Vitamin D deficiency, osteomalacia, and primary biliary cirrhosis. Response to orally administered vitamin D3.
Five patients with primary biliary cirrhosis and vitamin D deficiency (serum 25-hydroxyvitamin D less than 6 ng/ml) are presented. All patients had low serum 24,25-dihydroxyvitamin D3 concentrations. Three patients had histological osteomalacia, negative calcium balance, and subnormal serum 1,25-dihydroxyvitamin D3. Malabsorption of a standard dose of [3H]vitamin D3 was found in three of four patients with steatorrhea, enabling the effective dose of vitamin D3 given to be calculated. Oral vitamin D3 400-4000 IU/day (effectively 400-1860 IU/day) resulted in a return to normal of the serum vitamin D metabolites, correction of the impaired intestinal calcium absorption and healing of the osteomalacia. Increases in serum calcium, phosphate, and the renal tubular reabsorption of phosphate occurred with a concomitant decrease in serum parathyroid hormone. It is suggested that osteomalacia in primary biliary cirrhosis is the end result of vitamin D deficiency; the hepatic and renal hydroxylations of vitamin D are normal and target tissues are responsive to endogenously produced metabolites of vitamin D.
D000284:Administration, Oral; D000328:Adult; D000368:Aged; D001706:Biopsy; D002762:Cholecalciferol / Q000008:administration & dosage*; D004100:Dihydroxycholecalciferols / Q000097:blood; D006801:Humans; D007085:Ilium / Q000473:pathology; D008105:Liver Cirrhosis, Biliary / Q000150:complications / Q000188:drug therapy*; D008875:Middle Aged; D010018:Osteomalacia / Q000150:complications / Q000188:drug therapy*; D013997:Time Factors; D014808:Vitamin D Deficiency / Q000150:complications / Q000188:drug therapy*
D004100:Dihydroxycholecalciferols; D002762:Cholecalciferol