Vitamin D Deficiency and Spinal Cord Injuries

[dc2md]

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I just wrote a blog about the article from the March 2010 PM&R Journal regarding vitamin D deficiency in spinal cord injured patient in acute rehab hospitals -- and included some review material regarding vitamin D. It was striking the percentage of patients that had vitamin D deficiency (93%), and 21% were considered to have severe deficiency.

Has anyone read a prospective study looking at treating this vit D deficiency in spinal cord injured patients?? Or a study looking at bone mineral density in the same population. I know I could just do a pubmed search, but I wanted to make this thread informative for everyone else.

Also, the treatment dosage of vitamin D2 recommended by eMedicine was a lot higher than what an attending we work with uses. What does everyone else use?

Update: Forgot to put a link to the original article referenced above. If you're an AAPM&R member, you can see the full-text article for free. If you're not a member, join now.

 

[axm397]

Also, the treatment dosage of vitamin D2 recommended by eMedicine was a lot higher than what an attending we work with uses. What does everyone else use?

I usually write for 50,000 units q weekly x 8 weeks based on this http://www.medscape.com/viewarticle/516238_4 and http://emedicine.medscape.com/article/128762-treatment

But - a lot of my severely deficient patients were coming back low even after treatment. After talking to a couple endocrinologists, for severe vitamin D deficiency (less than 10), I will do 50,000 units q 3days disp #16.

Are you sure in your blog you meant to say 50,000 units DAILY?

 

[dc2md]

Are you sure in your blog you meant to say 50,000 units DAILY?

You're right. I completely looked at it wrong. Thanks for pointing that. I knew it sounded ridiculously high. I pasted in the excerpt from the eMedicine article I referenced. Your endocrinology source seems to be along the lines of treating patients with vit D b/c of malabsorption. Have you noticed an increased vit D-25(OH) level after 50,000 q 3days??


http://emedicine.medscape.com/article/128762-treatment
Adults
* Inadequate sun exposure, or if aging (age >50 y), pregnant, or lactating - 50,000 IU vitamin D2 per week for 8 weeks (Repeat for another 8 weeks if 25(OH)D remains less than 30 ng/mL.
* Malabsorption syndromes
o UVB irradiation (tanning bed or portable UVB device)
o 50,000 IU of vitamin D2 every day or every other day

 

[ml2001]

I'm still a learning resident, but I learned from one of my attendings to do Ergo 50K QWK plus Chole 2K for 3 months and recheck. Even though this technique hasn't been studied from what I can tell, it works pretty well.....

-ML

 

[dc2md]

I'm still a learning resident, but I learned from one of my attendings to do Ergo 50K QWK plus Chole 2K for 3 months and recheck. Even though this technique hasn't been studied from what I can tell, it works pretty well.....

-ML

Interesting. So your attending uses both vit D2 (ergocalciferol) and D3 (cholecalciferol)? I couldn't find WHY eMedicine recommended D2 over D3. Different absorptions? Cheaper? Ask your attending why he/she uses both forms.

And one of the problems with most residencies is the lack of continuity of care (no follow-up by the same resident). So I haven't been able to see how a particular protocol works.

 

[drvlad2004]

Why D2? D3 should be much better absorbed b/c it is the active form of vitamin D.

 

[dc2md]

Why D2? D3 should be much better absorbed b/c it is the active form of vitamin D.

D2 is made from plants and invertebrates. D3 is made by us. Both forms are inactive until they get hydroxylated in the liver and kidney (see here).

And a study published in the "Journal of Clinical Endocrinology & Metabolism" in 2008, showed that both forms given in pill form increased the serum levels of 25(OH)-vit D the same amount.

"One thousand IU of vitamin D2 daily was as effective as 1,000 IU of vitamin D3 in maintaining serum 25-hydroxyvitamin D levels and did not negatively influence serum 25-hydroxyvitamin D levels," said Holick. "Therefore, vitamin D2 is equally as effective as vitamin D3 in maintaining 25-hydroxyvitamin D status."​