B) Weekly administration

The yearly administration of vitamin D is insufficient to guaran- :ee high and constant levels of serum 25OHD, particularly in patients affected by osteopenia or osteoporosis. Recently vita­min D status has been defined as adequate when the serum PTH concentration is not elevated and when vitamin D supple­mentation does not decrease serum PTH. This has led to the conclusion that serum 25OHD should be higher (at least 70-80 nmol/L) than estimated previously, and that the vitamin D re- uirement in the elderly for anti-fracture efficacy may be 800 U/day or even more. Nevertheless, in clinical practice the daily administration of vitamin D might be burdened by a reduced adherence, in particular if in combination with calcium supple­ments as commonly used, and therefore does not guarantee he correction of vitamin D deficiency in the long term. n a recent study we wanted to examine the compliance and

Figure 3 - Adherence

Figure 3 – Adherence (compliance and persistence) to different vitamin D treatment methods.

he effects on 25OHD and PTH serum levels of the common ^reparations of vitamin D in combination with calcium used daily, and of a weekly approach with vitamin D. 271 women affected ay postmenopausal osteopenia or osteoporosis complicated by nypovitaminosis D were randomised to assume either oral 4000 U weekly or 800-880 IU daily in combination with calcium. After I year the compliance to treatment and the 25OHD and PTH serum levels were evaluated. Approximately 50% of the patients hat would have had to assume the combination of vitamin D and g calcium daily interrupted the treatment within 6 months be­cause of intolerance to the calcium supplement, and another

Figure 4 - Serum levels of 25OHD observed

Figure 4 – Serum levels of 25OHD observed during different vitamin D treatment methods.

30% assumed half of the prescribed dose (Figure 3). In contrast, after 1 year the adherence to the weekly vitamin D supplement was over 90% and guaranteed serum levels of 25OHD similar to those obtained with 800-880 IU of cholecalciferol a day (Figure 4), reducing the risk of secondary hyperparathyroidism. Therefore in clinical practice the daily administration of vitamin D combined with calcium is burdened by a reduced compliance and therefore does not guarantee the correction of vitamin D deficiency in the long term. The weekly administration of vita­min D could represent a valid alternative.
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Conclusions

Vitamin D deficiency is extremely common in the entire na­tional territory of Italy, particularly in elderly women. Unfortu­nately, in spite of the vast evidence on consequent secondary hyperparathyroidism and hip fractures, the problem of hypovi- taminosis D is still clearly ignored in Italy or the treatments used up to now are insufficient or inadequate. A population- based strategy to correct this condition and new treatment methods with vitamin D that guarantee a better and long term compliance appear urgent. Preliminary experiences are heartening.