The effect of vitamin D on calcium absorption in older women

J Clin Endocrinol Metab. 2012 Oct;97(10):3550-6. doi: 10.1210/jc.2012-2020. Epub 2012 Aug 1.


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).

Publication types

  • Randomized Controlled Trial
  • Research Support, N.I.H., Extramural
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Aged
  • Aged, 80 and over
  • Calcium Citrate / pharmacokinetics*
  • Cholecalciferol / administration & dosage*
  • Dose-Response Relationship, Drug
  • Double-Blind Method
  • Drug Interactions
  • Female
  • Follow-Up Studies
  • Food Additives / pharmacokinetics
  • Humans
  • Intestinal Absorption / drug effects*
  • Middle Aged
  • Postmenopause / metabolism
  • Treatment Outcome
  • Vitamin D / analogs & derivatives
  • Vitamin D / blood
  • Vitamin D Deficiency / drug therapy*
  • Vitamin D Deficiency / metabolism
  • Vitamins / administration & dosage*


  • Food Additives
  • Vitamins
  • Vitamin D
  • Cholecalciferol
  • 25-hydroxyvitamin D
  • Calcium Citrate