Vitamin D to prevent bone loss during acute pulmonary exacerbation: More study is needed

• Type of Material: Article
• Authors: Malinda Wu, Emory University; Anirudh Bhimavarapu, Emory University; Jessica A. Alvarez, Emory University; William R. Hunt, Emory University; Vin Tangpricha, Emory University
• Language: English
• Date: 2023-09-09
• Publisher: Elsevier
• Publication Version: Author Accepted Manuscript (After Peer Review)
• Copyright Statement: © 2023, Elsevier
• License: Creative Commons Attribution-NonCommercial-NoDerivs 4.0 International
• Final Published Version (URL): https://doi.org/10.1016/j.bone.2023.116894
• Title of Journal or Parent Work: Bone
• Volume: 177
• Start Page: 116894
• Keywords: 25-hydroxyvitamin D; cystic fibrosis
• Research Categories: Health Sciences, Pharmacology; Health Sciences, Public Health

Abstract

We appreciate the letter and interest in our work examining the role of vitamin D in the prevention of bone loss during an acute pulmonary exacerbation of cystic fibrosis (CF) by Kumar and colleagues [1,2]. We would like to address some of their key points raised. First, they noted that the serum 25-hydroxyvitamin D (25(OH)D) concentrations rose and declined by 90 days in the group randomized to receive a single oral dose of 250,000 IU of cholecalciferol. We found a similar rise and fall of serum 25(OH)D concentrations in healthy participants receiving a single dose oral dose of 250,000 IU of cholecalciferol prior to the winter [3]. Like our study, after 90 days of receiving the cholecalciferol, the mean serum 25(OH)D was not within the vitamin D sufficient range (>30 ng/mL). This is not an unexpected finding because the circulating half-life of 25(OH)D is generally thought to be about 2 weeks. We agree that more frequent dosing of vitamin D or other formulations of vitamin D that have a longer circulating half-life is required to sustain serum 25(OH)D in the sufficient range and is worthy of future investigation. Kumar et al. also suggest that intramuscular formations of vitamin D may be considered in this population. We agree that this may be a good strategy in patients with CF. However, intramuscular formulations of vitamin D are not easily available in the U.S. market.