title: Response of Vitamin D Concentration to Vitamin D3 Administration in Older Adults without Sun Exposure: A Randomized Double-Blind Trial.
abstract: OBJECTIVE
  To determine the dose-response relationship between 25-hydroxyvitamin D (25(OH)D) and supplemental vitamin D3 in elderly nursing home residents.
  
  
  METHODS
  Randomized double-blind investigation.
  
  
  METHODS
  Nursing home.
  
  
  METHODS
  Of 81 women (n=51) and men (n=30) (mean age 87.4±8) enrolled, 72 completed the study.
  
  
  METHODS
  Sixteen weeks of oral vitamin D3 at 800, 2,000, or 4,000 IU/d or 50,000 IU/wk.
  
  
  METHODS
  The main outcome was 25(OH)D concentrations (tandem mass spectrometry) after 16 weeks. Free 25(OH)D and intact parathyroid hormone (iPTH) were also analyzed. Safety monitoring of calcium and estimated glomerular filtration rate was performed, and adherence and clinical status were measured.
  
  
  RESULTS
  25(OH)D concentrations increased with dose (P<.001) and were higher with 50,000 IU/wk (P<.001) than other doses and with 4,000 IU/d than 800 or 2,000 IU/d, but 800 IU and 2,000 IU/d did not differ. One subject receiving 800 IU/d had concentrations less than 20 ng/mL. All subjects receiving more than 2000 IU/d had concentrations of 20 ng/mL and greater. Free 25(OH)D concentrations rose with total 25(OH) vitamin D. Total and free 25(OH)D were related to calcium concentrations; only free 25(OH)D was related to iPTH.
  
  
  CONCLUSIONS
  25(OH)D increased linearly with 800 to 4,000 IU/d and 50,000 IU/wk of vitamin D3, without a ceiling effect. Data suggest that some elderly adults will require more than 800 IU/d of vitamin D3 to ensure adequate vitamin D levels. Changes in 25(OH)D with vitamin D3 were related to starting concentrations (greatest with the lowest concentrations and unchanged with 800 and 2,000 IU/d if 20-40 ng/mL). Relationships between serum calcium and iPTH and free 25(OH)D suggest the potential for free 25(OH)D in defining optimal 25(OH)D concentrations.
authors.affiliation: Jewish Home of San Francisco, San Francisco, California.|Department of Medicine, University of California at San Francisco, San Francisco, California.|Department of Bioengineering and Therapeutic Sciences, University of California at San Francisco, San Francisco, California.
authors.forename: Janice B
authors.initials: JB
authors.lastname: Schwartz
authors.affiliation: Jewish Home of San Francisco, San Francisco, California.
authors.forename: Lynn
authors.initials: L
authors.lastname: Kane
authors.affiliation: Department of Medicine, University of California at San Francisco, San Francisco, California.|Department of Dermatology, University of California at San Francisco, San Francisco, California.
authors.forename: Daniel
authors.initials: D
authors.lastname: Bikle
mesh_terms: D000284:Administration, Oral; D000368:Aged; D000369:Aged, 80 and over; D002762:Cholecalciferol / Q000008:administration & dosage*; D004305:Dose-Response Relationship, Drug; D004311:Double-Blind Method; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D013472:Sunlight; D053719:Tandem Mass Spectrometry; D013997:Time Factors; D016896:Treatment Outcome; D014807:Vitamin D / Q000097:blood*; D014808:Vitamin D Deficiency / Q000097:blood / Q000188:drug therapy*; D014815:Vitamins / Q000008:administration & dosage
chemical_list: D014815:Vitamins; D014807:Vitamin D; D002762:Cholecalciferol
keywords: 25(OH)D; elderly; iPTH; vitamin D; vitamin D dosing