title: Vitamin D supplementation in nursing home patients: randomized controlled trial of standard daily dose versus individualized loading dose regimen.
abstract: BACKGROUND
  Supplementation of cholecalciferol 800 IU daily appears to be insufficient to raise vitamin D levels to >75 nmol/l in nursing home (NH) patients.
  
  
  OBJECTIVE
  Our objective was to compare the efficacy of an individualized cholecalciferol loading dose (LD) regimen and a daily dose (DD) regimen of cholecalciferol 800 IU in reaching 25-OH vitamin D (25OHD) levels >75 nmol/l.
  
  
  METHODS
  A total of 30 NH patients with 25OHD levels <50 nmol/l were included. Patients were randomized using the minimization method in the LD or DD group. The cholecalciferol LD, calculated with an algorithm based on serum 25OHD level and body weight, was administered in divided doses of 50,000 IU twice a week, followed by a monthly maintenance dose of either 50,000 or 25,000 IU. The DD regimen consisted of cholecalciferol 800 IU daily for 26 weeks. Serum 25OHD, calcium, creatinine, phosphate, and parathyroid hormone were measured, and 2-minute walking test, handgrip strength, and timed get up and go test were assessed at baseline (T 0), after 5 weeks (T 5), 12 weeks (T 12), and 26 weeks (T 26). The primary endpoint was the percentage of patients with 25OHD levels >75 nmol/l at T 5. Secondary endpoints were the proportion of patients with 25OHD levels >75 nmol/l at T 26, safety of LD regimen, and improvement of performance tests with normalization of vitamin D levels.
  
  
  RESULTS
  Median baseline 25OHD levels (interquartile range) were comparable between the 14 DD and 16 LD patients: 20.9 (15.9-29.6) and 21.7 (16.4-32.8) nmol/l, respectively. Levels of 25OHD >75 nmol/l at T 5 were reached in 79 % of the 14 LD patients, but in none of the 13 DD patients (p < 0.001). At T 26, 25OHD levels >75 nmol/l were reached in 83 % of the 12 LD patients and in 30 % of the ten DD patients (p < 0.05). Side effects or hypercalcemia were not observed. No improvement of performance tests was observed.
  
  
  CONCLUSIONS
  In NH patients with severe 25OHD deficiency, an individualized calculated cholecalciferol LD is likely to be superior to a DD of cholecalciferol 800 IU in terms of the ability to rapidly normalize vitamin D levels.
authors.affiliation: Department of Geriatrics, Rijnstate Hospital, PO box 9555, 6800 TA, Arnhem, The Netherlands, hwijnen@rijnstate.nl.
authors.forename: Hugo
authors.initials: H
authors.lastname: Wijnen
authors.forename: Dayenne
authors.initials: D
authors.lastname: Salemink
authors.forename: Lian
authors.initials: L
authors.lastname: Roovers
authors.forename: Diana
authors.initials: D
authors.lastname: Taekema
authors.forename: Hans
authors.initials: H
authors.lastname: de Boer
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000465:Algorithms; D001835:Body Weight; D002762:Cholecalciferol / Q000008:administration & dosage / Q000627:therapeutic use; D019587:Dietary Supplements; D023381:Endpoint Determination; D005260:Female; D018737:Hand Strength; D006801:Humans; D008297:Male; D009735:Nursing Homes; D010361:Patients; D057285:Precision Medicine / Q000379:methods*; D012015:Reference Standards; D016896:Treatment Outcome; D014807:Vitamin D / Q000008:administration & dosage* / Q000627:therapeutic use*; D014808:Vitamin D Deficiency / Q000150:complications; D014815:Vitamins / Q000008:administration & dosage* / Q000627:therapeutic use*; D016138:Walking
chemical_list: D014815:Vitamins; D014807:Vitamin D; D002762:Cholecalciferol