비타민 D 보충제 [활성형보다는 비활성형, ergocalciferol 보충제보다는 cholecalciferol 보충제]

Pathways of vitamin D synthesis

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● Vitamin D3 (cholecalciferol) is available in 400, 800, 1000, 2000, 5000, 10,000, and 50,000 unit capsules. It is available in some countries as an intramuscular injection, which can be extremely painful. ​ ● Vitamin D2 (ergocalciferol) is available for oral use in 400 and 50,000 unit capsules or in a liquid form (8000 unit/mL [200 mcg/mL]).

In a meta-analysis of seven randomized trials evaluating serum 25(OH)D concentrations after supplementation with cholecalciferol versus ergocalciferol, cholecalciferol increased serum 25(OH)D more efficiently than ergocalciferol (mean difference in serum 25[OH]D 6 ng/mL [15.23 nmol/L]). The greatest difference was seen in trials that used weekly or monthly rather than daily dosing. This difference is of uncertain clinical significance, however, particularly in patients with normal baseline serum 25(OH)D levels. In addition, the trials in the meta-analysis used varying doses and treatment time periods, resulting in significant heterogeneity among studies.

 

Goldman-Cecil Medicine, 26th edition

Vitamin D ​ ​ Appropriate circulating levels of 25(OH)D are necessary for optimal intestinal absorption of calcium and skeletal accrual and maintenance. Despite this, a significant proportion of children and adults have vitamin D levels that would be deemed insufficient (i.e., 25[OH]D <20 ng/mL). Data in adults with osteopenia and osteoporosis confirm a benefit of vitamin D supplementation for fracture risk reduction, although the effect is dependent on the patient population and the amount of supplementation. Doses of 400 to 800 IU of vitamin D combined with 1000 mg of calcium reduce the risk for hip fracture in postmenopausal women and men aged 65 years and older, although the benefit is less certain for community-dwelling individuals than for those in assisted living centers. Although some data suggest that a 25(OH)D level of at least 30 ng/mL is needed to reduce the risk for hip fracture, there is considerable controversy as to whether a vitamin D level above 30 ng/mL reduces the overall risk for fracture. ​ By comparison, routine vitamin D (with or without calcium supplementation) does not appear to prevent falls or fractures in community-dwelling adults without osteoporosis, vitamin D deficiency, or prior fractures. Although activated vitamin D analogues such as calcitriol and α-calcidiol have been shown to reduce fracture risk, they are generally not indicated based on unacceptable risk for hypercalcemia. The exception to use of vitamin D analogues is possibly patients with stages 3 and 4 chronic kidney disease, wherein treatment of secondary hyperparathyroidism could provide skeletal benefit.

REF. UpToDate 2020.07.26