Peritoneal Dialysis Patients.

Background Among the chronic diseases, chronic kidney failure is one of diseases that have the most difficulty in coping with oxidative stress due to the deterioration of the antioxidant system balance in the body. Beyond being a vitamin, 1α,25-dihydroxycholecalciferol (vitamin D3) is a molecule that positively or negatively affects many enzymes which are in protein structures. Thioredoxin (TRX), which has an important role in the antioxidant system, is one of these proteins. By conducting this study, we wanted to emphasize the role of vitamin D3 in reducing the oxidative stress load on patients undergoing peritoneal dialysis (PD) via serum TRX level measurement. Methods In this study, we evaluated the medical treatments of 69 PD patients who were followed up routinely. The patients were divided into 2 groups according to whether they used vitamin D3 or not. 49 of our patients were using vitamin D3. While requesting routine laboratory tests, we reserved a separate serum sample to measure serum TRX levels by double-antibody sandwich enzyme-linked immunosorbent assay for all patients. Results Only one parameter has a significant statistical relationship with serum TRX level and the treatment protocol. The serum TRX level was significantly higher (211,62 U/l ± 314,46) in the group receiving vitamin D3 compared to the group which is not using Vitamin D3 (101,63 U/l ± 215,03) (p < 0,006). Conclusion This study highlights the importance of appropriate dose of vitamin D3 replacement especially in PD patients who are under intense oxidative stress compared to healthy individuals.

Impact of Vitamin D3 Supplementation on Recurrent Aphthous Ulcer

Vitamin D is a well-known secosteroid hormone, which exerts multiple essential roles in bone physiology, cell growth and differentiation, the neuromuscular system, immunomodulatory functions and autoimmune diseases. Deficiency of vitamin D has been linked to many oral disorders including tooth decay, periodontitis, oral cancer, oral candidiasis, oral lichen planus and recurrent aphthous ulcers. Many studies have revealed a significant lower serum vitamin D level in recurrent aphthous ulcer patients compared with healthy volunteers. This proposes that vitamin D supplementation may reduce the severity of the lesion. To evaluate the efficacy of vitamin D3 replacement on recurrent aphthous ulcer severity is the objective of the study. This study involved 65 patients with idiopathic minor recurrent aphthous ulcer and vitamin D deficiency/insufficiency. These patients received vitamin D3 supplement over 1 y. Severity of the disease was delineated by the duration of episodes, the number of ulcers per attack and the frequency of recurrence. Severity parameters were compared before and after vitamin D3 intake. In addition, 25-hydroxy vitamin D3 concentrations were measured before and after administration of vitamin D3 by enzyme-linked immunosorbent assay technique. We found a significant decrease in the frequency of attacks and the number of ulcers in each attack with p-value<0.05 following vitamin D replacement. Moreover, a highly significant lowering in the duration of episodes was detected with p-value<0.001. Gender specific analysis showed no statistically significance regarding severity parameters at any point of the study stages. Correlation studies revealed the only detectable correlation was between serum 25-hydroxy vitamin D3 level at baseline and the number of ulcers before and after vitamin D correction. Vitamin D3 supplementation has a safe and positive impact on improving the severity of recurrent aphthous ulcer with regards to the number of lesions, the frequency of recurrence and the duration of episodes, in patients who have vitamin D deficiency/insufficiency.

Response of Severe Osteomalacia to High Dose Vitamin D3 Replacement in a Patient With Ulcerative Colitis and Liver Transplantation on Immunosuppressive Therapy

Background: Bone disease is common in inflammatory bowel disease (IBD), more frequently in Crohn’s disease than ulcerative colitis (UC). We present the case of a patient with prior history of ulcerative colitis with severe 25 OH vitamin D deficiency and metabolic bone disease. Case: 67 year old male with h/o ulcerative colitis, colon cancer s/p proctocolectomy and ileostomy, chemo-radiation, h/o primary sclerosing cholangitis (PSC) and orthotopic liver transplantation (OLT) 20 years prior presented with presented with severe muscle aches, severe limitation in mobility and severe vitamin D deficiency. He had been on chronic prednisone and tacrolimus, mycophenolate. Three years after OLT, he had fragility fractures at different times in both hips requiring hip arthroplasty. Labs were significant for persistently elevated alkaline phosphatase (ALP) up to 1569 U/L for last 10 years, bone specific ALP at 423.6 mcg/L, Calcium 9 mg/dl, phosphorus 2 mg/dl, 25 OH vitamin D was 4 ng/ml, 1, 25-hydroxy vitamin D (25-OHD) was 34 ng/ml, PTH was 189 pg/ml, urine calcium/creatinine ratio was 50 mg/g and urine NTX at 223 nM BCE/mM. Celiac screen was negative and tacrolimus levels were within normal range. Patient had extensive workup by gastroenterology for elevated ALP including three liver biopsies which were unrevealing. A bone scan showed increased uptake in thoracic region and metaphyses of large joints. A diagnosis of osteomalacia and secondary hyperparathyroidism was made and he was started on high dose vitamin D gradually increased to 8000 units thrice a day. Within few weeks, he noted marked improvement in mobility, bone pain and need for pain medications. In few months, BSAP decreased to 144.9 mcg/l, NTX and PTH also improved. 25 OH has also increased slightly to 13. He continues on high dose vitamin D and 1200mg of calcium daily. Discussion: Our patient likely had severe osteomalacia due to prolonged vitamin D deficiency, caused by multiple etiologies. Firstly, poor absorption in UC might lower 25-OHD levels. Secondly CYP3A enzymes are involved in the metabolism of calcineurin inhibitor tacrolimus as well as vitamin D, this could result in enhanced vitamin D metabolism, which would explain persistently low vitamin D level despite replacement with such high doses. The significant improvement in his symptoms with supplementation resulting in increased mobility despite not having a normal vitamin D level suggest other pleiotropic effects of vitamin D on muscle and bone as well. Additionally effects of liver transplantation on vitamin D metabolism need to be explored further.

Vitamin D3 replacement enhances antigen-specific immunity in older adults.

SummaryIntroductionAgeing is associated with increased number of infections, decreased vaccine efficacy and increased systemic inflammation termed inflammageing. These changes are reflected by reduced recall responses to varicella zoster virus (VZV) challenge in the skin of older adults. Vitamin D deficiency is more common in the old and has been associated with frailty and increased inflammation. In addition, vitamin D increases immunoregulatory mechanisms and therefore has the potential to inhibit inflammageing.ObjectivesWe investigated the use of vitamin D3 replacement to enhance cutaneous antigen-specific immunity in older adults (≥65 years).MethodsVitamin D insufficient older adults (n = 18) were administered 6400IU of vitamin D3/day orally for 14 weeks. Antigen-specific immunity to VZV was assessed by clinical score assessment of the injection site and transcriptional analysis of skin biopsies collected from challenged injection sites pre- and post-vitamin D3 replacement.ResultsWe showed that older adults had reduced VZV-specific cutaneous immune response and increased non-specific inflammation as compared to young. Increased non-specific inflammation observed in the skin of older adults negatively correlated with vitamin D sufficiency. We showed that vitamin D3 supplementation significantly increased the response to cutaneous VZV antigen challenge in older adults. This enhancement was associated with a reduction in inflammatory monocyte infiltration with a concomitant enhancement of T cell recruitment to the site of antigen challenge in the skin.ConclusionVitamin D3 replacement can boost antigen-specific immunity in older adults with sub-optimal vitamin D status.

Comparing Different Routes of Vitamin D Administration: A Randomized Interventional Trial

Background: Vitamin D maintains overall good health by boosting up of the immune system through proper function of lungs, heart, muscles, brain and bones. The goal of the study was to determine and compare different routes and formulation of vitamin D3 that was per oral, injectable formulation given orally and intramuscular injection in patients of different groups. Methods: This was a randomized clinical trial designed for vitamin D deficient patients. Patients were randomly assigned to three routes of administration i.e. orally, injection formulation given orally andintramuscular injection group. For mild deficiency, 2 doses of 200,000 IU, for moderate deficiency, 3 doses of 200,000 IU and for severe deficiency, 4 doses of 200,000 IU, 25[OH] D was prescribed.Chi-Square (χ2) test was used to evaluate the significant association . Results: A total of 150 patients were enrolled in the study. The mean age ±SD of patients was 48.29 ± 4.65 years. At 4 and 12 weeks after completion of vitamin D3 replacement, levels of 25-hydroxycholecalciferol were measured. In the majority of participants of all three groups, the levels of vitamin D were increased to normal range by week 4 after the final dose of vitamin D3. However, the majority of patients failed to maintain their Vitamin D3 levels within the normal range 12 weeks after the final dose. All three routes of administration of Vitamin D were found equally effective with no significant difference between the routes (p&gt;0.05). Conclusion: All three routes of administration of vitamin D supplements had equal efficacy with no significant advantage over one another.

The Effect of Low Dose Oral Vitamin D on Bone Mineral Density Changes in HIV Patients: 36 Months Follow Up.

A high incidence of vitamin-D deficiency and abnormal bone mineral density (BMD) is reported among Human Immunodeficiency Virus (HIV) infected patients. The study highlighted the effect of oral low dose vitamin-D replacement in patients with a known vitamin- D deficiency on the levels of vitamin-D [25 (OH)D], parathyroid hormone (PTH) and Bone Mineral Density (BMD) of hip and spine. Patients took a daily low dose of 800IU of vitamin-D. The following details were collected on all patients: demographics, CD-4 cell count, viral load, fracture risk factors, treatment history, corrected calcium, alkaline phosphatase (ALP), Parathyroid Hormone (PTH) (intact PTH), vitamin D 25(OH)D, inorganic phosphate and BMD of hip and spine at baseline, 12 and 36 months. Our Cohort consisted of 86 patients. Patient details included: mean age 42.8 (+/-7.7) years, 48 (55%) females 64, (74%) black African, CD-4 count 440.7 (+/-180.8) cells/dL, plasma VL 1.6 log (+/-2.3) copies/mL, duration of illness 80.9 (34.1) months, duration of exposure to antiretroviral 65.2 (+/-27.9) months. At baseline, no difference in BMD of hip or spine was observed, however, a higher PTH (0.001) in patients taking Tenofivir and a lower vitamin-D was noticed in patients taking Efavirenz. After 36 months, patients on vitamin D replacement (n=44) had a significant increase in vitamin- D level (15.4 +/-10.4 vs 104.1+/-29.1 p=0.0001), lower PTH (6.3 +/-3.4 vs 4.4 +/-1.4 p=0.0001) ALP (108.9+/-78.8 vs 90.6+/-45.8 p=0.05) but no change in corrected calcium (2.13 +/-0.1 vs 2.16 +/-0.34 p=0.5) and BMD of spine (1.039+/-0.226 vs.1.027+/-0.211, p=0.77), and BMD of hip (1.020 +/- 0.205 vs. 1.039, p=0.61). In a multivariate logistic regression analysis that included all significant variables, vitamin-D replacement independently was associated with increase in vitamin- D level (OR 2.08, CI 1.03, 4.12, p=0.005), decrease in PTH level (OR 0.53, CI 0.35, 0.82, p=0.04), but not with change in corrected calcium, alkaline phosphatase, BMD of hip or spine. After 36 months of follow up, the replacement of low dose once daily oral vitamin-D in the treatment experienced HIV infected patients with vitamin-D deficiency can increase vitamin- D level, reduce PTH level without any change in BMD of spine and hip.

Evaluation of nasal mucociliary clearance time in patients with Vitamin-D deficiency.

The main purpose of the current study was to investigate nasal mucociliary clearance time (NMC) in patients with Vitamin-D deficiency. A total of 55 patients with Vitamin-D deficiency and 32 controls were evaluated. NMC time was measured with subjective saccharine test and compared between study and control groups. In addition, NMC time was re-evaluated after Vitamin-D replacement protocol in patients with Vitamin-D deficiency. The mean 25(HO)Vitamin-D levels were 14.32 ± 4.23ng/mL (7-24.6) and 29.38 ± 7.05ng/mL (25-53.8) in study and control groups, respectively (p < 0.001). The mean NMC time was 11.15 ± 3.05 (6.3-17.6) and 8.40 ± 2.33 (6-13.2) in study and control groups, respectively (p < 0.001). The mean 25(HO)Vitamin-D level after the replacement protocol was 33.38 ± 10.03 and the mean NMC time was 9.56 ± 2.54 (p < 0.001). The mean NMC time was significantly increased in patients with Vitamin-D deficiency which can be corrected after Vitamin-D replacement protocols. The prolonged mucociliary clearance might be one of the pathophysiologic pathways at increased upper respiratory tract infections, and sinonasal and ear infections in patients with Vitamin-D deficiency.

Effect of Vitamin D Replacement on Serum TSH in Women with Anti-TPO Positive Sub-clinical Hypothyroidism

Introduction: The coexistence of Sub-Clinical Hypothyroidism (SCH) and vitamin D deficiency is a common problem and may lead to various clinical disorders. Several genetic studies have shown an association between gene polymorphism of Vitamin D receptor and of 1a hydroxylase with autoimmune thyroid diseases. Aim: To evaluate the effects of vitamin D3 replacement on Thyroid-Stimulating Hormone (TSH) and anti-TPO levels in women with SCH. Materials and Methods: This clinical trial was performed on 58 Sub-Clinical Hypothyroidism vitamin D deficient women. Patients were treated with 50,000 unit/week vitamin D3 capsule for eight weeks and TSH, Free thyroxine (FT4) and anti-TPO levels were measured before and after drug administration, using an electrochemiluminescence system. Results: The mean age of the population was 38.02±12.68 years. Vitamin D3 replacement caused serum 25(OH) D3 level correction in SCH patients (p<0.001). Additionally, a significant decrease in anti-TPO and TSH levels were also observed in anti-TPO positive patients (n=29) (p=0.002 and p=0.02, respectively). No significant differences in anti-TPO and TSH levels were seen in anti-TPO negative group (p=0.507 and p=0.447, respectively). Conclusion: The study showed that vitamin D3 replacement may be considered as an effective therapy to reduce TSH and anti-TPO levels in vitamin D deficient SCH patients.

The impact of circulating 25-hydroxyvitamin and oral cholecalciferol treatment on menstrual pain in dysmenorrheic patients

This study aims to determine Vitamin-D level in patients with primary dysmenorrhea and investigate the effect of Vitamin-D replacement on symptoms. About 100 patients in the 18–30 age group followed-up with primary dysmenorrhea diagnosis were included in this observational study. The pain severity was assessed using the visual analog scale (VAS). 25-hydroxy vitamin D(25(OH)D) levels of the patients were measured and the replacement therapy was applied according to measurement results. The patients were followed for three months in total. At the end of the three-month period, the 25(OH)D level was measured and the VAS score was assessed once more after the therapy. 25(OH)D level was insufficient in 23.0%, deficient in 45.0%, and severely deficient in 32.0% of the patients. It was found that the VAS score increased as the 25(OH)D level decreased (r = −0.320; p = .002). A significant reduction was observed in VAS scores after Vitamin-D treatment in all three groups; the amount of reduction in VAS score was determined to be higher in the patients with severely deficient levels of 25(OH)D, compared to the patients with deficient or insufficient levels (p < .001). A significant and negative correlation was found between Vitamin-D and symptoms associated with dysmenorrhea in our study. The Vitamin-D replacement therapy led to a significant decrease in symptoms.

Vitamin D and Subjective Memory Complaint in Community-Dwelling Older Adults.

Older adults with hypovitaminosis D report more often subjective cognitive complaints, especially with regards to memory. This raises prospects that vitamin D may improve older adults' subjective experience of memory disorders. To determine among older community-dwellers whether higher serum 25- hydroxyvitamin D (25OHD) concentrations were associated with fewer memory complaints, while considering different subtypes of memory complaints. One hundred eighty Caucasian community-dwellers with memory complaint and no dementia (mean±standard deviation, 71.1±3.4years; 33.3%female) from the French 'EVATEM study' were included in this analysis. Subjective memory complaints regarding memory lapses, problems learning new information, problems finding words, problems calculating and problems concentrating were assessed using a standardized questionnaire. Participants were categorized according to the highest tertile of serum 25OHD (i.e., ≥68nmol/L). Age, gender, body mass index, morbidities burden, use of vitamin D supplements, cognitive performance, mood, serum concentrations of calcium, parathyroid hormone and vitamin B12, creatinine clearance, and season of evaluation were used as potential confounders. Compared to participants with 25OHD<68nmol/L (n=121), those with 25OHD≥68nmol/L had less often problems learning new information (P=0.027). There were no between-group differences for the other memory complaints. The highest 25OHD tertile was cross-sectionally associated with fewer problems learning new information (odds ratio (OR)=0.48, P=0.029), even after adjustment for potential confounders (OR=0.32, P=0.039). Higher vitamin D status was associated with reduced problems memorizing new information in older community-dwellers. This novel finding provides a scientific base for vitamin D replacement trials attempting to improve older patients' subjective experience of cognitive decline.

Cholecalciferol improves glycemic control in type 2 diabetic patients: a 6-month prospective interventional study.

Background and purposeTo investigate the effects of vitamin D supplementation on glucose homeostasis and lipid profile in type 2 diabetic patients who have vitamin D deficiency.Patients and methodsOne hundred twenty-five type 2 diabetic patients taking oral hypoglycemic agents as mono- or combination therapy were recruited from the diabetes and endocrinology clinic. Subject demographics, duration of diabetes, antidiabetic medication, body mass index (BMI), pulse, and blood pressure (BP) were assessed. Laboratory measurements of serum vitamin D3 level, hemoglobin A1c (HbA1c), fasting plasma glucose (FPG), and lipid profile were measured. Homeostatic model assessment-insulin resistance (HOMA-IR) was calculated whenever fasting insulin (FI) was available. Forty-one patients (27 males and 14 females) were started on cholecalciferol replacement–45,000 units once weekly for 8 weeks and then 22,500 units once weekly for 16 weeks. Calcium carbonate tablets 500 mg once daily were also prescribed for the initial 2 months of treatment. Measured variables were reassessed after 6 months of replacement therapy. During the trial, subjects were instructed not to change their diabetes drugs or lifestyle.ResultsNo significant association was found between vitamin D3 level and any of the measured variables apart from a significant positive correlation with blood urea nitrogen. Vitamin D3 replacement was associated with a significant increase in its level (14.0±4.0 vs 31.0 vs 7.9 ng/mL, P<0.001). This was associated with a significant reduction of HbA1c (7.9±1.7 vs 7.4%±1.2%, P=0.001) and FPG (9.1±4.3 vs 7.9±2.4 mmol/L, P=0.034). Mean reduction of HbA1c was 0.54% and that of FPG was 1.22 mmol/L. FI, c-peptide and insulin resistance (IR) were reduced but this was statistically insignificant (P=0.069, 0.376, 0.058, respectively). FI decreased by 22%, HOMA-IR by 27.6%, and c-peptide by 1.83%. Total cholesterol, low-density lipoprotein cholesterol, parathyroid hormone, alkaline phosphatase, serum creatinine, and pulse rate significantly decreased (4.3±0.9 vs 4.0±0.9 mmol/L, P=0.036; 2.5±0.8 vs 2.2±0.8 mmol/L, P=0.018; 4.6±2.1 vs 3.5±1.8 pmol/L, P=0.001; 82.1±26.2 vs 66.2±19.5 U/L, P<0.001; 74.6±15.6 vs 70.7±14.7 μmol/L, P=0.047; and 81.6±11.9 vs 77.5±12.0 bpm, P=0.045, respectively). Triglycerides and high-density lipoprotein cholesterol, both systolic and diastolic BP, and BMI did not show significant change.ConclusionCholecalciferol helps improve blood glucose control and cholesterol profile in vitamin D3-deficient type 2 diabetic patients.

Factors influencing pre-operative urinary calcium excretion in primary hyperparathyroidism.

Normal or elevated 24-hour urinary calcium (Ca) excretion is a diagnostic marker in primary hyperparathyroidism (PHPT). It is used to distinguish familial hypocalciuric hypercalcaemia (FHH) from PHPT by calculating the Ca/creatinine clearance ratio (CCCR). The variance of CCCR in patients with PHPT is considerable. The aim of this study was to analyse the parameters affecting CCCR in patients with PHPT. The data were collected prospectively. Patients with sporadic PHPT undergoing successful surgery were included in a retrospective analysis. The analysis covered 381 patients with pre-operative workup 2days before removal of a solitary parathyroid adenoma. The impact of serum Ca and 25-hydroxyvitamin D3 (25-OH D3) on CCCR. The coefficient of determination (R2 ) in the multivariable model for CCCR consisting of age, Ca, 25-OH D3, 1,25-dihydroxyvitamin D3 (1,25-(OH)2 D3), testosterone (separately for males and females), intact parathyroid hormone (iPTH) and osteocalcin was 25.8%. The only significant parameters in the multivariable analysis were 1,25-(OH)2 D3 and osteocalcin with a drop in R2 of 15.4% (P<.001) and 2.4% (P=.006), respectively. Bone mineral densities at the lumbar spine, distal radius and left femoral neck were not associated with CCCR (r=-.08, r=-.10 and r=-0.09). In multivariable analysis, 1,25-(OH)2 D3 and osteocalcin were the only factors correlating with CCCR. Vitamin D3 replacement may therefore impair the diagnostic value of CCCR and increase the importance of close monitoring of urinary Ca excretion during treatment.

Effect of Vitamin D Replacement on Cognition in Multiple Sclerosis Patients

Multiple Sclerosis is associated with deficient serum 25 hydroxyvitamin D (25 (OH)D) level and cognitive impairment. The aim of this study is to evaluate cognitive performance in MS patients with deficient 25 (OH)D (<25 ng/ml) compared to patients with sufficient levels (>35 ng/ml), then to evaluate the change in cognitive performance after 3 months of vitamin D3 oral replacement. Eighty-eight MS patients with relapsing remitting and clinically isolated type of MS, older than 18 years treated with interferon beta were enrolled. Cognitive testing was performed at baseline and at 3 months using the Montreal Cognitive Assessment (MoCA), Stroop, Symbol Digit Modalities (SDMT) and Brief Visuospatial Memory Test (BVMT-R). Serum 25 (OH)D was measured at baseline and at the end of the study. Vitamin D3 replacement improved the MS patients’ cognitive performance after 3 months on the MoCA and BVMT-Delayed Recall (DR). Sufficient serum 25 (OH)D level predicted better cognitive performance on the BVMT-DR at baseline (β: 1.74, p: <0.008) and 3 months (β: 1.93, p: <0.01) after adjusting for all measured confounding variables. Vitamin D3 replacement could improve cognitive performance in MS patients and make a significant difference in the patient’s quality of life.

199P - Impact of vitamin D3 replacement therapy on clinical outcomes and survival rates in patients with early stage breast cancer

199P - Impact of vitamin D3 replacement therapy on clinical outcomes and survival rates in patients with early stage breast cancer

Frailty and sarcopenia in elderly.

Frailty is apre-disability syndrome where an older person can be identified as being at risk when exposed to stressors associated with high risk for disability or needing to be hospitalized. Two major frailty definitions exist. The physical phenotype of frailty and the multiple deficit model. Asimple frailty screening tool-FRAIL-has been validated. Treatment of frailty involves resistance exercise, optimization of nutrition, and treatment of fatigue (sleep apnea, depression), treatable causes of weight loss and adjustment of polypharmacy. Sarcopenia (decline in function with low muscle mass) is amajor cause of frailty. Asimple sarcopenia screening tool-SARC-F-has been validated. The multiple causes of sarcopenia are reviewed. Optimal treatment is resistance exercise, leucine-enriched essential amino acids and vitaminD replacement.