Effects of High-Dose Vitamin D2 Versus D3 on Total and Free 25-Hydroxyvitamin D and Markers of Calcium Balance.
Effects of High-Dose Vitamin D2 Versus D3 on Total and Free 25-Hydroxyvitamin D and Markers of Calcium Balance.
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DOI：
10.1210/jc.2016-1871
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发表时间：
2016-05
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通讯作者：
Albert Shieh;R. Chun;Christina Ma;Sten Witzel;B. Meyer;Brandon Rafison;L. Swinkels;Tonnie Huijs;S. Pepkowitz;B. Holmquist;M. Hewison;J. Adams
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作者：
Albert Shieh;R. Chun;Christina Ma;Sten Witzel;B. Meyer;Brandon Rafison;L. Swinkels;Tonnie Huijs;S. Pepkowitz;B. Holmquist;M. Hewison;J. Adams
背景争议持续存在：1)如何最好地恢复低血清25-羟基维生素D （25D）水平（维生素D2 [D2] vs维生素D3 [D3]）；2)如何最好地定义维生素D状态（总[蛋白质结合+游离]vs游离25D）；3)如何更好地评估游离25D的生物活性。目的探讨：1)D2与D3对血清总25D和游离25D的影响；2)完整PTH （iPTH）的变化是否与总25D和游离25D的变化更密切相关。先前参加D2 vs D3试验的参与者在年龄、体重指数和种族/民族方面匹配。参与者每周两次服用5万IU的D2或D3，持续5周，随后是5周的平衡期。在基线和第10周进行生化评估。背景和参与者：38名成人（19名D2和19名D3）≥18岁，基线25D水平<30 ng/mL，从学术骨质疏松门诊招募。结果：血清总25D、游离25D（直接测量）、1,25-二羟基维生素D、钙、iPTH。尿液测量为空腹钙：肌酐比值。结果D2组和D3组总25D水平（22.2±3.3 vs 23.3±7.2 ng/mL, P = 0.5）和游离25D水平（5.4±0.8 vs 5.3±1.7 pg/mL, P = 0.8）相似。总25D水平升高（+27.6 vs +12.2 ng/mL, P = 0.001），游离25D水平升高（+3.6 vs +6.2 pg/mL, P = 0.02）， D3高于D2。iPTH的百分比变化与游离（但不是总）25D的变化、补充方案的调整、1,25-二羟基维生素D的变化和钙的变化显著相关。结论D3比D2更能提高总25D和游离25D水平。游离25D可能优于总25D作为维生素D生物活性的标志。
CONTEXT Controversy persists over: 1) how best to restore low serum 25-hydroxyvitamin D (25D) levels (vitamin D2 [D2] vs vitamin D3 [D3]); 2) how best to define vitamin D status (total [protein-bound + free] vs free 25D); and 3) how best to assess the bioactivity of free 25D. OBJECTIVE To assess: 1) the effects of D2 vs D3 on serum total and free 25D; and 2) whether change in intact PTH (iPTH) is more strongly associated with change in total vs free 25D. DESIGN Participants previously enrolled in a D2 vs D3 trial were matched for age, body mass index, and race/ethnicity. Participants received 50 000 IU of D2 or D3 twice weekly for 5 weeks, followed by a 5-week equilibration period. Biochemical assessment was performed at baseline and at 10 weeks. SETTING AND PARTICIPANTS Thirty-eight adults (19 D2 and 19 D3) ≥18 years of age with baseline 25D levels <30 ng/mL were recruited from an academic ambulatory osteoporosis clinic. OUTCOME MEASURES Serum measures were total 25D, free 25D (directly measured), 1,25-dihydroxyvitamin D, calcium, and iPTH. Urine measure was fasting calcium:creatinine ratio. RESULTS Baseline total (22.2 ± 3.3 vs 23.3 ± 7.2 ng/mL; P = .5) and free (5.4 ± 0.8 vs 5.3 ± 1.7 pg/mL; P = .8) 25D levels were similar between D2 and D3 groups. Increases in total (+27.6 vs +12.2 ng/mL; P = .001) and free (+3.6 vs +6.2 pg/mL; P = .02) 25D levels were greater with D3 vs D2. Percentage change in iPTH was significantly associated with change in free (but not total) 25D, without and with adjustment for supplementation regimen, change in 1,25-dihydroxyvitamin D, and change in calcium. CONCLUSIONS D3 increased total and free 25D levels to a greater extent than D2. Free 25D may be superior to total 25D as a marker of vitamin D bioactivity.