Gains in Bone Mineral Density with Resolution of Vitamin D Intoxication
- John S. Adams, MD; and
- Gene Lee
- From Cedars-Sinai Medical Center and University of California, Los Angeles, School of Medicine, Los Angeles, California. Acknowledgments: The authors thank Glenn D. Braunstein, MD, and Thomas L. Clemens, PhD, for their advice; Richard Gray, PhD, for performing high-performance liquid chromatography; and Cecelia Ramirez for help with acquisition of patient data. Grant Support: In part by General Clinical Research Center grant RR00425-28 from the National Institutes of Health. Current Author Addresses: Dr. Adams: B131, Cedars-Sinai Medical Center, 8700 Beverly Boulevard, Los Angeles, CA 90048. Mr. Lee: PO Box 11442, Stanford, CA 94309.
Abstract
Background: Vitamin D intoxication is associated with the mobilization of skeletal calcium.
Objective: To ascertain how the resolution of vitamin D intoxication affects bone density.
Design: Case series.
Setting: Referral service for metabolic bone disease in a tertiary care teaching hospital.
Patients: Four patients with osteoporosis who were each using several nonprescription dietary supplements and were found to have fasting hypercalciuria.
Intervention: Discontinuation of use of dietary supplements.
Measurements: Serial measurement of serum levels of 25-hydroxyvitamin D, ratio of fasting urinary calcium to creatinine, and bone mineral density for 3 years.
Results: Discontinuation of use of dietary supplements resulted in the normalization of serum levels of 25-hydroxyvitamin D, the normalization of the ratio of urinary calcium to creatinine, and a mean annual increase in bone mineral density (±SD) of 1.9% ± 0.6%.
Conclusions: Occult vitamin D intoxication was detected in patients who were using dietary supplements that contained an unadvertised high level of vitamin D. Resolution of vitamin D intoxication was associated with a rebound in bone mineral density.
- Copyright ©2004 by the American College of Physicians
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