Combined Calcium and Vitamin D Supplementation Is Not Superior to Calcium Supplementation Alone in Improving Disturbed Bone Metabolism in Patients With Congestive Heart Failure

Eur J Clin Nutr. 2008 Dec;62(12):1388-94. doi: 10.1038/sj.ejcn.1602861. Epub 2007 Aug 8.

Abstract

Objectives: To clarify the potential role of vitamin D supplementation on bone metabolism in congestive heart failure (CHF) patients with low vitamin D status and insufficient dietary calcium intake.

Subjects/methods: One hundred and two ambulatory male CHF patients were recruited, of whom the majority was treated with loop diuretics. Nine patients died during follow-up. Additional 14 participants dropped out prematurely because their health status worsened markedly. Five patients had to be excluded due to lack of compliance. A daily vitamin D3 supplement plus 500 mg calcium (CaD group) or a placebo plus 500 mg calcium (Ca group) was given for 9 months. Biochemical parameters of vitamin D and bone metabolism were analyzed at baseline and after 9 months.

Results: Median 25-hydroxyvitamin D concentrations increased from 41.7 to 103.0 nmol/l (P < 0.001) in the CaD group and remained constant in the Ca group, while median calcium intake increased above 1200 mg/day in both groups. The percentage of patients with elevated parathyroid hormone levels (> 60 pg/ml), as well as the serum concentration of undercarboxylated osteocalcin, an indicator of osteoporotic fracture risk and the bone resorption marker C-telopeptide fell significantly in both study groups (P < 0.025-0.001). At the end of the study period, biomarkers of bone turnover did not differ between groups.

Conclusions: A vitamin D3 supplement of 50 microg/day has no additional beneficial effects on markers of bone metabolism in CHF patients with low initial 25-hydroxyvitamin D concentrations if an adequate daily calcium intake is guaranteed.

Publication types

  • Randomized Controlled Trial
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Biomarkers / analysis
  • Bone Resorption / metabolism
  • Bone and Bones / drug effects*
  • Bone and Bones / metabolism*
  • Calcium / metabolism
  • Calcium, Dietary / administration & dosage*
  • Dietary Supplements
  • Double-Blind Method
  • Drug Synergism
  • Follow-Up Studies
  • Heart Failure / blood
  • Heart Failure / metabolism*
  • Humans
  • Male
  • Middle Aged
  • Osteocalcin / blood
  • Parathyroid Hormone / blood
  • Vitamin D / administration & dosage*
  • Vitamin D / analogs & derivatives
  • Vitamin D / blood
  • Vitamin D / metabolism
  • Vitamin D Deficiency / blood
  • Vitamin D Deficiency / drug therapy*

Substances

  • Biomarkers
  • Calcium, Dietary
  • Parathyroid Hormone
  • Osteocalcin
  • Vitamin D
  • 25-hydroxyvitamin D
  • Calcium