Published ahead of print on April 28, 2005, doi:10.1164/rccm.200403-387OC Am. J. Respir. Crit. Care Med., Volume 172, Number 2, July 2005, 212-217 A more recent version of this article appeared on July 15, 2005
Submitted on March 22, 2004 Failure of High-Dose Ergocalciferol to Correct Vitamin D Deficiency in Adults with Cystic FibrosisMichael P Boyle1*,1 Department of Medicine, Division of Pulmonary and Critical Medicine, Johns Hopkins, Baltimore, MD, USA * To whom correspondence should be addressed. E-mail: mboyle{at}jhmi.edu.
Rationale: Treatment guidelines for vitamin D monitoring and supplementation in cystic fibrosis have recently been developed and published by a consensus committee, but have not been prospectively tested.
Objectives: To use these guidelines to determine the percentage of adults with cystic fibrosis requiring vitamin D repletion therapy and to evaluate the effectiveness of the currently recommended high-dose oral ergocalciferol repletion protocol.
Methods: Prospective study of clinical outcomes following therapy with the recommended vitamin D repletion algorithm.
Results: 109 of 134 CF adults (81.3%) were found to have 25-hydroxyvitamin D levels below the recommended 30 ng/ml. 66 of these adults completed the recommended course of 400,000 IU of oral ergocalciferol over two months, and only 5 (8%) responded with correction of their serum 25-OHD to the goal of Key words: 25-Hydroxyvitamin D, osteoporosis, dietary supplements, bone growth
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30 ng/ml (mean change +0.3 ng/ml, from 18.8 to 19.1 ng/ml). In the 33 CF adults who also completed the recommended second course of 800,000 IU of ergocalciferol over two months, none demonstrated correction of their deficiency (mean change -1.2 ng/ml).
Conclusion: The results of this study demonstrate that a majority of CF adults have serum 25-OHD levels below 30 ng/ml, and the currently recommended ergocalciferol repletion regimen often does not fully correct vitamin D deficiency and may need to be revised to include even higher dosing of ergocalciferol. Further work is needed to establish the ideal 25-OHD level for maximizing calcium absorption and bone health in cystic fibrosis.
