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 (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 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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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.