Long-term effects of giving nursing home residents bread fortified with 125 microg (5000 IU) vitamin D(3) per daily serving

Am J Clin Nutr. 2009 Apr;89(4):1132-7. doi: 10.3945/ajcn.2008.26890. Epub 2009 Feb 25.


Background: In older adults, a serum 25-hydroxyvitamin D [25(OH)D] concentration >75 nmol/L lowers the risk of fracture. An oral intake of 125 microg (5000 IU) vitamin D(3)/d may be required to achieve this target.

Objective: The objective was to characterize the safety and efficacy of fortifying bread with a biologically meaningful amount of vitamin D(3).

Design: In a single-arm design, 45 nursing home residents consumed one bun daily that had been fortified with 125 microg (5000 IU) vitamin D(3) and 320 mg elemental calcium.

Results: The initial mean (+/-SD) serum 25(OH)D concentration was 28.5 +/- 10.8 nmol/L. After 12 mo, the 25(OH)D concentration was 125.6 +/- 38.8 nmol/L, and it exceeded 74 nmol/L in 92% of the patients. At every 3-mo follow-up, serum parathyroid hormone was lower than at baseline (P = 0.001). No changes in serum calcium or cases of hypercalcemia were observed at the follow-up assessments. Both mean total urinary calcium and the mean urinary calcium-creatinine ratio increased from baseline at one follow-up time point (P < 0.05). Between baseline and the 12-mo visit, z scores for bone mineral density at the lumbar spine and the hip both increased significantly (P < 0.001).

Conclusions: Fortification of bread with much more vitamin D than used previously produced no evident adverse effects on sun-deprived nursing home residents and improved bone density measures. Fortification of bread with 5000 IU vitamin D(3)/d provided reasonable assurance that vitamin D-deficient older adults attained a serum 25(OH)D concentration greater than the desirable objective of >75 nmol/L. This trial was registered at (ClinicalTrials.gov) as: NCT00789503.

Publication types

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

MeSH terms

  • Aged
  • Aged, 80 and over
  • Aging / blood
  • Aging / physiology
  • Bone Density / drug effects*
  • Bone Density / physiology
  • Bone Density Conservation Agents / administration & dosage*
  • Bread
  • Calcium / blood
  • Calcium / urine
  • Calcium, Dietary / administration & dosage*
  • Cholecalciferol / administration & dosage*
  • Cholecalciferol / adverse effects
  • Dose-Response Relationship, Drug
  • Female
  • Food, Fortified*
  • Homes for the Aged
  • Humans
  • Male
  • Middle Aged
  • Nursing Homes
  • Nutrition Assessment
  • Nutritional Requirements
  • Parathyroid Hormone / blood
  • Romania
  • Vitamin D / analogs & derivatives*
  • Vitamin D / blood
  • Vitamin D Deficiency / prevention & control


  • Bone Density Conservation Agents
  • Calcium, Dietary
  • Parathyroid Hormone
  • Vitamin D
  • Cholecalciferol
  • 25-hydroxyvitamin D
  • Calcium

Associated data

  • ClinicalTrials.gov/NCT00789503