Re: VItamin D Deficiency/addendum

[Guest guest]

I might also add that you should not 'tinker' with this on your own; it needs to

be closely monitored by a physician.

VItamin D Deficiency

" JRA, List " < >

> Recently, my rheumatologist checked my vitamin d levels, among

> other things. He found that it was low. They state that with

> rheumatoid arthritis patients, a deficiency can cause increased

> pain in joints and bone. So I was prescribed 50,000 IU once a

> week for 12 weeks, then I will be rechecked. There is hard data

> from a rheumatology study that this treatment reduces joint and

> bone pain, as well as corrects the deficiency. Just thought it

> might be of interest. I also have osteopenia and malabsorption

> of vitamin d can be the underlying cause. It is common in

> patients with immune system disease.

>

> How is vitamin D deficiency treated and monitored?

> Treatment. The initial treatment for vitamin D deficiency in

> patients with normal renal and liver function should be large

> doses of ergocalciferol, 50,000 IU once a week for eight weeks,

> in addition to 1500 mg of elemental calcium daily. For patients

> with malabsorption, larger doses of ergocalciferol (50,000 IU

> two to three times a week) may be necessary.

> The vitamin D form of choice is ergocalciferol because:

> It is inexpensive and readily available.

> Even patients with malabsorption syndromes will absorb > 60

> percent of vitamin D in this form (1).

> Other forms of vitamin D might be more appropriate under certain

> clinical circumstances (see table below).

> Monitoring. The parathyroid hormone (PTH) and 25-OH vitamin D

> levels should be checked 8 weeks after initiating therapy with

> ergocalciferol. Once the PTH and 25-OH vitamin D concentrations

> normalize, then the patient can be placed on a maintenance dose

> of vitamin D. The maintenance dose will vary depending on the

> underlying cause of vitamin D deficiency. Patients with a

> deficiency from lack of sun exposure and decreased dietary

> intake would require 1000 IU of cholecalciferol or

> ergocalciferol a day. An individual with malabsorption may

> require 25,000 to 50,000 IU (or more) per week. Anti-resorptive

> therapy for osteoporosis can then be initiated if indicated by

> bone densitometry.

> If PTH and 25-OH vitamin D levels do not normalize with time in

> patients with gastrointestinal disorders, then ergocalciferol

> should be replaced with either oral calcitriol (1,25 dihydroxy

> vitamin D) which may help absorb calcium better on the luminal

> side of the gut or an injectable form of calcitriol. It is

> important to monitor the calcium levels frequently (every two

> weeks) when initiating the injectable form of calcitriol as it

> can cause hypercalcemia.

> Osteopenia due to vitamin D deficiency should not be treated

> with an anti-resorptive medication such as calcitonin or a

> bisphosphonate. These medications could lead to severe

> hypocalcemia because the serum calcium level is being maintained

> at the expense of the calcium in the bones. There have not been

> any studies evaluating the effects of anti-resorptive

> medications in patients with vitamin D deficiency. The large

> studies addressing the effects of bisphosphonates on bone

> density excluded patients with hyperparthyroidism (2-4).

>

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