Vitamin D Deficiency Fixed in A Shot

The major source of vitamin D in humans is sunlight, but supplements are important when people don't get adequate exposure to sunlight.

Research results published in the current issue of the Medical Journal of Australia show that an annual injection of 15 mg of vitamin D3 (cholecalciferol) can restore vitamin D to healthy levels.

Associate Professor Terrence Diamond, endocrinologist at St George Hospital in Sydney, and Dr Matthew Meerkin, chemical pathologist from Mayne Health Laverty Pathology in Sydney, studied five men and 45 women with vitamin D deficiency. All were given a 15 mg injection of cholecalciferol.

Prior to the injection, vitamin D deficiency was severe (<12.5 nmol/L) in one participant, moderate (12.5-24 nmol/L) in 14, and mild (25-49 nmol/L) in 35. Twenty-four participants had secondary hyperparathyroidism.

Levels of vitamin D returned to normal in all participants following the injection and remained above 50 nmol/L throughout the 12 months of the study.

This preparation is currently being used to treat vitamin D deficiency in India and Canada, and its safety has previously been evaluated. But the authors say that while this therapy appears to be safe, with no deterioration in renal function, the potential for developing hypercalcaemia (high levels of calcium in the blood) needs more research.

Studies estimate that at least 50 per cent of elderly people living in residential homes and around 80 per cent of veiled pregnant women are vitamin D deficient. Other high-risk groups include ethnic populations from the Horn of Africa, India and Pakistan, and patients with gastrointestinal malabsorption syndromes.

While vitamin D preparations can reduce the risk of fractures, the dose in oral supplements available in Australia is inadequate, especially for people with severe deficiency.

"At a cost of $5-$10 per injection annually compared with $35 for a monthly course of 5 Ostelin capsules daily (suggested dosages to treat vitamin D deficiency), it is remarkably cost-effective," the authors say.

"The simple dosing regimen also allows convenient outpatient management and may improve patient compliance," they say.

In an editorial in the same issue of the Journal, Associate Professor Peter Ebeling agrees that despite Australia being a 'sunburnt country', vitamin D deficiency is common, with one third of people in Qld, WA, NSW, WA and Vic having mild to moderate deficiency.

"The study by Diamond and colleagues represents a step forward in currently available treatment options for vitamin D deficiency, but further large studies of vitamin D and its effects on fractures and falls are still needed," Associate Professor Ebeling said.

The Medical Journal of Australia is a publication of the Australian Medical Association.

CONTACT Dr Peter ROHL 0419 269 414 / 02 9350 2771

Associate Professor Peter EBELING 0409 135 510 / 03 9342 7942

Judith TOKLEY, AMA Public Affairs, 0408 824 306 / 02 6270 5471