Effect of vitamin D3 on bone turnover markers in critical illness: post hoc analysis from the VITdAL-ICU study

V Schwetz, C Schnedl, T Urbanic-Purkart, C Trummer, H P Dimai, A Fahrleitner-Pammer, C Putz-Bankuti, K B Christopher, B Obermayer-Pietsch, T R Pieber, H Dobnig, K Amrein, V Schwetz, C Schnedl, T Urbanic-Purkart, C Trummer, H P Dimai, A Fahrleitner-Pammer, C Putz-Bankuti, K B Christopher, B Obermayer-Pietsch, T R Pieber, H Dobnig, K Amrein

Abstract

In this post hoc analysis of the VITdAL-ICU study, an RCT in critically ill adults with 25-hydroxyvitamin D levels ≤20 ng/ml, vitamin D3 did not have a significant effect on β-Crosslaps and osteocalcin.

Introduction: Observational studies have shown accelerated bone loss in ICU survivors. A reversible contributor is vitamin D deficiency. In a post hoc analysis of the VITdAL-ICU study, we evaluated the effect of high-dose vitamin D3 on the bone turnover markers (BTM) β-Crosslaps (CTX) and osteocalcin (OC).

Methods: The VITdAL-ICU study was a randomized, double-blind, placebo-controlled trial in critically ill adults with 25-hydroxyvitamin D levels ≤20 ng/ml who received placebo or high-dose vitamin D3 (a loading dose of 540,000 IU and starting 1 month after the loading dose five monthly maintenance doses of 90,000 IU). In this analysis on 289 survivors (209 telephone, 80 personal follow-up visits), BTM were analyzed on days 0, 3, 7, 28, and 180; self-reported falls and fractures were assessed. Bone mineral density (BMD) was measured after 6 months.

Results: At baseline, CTX was elevated; OC was low in both groups-after 6 months, both had returned to normal. There were no differences between groups concerning BTM, BMD, falls, or fractures. In linear mixed effects models, CTX and OC showed a significant change over time (p < 0.001, respectively), but there was no difference between the vitamin D and placebo group (p = 0.688 and p = 0.972, respectively).

Conclusions: Vitamin D supplementation did not have a significant effect on BTM. Further studies should assess the effectiveness of vitamin D on musculoskeletal outcomes in ICU survivors.

Trial registration: ClinicalTrials.gov NCT01130181.

Keywords: Bone loss; Bone mineral density; Bone turnover markers; Critical illness; Fracture; Long-term outcomes; Osteoporosis; Vitamin D3.

Conflict of interest statement

Funding

Karin Amrein and Harald Dobnig report grants from European Society for Clinical Nutrition and Metabolism (ESPEN), grants, lecture fees, and non-financial support from Fresenius Kabi (Germany), and a grant from the Austrian National Bank (Jubiläumsfonds) during the conduct of the study.

Conflicts of interest

None of the authors is in any regards financially dependent on the named institutions.

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