The effect of vitamin D on calcium absorption in older women

Abstract

Context: Vitamin D is often recommended for use with calcium supplements to increase absorption. There are no systematic studies of vitamin D on calcium absorption that indicate what dose should be recommended.

Objective: Our objective was to study the effect of increasing doses of vitamin D3 on calcium absorption.

Design and setting: We conducted a randomized double-blind placebo-controlled trial at Creighton University Medical Center, Omaha, NE.

Participants: Participants included 163 postmenopausal Caucasian women with vitamin D insufficiency, defined as a serum 25-hydroxyvitamin D (25OHD) below 20 ng/ml (50 nmol/liter).

Intervention: Participants were randomized to receive one of the vitamin D3 doses, 400, 800, 1600, 2400, 3200, 4000, or 4800 IU/d, or placebo for 1 yr. Calcium intake was increased to 1200-1400 mg daily by giving daily calcium citrate.

Main outcome: We evaluated the change in calcium absorption on vitamin D.

Results: Mean serum 25OHD increased from baseline 15.6 ng/ml (39 nmol/liter) to 46.5 ng/ml (112 nmol/liter) in subjects randomized to the highest dose of vitamin D (4800 IU). Calcium absorption was more significantly related to serum 25OHD (R2=0.50; P=0.001) than dose (R2=0.47; P=0.033). Calcium absorption of a 100-mg dose increased from 52-58% (6 mg) over a serum 25OHD range of 20-66 ng/ml (50-165 nmol/liter).

Conclusions: There was no evidence of a threshold for reduced calcium absorption in the serum 25OHD range of 10-66 ng/ml (25-165 nmol/liter). The increase in absorbed calcium of 6% on high doses of vitamin D is so small that the same amount could be obtained from half a glass of milk (100 ml) or 100 mg elemental calcium. The results challenge assumptions about the value of adding vitamin D to increase calcium absorption except when serum 25OHD is very low that is less than 10 ng/ml (25 nmol/liter).

Fig. 1.

A, Multiple regression analysis of 12-month calcium absorption (percent absorbed) on vitamin D3 doses of 400–4800 IU daily. Calcium absorption was significantly correlated with dose after adjustment for age, body weight, daily total calcium intake, serum 1,25(OH)₂D, and baseline serum 25OHD (adjusted R² = 0.48; P = 0.033). B, Multiple regression analysis of 12-month calcium absorption (percent absorbed) vs. 12-month serum 25OHD. Final calcium absorption was significantly correlated with final serum 25OHD after adjustment for age, body weight, daily total calcium intake, serum 1,25(OH)₂D, and baseline serum 25OHD (adjusted R² = 0.51; P = 0.0019).