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Treatment and Prevention of Vitamin D Insufficiency in Cystic Fibrosis Patients: Comparative Efficacy of Ergocalciferol, Cholecalciferol, and UV Light

Division of Endocrinology, Diabetes, and Lipids (N.B.K., L.J., T.R.Z., V.T.), Department of Medicine, Emory University School of Medicine, Atlanta, Georgia 30322; Nutrition and Health Sciences Program (S.J., T.R.Z., V.T.), Graduate Division of Biological and Biomedical Sciences, Emory University, Atlanta, Georgia 30322; Division of Pulmonary, Allergy, and Critical Care Medicine (L.W.), Division of Pediatric Pulmonary, Allergy/Immunology, Cystic Fibrosis, and Sleep (A.S.), and Center for Clinical and Molecular Nutrition (T.R.Z., V.T.), Emory University School of Medicine, Atlanta, Georgia 30322; and Staff Physician (V.T.), Division of Endocrinology, Department of Veterans Affairs Medical Center, Atlanta, Georgia 30300

Address all correspondence and requests for reprints to: Vin Tangpricha, M.D., Ph.D., Woodruff Memorial Research Building, Room 1301, 101 Woodruff Circle NE, Atlanta, Georgia 30322. E-mail: vin.tangpricha{at}emory.edu.

Background: The optimal treatment for correcting or preventing vitamin D insufficiency in cystic fibrosis (CF) patients has not been established.

Objective: The aim of the study was to assess the relative efficacy of three modes of vitamin D therapy: cholecalciferol (D₃), ergocalciferol (D₂), and UV light in raising or maintaining 25(OH)D levels above 30 ng/ml.

Design: Thirty adult CF subjects with vitamin D insufficiency were randomized into one of three treatment arms: D₃, D₂, or UV light. Subjects randomized to D₃ or D₂ ingested 50,000 IU of vitamin D weekly, and those randomized to UV exposed their skin to UV light from a lamp five times a week. Serum was collected for 25(OH)D and PTH at baseline and at 12 wk.

Results: Treatment with D₃ and D₂ raised 25(OH)D levels significantly, from a mean of 21.2 ± 10.18 to 47.1 ± 20.5 ng/ml (P < 0.001) and 24.4 ± 10.3 to 32.7± 9.7 ng/ml (P = 0.01), with 100% and 60% reaching 25(OH)D levels above 30 ng/ml, respectively. Treatment with UV did not raise 25(OH)D levels significantly; however, only 55% of subjects were adherent with UV therapy.

Conclusion: This study demonstrates that CF subjects are able to achieve or maintain optimal vitamin D status (>30 ng/ml) with two oral regimens of either D₃ or D₂ treatment, the former being more efficacious. A confounding variable for this observation is the fact that the D₃ and D₂ capsules contained different carriers, powder-based vs. oil-based, respectively. UV therapy did not alter vitamin D status, possibly due to poor adherence to UV therapy.