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Vitamin D Deficiency in Postmenopausal Women

Does cholecalciferol therapy help?

Publish date:: October 20, 2015

The effect of high-dose cholecalciferol therapy in increasing calcium absorption was small and did not translate into beneficial effects on bone mineral density in a study of 230 postmenopausal women aged 75 years and younger with baseline 25-hydroxyvitamin D levels of 14 through 27 ng/mL and no osteoporosis. The trial’s 3 arms included daily white and twice monthly yellow placebo (n=76), daily 800 IU vitamin D₃ and twice monthly yellow placebo (n=75), and daily white placebo and twice monthly 50,000 IU vitamin D₃ (n=79). The high-dose vitamin D regimen achieved and maintained 25(OH)D levels ≥30 ng/mL. Results showed:

• Calcium absorption increased 1% in the high-dose arm but decreased 2% in the low-dose arm and 1.3% in the placebo arm.

• There was no between-arm changes in spine, mean total hip, mean femoral neck, or total body bone mineral density, trabecular bone score, and muscle mass.

• There was no data to support recommendations to maintain serum 25(OH)D levels of 30 ng/ML or higher in postmenopausal women.

Citation: Hansen KE, Johnson RE, Chambers KR, et al. Treatment of vitamin D insufficiency in postmenopausal women: a randomized clinical trial. JAMA Intern Med. 2015;175(10):1612-1621. doi: 10.1001/jamainternmed.2015.3874.

Commentary: The optimal serum level for vitamin D recommended by the Institute of Medicine is 20 ng/L¹. A number of authors have suggested that higher levels, specifically 30 ng/L, should be considered the cut-off for normal². This study, using high-dose vitamin D, shows that there is little or no benefit in increasing vitamin D levels to above 30 ng/L on BMD, muscle function or falls in women with serum vitamin D levels below 30 ng/L. If vitamin D supplementation is helpful, it is likely to be helpful in those with vitamin D deficiency with levels below 20 ng/L. —Neil Skolnik, MD

1. Dawson-Hughes B, Heaney RP, Holick MF, Lips P, Meunier PJ, Vieth R. Estimates of optimal vitamin D status. Osteoporos Int. 2005;16(7):713-716.

2. Institute of Medicine. Dietary Reference Intakes for Calcium and Vitamin D. Washington, DC: The National Academies Press; 2011.