Serum 25-hydroxyvitamin D levels in vitamin D-insufficient hip fracture patients after supplementation with ergocalciferol and cholecalciferol

Glendenning, Paul; Chew, Gerard T.; Seymour, Hannah M.; Gillett, Melissa J.; Goldswain, Peter R.; Inderjeeth, Charles A.; Vasikaran, Samuel D.; Taranto, Mario; Musk, Alexander A.; Fraser, William D.

doi:10.1016/j.bone.2009.07.015

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Volume 45, Issue 5 , Pages 870-875, November 2009

Serum 25-hydroxyvitamin D levels in vitamin D-insufficient hip fracture patients after supplementation with ergocalciferol and cholecalciferol☆

Paul Glendenning
- Department of Core Clinical Pathology and Biochemistry, Pathwest Royal Perth Hospital, Wellington Street, Perth, Western Australia 6000, Australia
- School of Medicine and Pharmacology, University of Western Australia, Perth, Western Australia, Australia
- Corresponding author. Department of Core Clinical Pathology and Biochemistry, Royal Perth Hospital, Wellington Street, Perth, Western Australia 6000, Australia. Fax: +618 92242491.
Gerard T. Chew
- School of Medicine and Pharmacology, University of Western Australia, Perth, Western Australia, Australia
- Department of Geriatric Medicine, Royal Perth Hospital, Perth, Western Australia, Australia
Hannah M. Seymour
- Department of Geriatric Medicine, Royal Perth Hospital, Perth, Western Australia, Australia
Melissa J. Gillett
- Department of Core Clinical Pathology and Biochemistry, Pathwest Royal Perth Hospital, Wellington Street, Perth, Western Australia 6000, Australia
Peter R. Goldswain
- Department of Geriatric Medicine, Royal Perth Hospital, Perth, Western Australia, Australia
Charles A. Inderjeeth
- School of Medicine and Pharmacology, University of Western Australia, Perth, Western Australia, Australia
- Department of Rehabilitation and Aged Care, Sir Charles Gairdner Hospital, Perth Western Australia, Australia
Samuel D. Vasikaran
- Department of Core Clinical Pathology and Biochemistry, Pathwest Royal Perth Hospital, Wellington Street, Perth, Western Australia 6000, Australia
Mario Taranto
- Department of Core Clinical Pathology and Biochemistry, Pathwest Royal Perth Hospital, Wellington Street, Perth, Western Australia 6000, Australia
Alexander A. Musk
- Department of Core Clinical Pathology and Biochemistry, Pathwest Royal Perth Hospital, Wellington Street, Perth, Western Australia 6000, Australia
William D. Fraser
- Department of Clinical Chemistry, University of Liverpool, Liverpool, UK

Received 18 November 2008; received in revised form 30 June 2009; accepted 14 July 2009. published online 17 August 2009.

Edited by: R. Baron

Abstract

Vitamin D insufficiency is commonly associated with hip fracture. However, the equipotency of ergocalciferol and cholecalciferol supplementation in this patient group has not been studied in a randomized trial using high-performance liquid chromatography (HPLC) measurement of serum 25-hydroxyvitamin D (25OHD). The objective of this study was to determine if ergocalciferol and cholecalciferol are equipotent therapies in vitamin D-insufficient hip fracture patients.

Ninety five hip fracture inpatients with vitamin D insufficiency (25OHD<50 nmol/L) were randomized, double-blind, to treatment with ergocalciferol 1000 IU/day (n=48) or cholecalciferol 1000 IU/day (n=47) for three months. All participants were also given a placebo matching the alternative treatment to maintain blinding of treatment allocation. The primary endpoint was total serum 25OHD measured by HPLC. Secondary endpoints included 25OHD measured by radioimmunoassay (RIA), intact parathyroid hormone (iPTH), and bioactive (1–84) whole PTH (wPTH).

Seventy patients (74%) completed the study with paired samples for analysis. Cholecalciferol supplementation resulted in a 31% greater increase in total HPLC-measured 25OHD (p=0.010) and 52% greater rise in RIA-measured 25OHD (p<0.001) than supplementation with an equivalent dose of ergocalciferol. Changes in iPTH and wPTH were not significantly different between calciferol treatments (p>0.05).

In vitamin D-insufficient hip fracture patients, supplementation with cholecalciferol 1000 IU/day for three months was more effective in increasing serum 25OHD than an equivalent dose of ergocalciferol. However, the lack of difference in PTH lowering between calciferol treatments raises questions about the biological importance of this observation.

Keywords: Vitamin D insufficiency, Ergocalciferol, Cholecalciferol, Equipotency, Hip fractures