title: Vitamin D Supplementation: Not So Simple in Sarcoidosis.
abstract: Americans are increasingly receiving vitamin D supplementation, often based on low-measured 25-hydroxy-vitamin D (25-OH-vit D). In sarcoidosis, there is often increased metabolism of 25-OH-vit D to 1,25-dihydroxy-vitamin D (1,25-OH-vit D), so 25-OH-vit D may remain low, despite high levels of 1,25-OH-vit D. In such cases, vitamin D supplementation may lead to hypercalcemia.
  
  
  
  We randomly selected 196 patients with sarcoidosis who received at least 1 prescription of vitamin D between 2005 and 2011 and 196 control patients. Primary outcome was the incidence of hypercalcemia during the 2 years following the vitamin D prescription. A secondary outcome was the proportion of patients who had received vitamin D prescriptions and who had adequate blood work performed before the prescription.
  
  
  
  The 25-OH-vit D and 1,25-OH-vit D levels were measured in only 70% and 23%, respectively, of those receiving supplementation. Hypercalcemia was noted more frequently in the group that received vitamin D (42.3%) as compared with the nonsupplemented group (18.3%), P < 0.0001. Patients who received a vitamin D prescription developed moderate and severe hypercalcemia more frequently (12.8%) as compared to the group that did not receive vitamin D (3.6%), P = 0.001. In multivariate analysis, having a prescription for vitamin D increased the risk of developing hypercalcemia to approximately 2-fold. The risk of developing hypercalcemia (odds ratio = 4.1) was increased with renal failure.
  
  
  
  Our study demonstrates that a substantial proportion of patients with sarcoidosis who receive vitamin D are not getting appropriate pretesting. This increases their risk for developing hypercalcemia.
authors.affiliation: Division of Pulmonary Medicine, Albert Einstein College of Medicine, Montefiore Medical Center, Bronx, New York. Electronic address: asodhi@uthsc.edu.
authors.forename: Amik
authors.initials: A
authors.lastname: Sodhi
authors.affiliation: Division of Pulmonary Medicine, Albert Einstein College of Medicine, Montefiore Medical Center, Bronx, New York.
authors.forename: Thomas
authors.initials: T
authors.lastname: Aldrich
mesh_terms: D002118:Calcium / Q000378:metabolism*; D019587:Dietary Supplements; D004305:Dose-Response Relationship, Drug; D005260:Female; D006801:Humans; D006934:Hypercalcemia / Q000097:blood / Q000209:etiology / Q000378:metabolism*; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012507:Sarcoidosis / Q000097:blood / Q000188:drug therapy* / Q000378:metabolism; D014807:Vitamin D / Q000008:administration & dosage / Q000009:adverse effects / Q000031:analogs & derivatives* / Q000097:blood / Q000493:pharmacokinetics / Q000627:therapeutic use*
chemical_list: D014807:Vitamin D; C097949:1,25-dihydroxyvitamin D; C104450:25-hydroxyvitamin D; D002118:Calcium
keywords: Hypercalcemia; Sarcoidosis; Vitamin D