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Gains in Bone Mineral Density with Resolution of Vitamin D Intoxication

John S. Adams, MD; and Gene Lee
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From Cedars-Sinai Medical Center and University of California, Los Angeles, School of Medicine, Los Angeles, California. Acknowledgments: The authors thank Glenn D. Braunstein, MD, and Thomas L. Clemens, PhD, for their advice; Richard Gray, PhD, for performing high-performance liquid chromatography; and Cecelia Ramirez for help with acquisition of patient data. Grant Support: In part by General Clinical Research Center grant RR00425-28 from the National Institutes of Health. Current Author Addresses: Dr. Adams: B131, Cedars-Sinai Medical Center, 8700 Beverly Boulevard, Los Angeles, CA 90048. Mr. Lee: PO Box 11442, Stanford, CA 94309.

Copyright ©2004 by the American College of Physicians

Ann Intern Med. 1997;127(3):203-206. doi:10.7326/0003-4819-127-3-199708010-00004
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Background: Vitamin D intoxication is associated with the mobilization of skeletal calcium.

Objective: To ascertain how the resolution of vitamin D intoxication affects bone density.

Design: Case series.

Setting: Referral service for metabolic bone disease in a tertiary care teaching hospital.

Patients: Four patients with osteoporosis who were each using several nonprescription dietary supplements and were found to have fasting hypercalciuria.

Intervention: Discontinuation of use of dietary supplements.

Measurements: Serial measurement of serum levels of 25-hydroxyvitamin D, ratio of fasting urinary calcium to creatinine, and bone mineral density for 3 years.

Results: Discontinuation of use of dietary supplements resulted in the normalization of serum levels of 25-hydroxyvitamin D, the normalization of the ratio of urinary calcium to creatinine, and a mean annual increase in bone mineral density (±SD) of 1.9% ± 0.6%.

Conclusions: Occult vitamin D intoxication was detected in patients who were using dietary supplements that contained an unadvertised high level of vitamin D. Resolution of vitamin D intoxication was associated with a rebound in bone mineral density.


Grahic Jump Location
Figure 1.
Serum levels of 25-hydroxyvitamin D (left), ratio of fasting urinary calcium to creatinine (middle), and lumbar vertebral bone density expressed as a percentage of theoretical peak bone density of vertebral bodies L1 to L4 (right) in four osteopenic patients.

One patient was male (□s) and three were female (closed boxes, closed circles, and open circles). All had hypercalciuria before and after discontinuation of use of dietary supplements that contained vitamin D. A time of 0 years was arbitrarily set at the extrapolated time of resolution of vitamin D intoxication. The solid horizontal lines represent the upper limit of normal values.

Grahic Jump Location




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Questions regarding levels of 25 OH D and 1, 25 OH D and PTH
Posted on March 15, 2007
Barbara Z Kravets CCN LDN
Conflict of Interest: None Declared

Dear Sirs: In re: your article Gains in Bone Mineral Density with Resolution of Vitamin D Intoxication

John S. Adams, MD, and Gene Lee

1 August 1997 | Volume 127 Issue 3 | Pages 203-206 in Annals of Internal Medicine.

Thank you for your interesting article. However, I would appreciate if you could answer questions for me:

1) What was the level of Vitamin D consumed? Two sententences, as below, are confusing.

"No patient knowingly consumed more than 1200 IU of vitamin D daily or took other medications known to alter skeletal metabolism."

"Some of these products were advertised as containing as much as 3600 IU of vitamin D3 per daily dosage"

2) What were the measured levels of 25 OH D3 and 1,25 OH D3 and 25 OH D2?

3) What was the measured level of Parathyroid Hormone?

4) Was was the animal extract product?.

5) What was the level of Calcium measured?

Thank you for your attention to my questions.

Barbara Zeitlin Kravets CCN LDN


Conflict of Interest:

None declared

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