4,000 IU of Vitamin D daily is safe, but takes a year to plateau (Best-D) – RCT Dec 2016

Optimum dose of vitamin D for disease prevention in older people: BEST-D trial of vitamin D in primary care

Response was still increasing at 12 months

See also VitaminDWiki
Note: this study was looking at Vitamin D safety for Osteoporosis

• Osteoporosis helped by Vitamin D, still not willing to recommend exact dose size – Nov 2016
• Osteoporosis treatment guidelines by US Endocrinology groups – Sept 2016
• Vitamin D can quickly deal with Osteoporosis in the very old – Europe working group review – July 2014
• Even taking as much as 4200 IU vitamin D 43 percent had less than 30 ng in blood – RCT Jan 2013
• Overview Loading of vitamin D Get Vitamin D benefit in 5-20 days instread of 100-300 days
• Seniors need at least 4,000 IU vitamin D, no test needed – Consensus Jan 2014
• 4,000 IU of Vitamin D - many pages

Overview Osteoporosis and vitamin D contains the following summary

• FACT: Bones need Calcium (this has been known for a very long time)
• FACT: Vitamin D improves Calcium bioavailability (3X ?)
• FACT: Should not take > 750 mg of Calcium if taking lots of vitamin D (Calcium becomes too bio-available)
• FACT: Adding vitamin D via Sun, UV, or supplements increased vitamin D in the blood
• FACT: Vitamin D supplements are very low cost
• FACT: Many trials, studies. reviews, and meta-analysis agree: adding vitamin D reduces osteoporosis
• FACT: Toxic level of vitamin D is about 4X higher than the amount needed to reduce osteoporosis
• FACT: Co-factors help build bones.
• FACT: Vitamin D Receptor can restrict Vitamin D from getting to many tissues, such as bones
• It appears that to TREAT Osteoporosis:
•        Calcium OR vitamin D is ok
•        Calcium + vitamin D is good
•        Calcium + vitamin D + other co-factors is great
•        Low-cost Vitamin D Receptor activators sometimes may be helpful
• CONCLUSION: To PREVENT many diseases, including Osteoporosis, as well as TREAT Osteoporosis
• Category Osteoporosis has 219 items
• Category Bone Health has 311 items

Note: Osteoporosis causes bones to become fragile and prone to fracture
  Osteoarthritis is a disease where damage occurs to the joints at the end of the bones
Overview Vitamin D Dose-Response has the following chart
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Note the increase between triangles at 6 months and circles at 12 months

Takes a year to restore children and youths to good levels of vitamin D without loading dose - RCT Dec 2016

In 3 studies people have taken 12 months to plateau

However, typically studies show the response leveling out at about 3 months

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Osteoporosis International pp 1–11, First Online: 16 Dec 2016, DOI: 10.1007/s00198-016-3833-y
H. HinJ. TomsonC. NewmanR. KurienM. LayJ. CoxJ. SayerM. HillJ. EmbersonJ. ArmitageR. Clarke

 Download the BEST-D PDF from VitaminDWiki

Summary
This trial compared the effects of daily treatment with vitamin D or placebo for 1 year on blood tests of vitamin D status. The results demonstrated that daily 4000 IU vitamin D3 is required to achieve blood levels associated with lowest disease risks, and this dose should be tested in future trials for fracture prevention.

Introduction
The aim of this trial was to assess the effects of daily supplementation with vitamin D3 4000 IU (100 μg), 2000 IU (50 μg) or placebo for 1 year on biochemical markers of vitamin D status in preparation for a large trial for prevention of fractures and other outcomes.

Methods
This is a randomized placebo-controlled trial in 305 community-dwelling people aged 65 years or older in Oxfordshire, UK. Outcomes included biochemical markers of vitamin D status (plasma 25-hydroxy-vitamin D [25[[OH]D], parathyroid hormone [PTH], calcium and alkaline phosphatase), cardiovascular risk factors and tests of physical function.

Results
Mean (SD) plasma 25(OH)D levels were 50 (18) nmol/L at baseline and increased to 137 (39), 102 (25) and 53 (16) nmol/L after 12 months in those allocated 4000 IU, 2000 IU or placebo, respectively (with 88%, 70% and 1% of these groups achieving the pre-specified level of >90 nmol/L). Neither dose of vitamin D3 was associated with significant deviation outside the normal range of PTH or albumin-corrected calcium. The additional effect on 25(OH)D levels of 4000 versus 2000 IU was similar in all subgroups except for body mass index, for which the further increase was smaller in overweight and obese participants compared with normal-weight participants. Supplementation with vitamin D had no significant effects on cardiovascular risk factors or on measures of physical function.

Conclusions
After accounting for average 70% compliance in long-term trials, doses of 4000 IU vitamin D3 daily may be required to achieve plasma 25(OH)D levels associated with lowest disease risk in observational studies.