Comment on: Supplementing vitamin D: Dangers of too much of a good thing: Reply :Saba Fathima, Kurian Thomas, Vineeta Shobha, Jyothi Idiculla, Indian Journal of Rheumatology

LETTER TO EDITOR
Year : 2017 | Volume : 12 | Issue : 1 | Page : 59-

Comment on: Supplementing vitamin D: Dangers of too much of a good thing: Reply

Saba Fathima¹, Kurian Thomas¹, Vineeta Shobha², Jyothi Idiculla¹,
¹ Department of Medicine, St. John's Medical College, Bengaluru, Karnataka, India
² Department of Immunology, St. John's Medical College, Bengaluru, Karnataka, India

Correspondence Address:

How to cite this article:
Fathima S, Thomas K, Shobha V, Idiculla J. Comment on: Supplementing vitamin D: Dangers of too much of a good thing: Reply.Indian J Rheumatol 2017;12:59-59

How to cite this URL:
Fathima S, Thomas K, Shobha V, Idiculla J. Comment on: Supplementing vitamin D: Dangers of too much of a good thing: Reply. Indian J Rheumatol [serial online] 2017 [cited 2022 May 25 ];12:59-59
Available from: https://www.indianjrheumatol.com/text.asp?2017/12/1/59/199134

Full Text

Dear editor,

We thank Dr. Subramanian for his interest [1] in our case report on Vitamin D toxicity.[2] This was to alert clinicians about the excessive and indiscriminate use of Vitamin D. The patient in the case report underwent a through screen to rule out malignancies of thyroid, breast, uterus, and intestines, which were all negative. On follow-up, she remains normocalcemic and well. If the biochemical parameters derange in future, we shall perform parathyroid hormone-related peptide assay as suggested by you.

The assay method used in our institution for Vitamin D estimation is chemiluminescent immunoassay. We have also observed low levels of Vitamin D even in asymptomatic individuals. The reason for this remains elusive, though studies on Vitamin D receptor polymorphisms and free Vitamin D levels may throw light.

Senior citizens are vulnerable to Vitamin D deficiency and consequent fractures. The Endocrine Society recommends Vitamin D levels above 30 ng/ml, while the Institute of Medicine's suggests levels above 20 ng/ml. The recommendation of the endocrine society is to provide at least 600 IU for those aged 50–70 and 800 IU in those above 70.[3] A dose of 1500–2000 units a day is required to raise the levels to 30 ng/dl, which in turn will prevent fractures. In Indians, a daily dose of 2000 units is recommended.[4] The dangers of over-treatment was reported by a case series from India recently.[5] In order to correct deficiency 50,000 units/week for 8 weeks or equivalent daily doses is suggested.[3] Parenteral administration may also be considered at the same dose as the effectiveness remains mostly similar.[6]

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

References

1	Nallasivan S. Comment on: Supplementing Vitamin D: Dangers of Too Much of a Good Thing. Ind J Rheumatol 2017;12:58.
2	Fathima S, Tomas K, Shoba V, Idiculla J. Supplementing Vitamin D: Dangers of too much of a good thing. Indian J Rheumatol 2016;11:226-7.
3	Evaluation, Treatment and Prevention of Vitamin D Deficiency – Endocrine Society. Available from: http://www.endocrine.org>publications. [Last accessed on 2016 Dec 30].
4	Mudur G. Indian endocrinologists set guidance to combat Vitamin D deficiency. BMJ 2015;351:h5997.
5	Kaur P, Mishra SK, Mithal A. Vitamin D toxicity resulting from overzealous correction of Vitamin D deficiency. Clin Endocrinol (Oxf) 2015;83:327-31.
6	Zabihiyeganeh M, Jahed A, Nojomi M. Treatment of hypovitaminosis D with pharmacologic doses of cholecalciferol, oral vs. intramuscular; an open labeled RCT. Clin Endocrinol (Oxf) 2013;78:210-6.