Effect of a single 'megadose' intramuscular vitamin D (600,000 IU) injection on vitamin D concentrations and bone mineral density following biliopancreatic diversion surgery.
BACKGROUND
Vitamin D (VitD) deficiency is common following biliopancreatic diversion (BPD). We conducted a prospective open-label study to evaluate the efficacy of a single intramuscular injection with 600,000 IU of cholecalciferol in an arachis oil depot formulation (VitD3, Arachitol Solvay Pharmacia) as an adjunct to regular oral VitD supplementation (Citrical+D) for a period of 12 months following BPD surgery.


METHODS
Some 29 patients who had undergone BPD during 2000-2005 were recruited and received a single injection of 600,000 IU of cholecalciferol. Venous blood VitD, parathyroid hormone (PTH), alkaline phosphatase (ALP), ionised calcium and urinary N-telopeptide (NTX) were assessed at baseline and at 1.5, 3, 6, 9 and 12 months post-injection. Bone mineral density (BMD) was determined at baseline and 12 months post-injection.


RESULTS
VitD concentrations (mean +/- SD) were significantly increased from baseline values (61.5 +/- 18.8 nmol/L) at 1.5 months (92.4 +/- 21.5, p < 0.001), 3 months (100.5 +/- 24.4, p < 0.001) and 6 months (79.1 +/- 20.9, p = 0.014) post-injection, with non-significant elevations at 9 months (73.3 +/- 15.1, p = 0.248) and 12 months (73.4 +/- 17.3, p = 0.278). The proportion of patients with 'normalised' VitD levels was significantly higher at all post-injection time points (range, 93-100%) compared with baseline (71.4%; p < 0.01). Ionised calcium and ALP remained within normal levels at baseline and all follow-up time points, although ionised calcium decreased by 3.4% (p = 0.015) and ALP increased by 14.6% (p = 0.021) at 12 months compared with baseline. No significant change in PTH, NTX or BMD was observed.


CONCLUSIONS
Intramuscular cholecalciferol injection, as an adjunct to oral supplementation, appears a safe and effective method to increase and maintain VitD levels after BPD.
Einarsdóttir
Kristjana
K
Centre for Health Services Research, School of Population Health M431, The University of Western Australia, 35 Stirling Highway, Crawley, 6009, Perth, Australia. kristjana.einarsdottir@uwa.edu.au
Preen
David B
DB
Clay
Timothy D
TD
Kiely
Laura
L
Holman
C D'Arcy J
CD
Cohen
Leon D
LD
D000284:Administration, Oral; D000328:Adult; D000368:Aged; D000469:Alkaline Phosphatase / Q000097:blood; D015904:Biliopancreatic Diversion / Q000009:adverse effects*; D015519:Bone Density / Q000187:drug effects* / Q000502:physiology; D002118:Calcium / Q000097:blood; D002762:Cholecalciferol / Q000008:administration & dosage*; D024042:Collagen Type I / Q000652:urine; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007273:Injections, Intramuscular; D008297:Male; D008875:Middle Aged; D010281:Parathyroid Hormone / Q000097:blood; D010455:Peptides / Q000652:urine; D011446:Prospective Studies; D016896:Treatment Outcome; D014807:Vitamin D / Q000008:administration & dosage*; D014808:Vitamin D Deficiency / Q000209:etiology / Q000517:prevention & control; D014815:Vitamins / Q000008:administration & dosage*
D024042:Collagen Type I; D010281:Parathyroid Hormone; D010455:Peptides; D014815:Vitamins; C052929:collagen type I trimeric cross-linked peptide; D014807:Vitamin D; D002762:Cholecalciferol; D000469:Alkaline Phosphatase; D002118:Calcium