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Year : 2017  |  Volume : 12  |  Issue : 1  |  Page : 59

Comment on: Supplementing vitamin D: Dangers of too much of a good thing: Reply

1 Department of Medicine, St. John's Medical College, Bengaluru, Karnataka, India
2 Department of Immunology, St. John's Medical College, Bengaluru, Karnataka, India

Date of Web Publication23-Feb-2017

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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/0973-3698.199134

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How to cite this article:
Fathima S, Thomas K, Shobha V, Idiculla J. Comment on: Supplementing vitamin D: Dangers of too much of a good thing: Reply. Indian J Rheumatol 2017;12:59

How to cite this URL:
Fathima S, Thomas K, Shobha V, Idiculla J. Comment on: Supplementing vitamin D: Dangers of too much of a good thing: Reply. Indian J Rheumatol [serial online] 2017 [cited 2023 Feb 2];12:59. Available from:

Dear editor,

We thank Dr. Subramanian for his interest [1] in our case report on Vitamin D toxicity.[2] This was to alert clinicians about the excessive and indiscriminate use of Vitamin D. The patient in the case report underwent a through screen to rule out malignancies of thyroid, breast, uterus, and intestines, which were all negative. On follow-up, she remains normocalcemic and well. If the biochemical parameters derange in future, we shall perform parathyroid hormone-related peptide assay as suggested by you.

The assay method used in our institution for Vitamin D estimation is chemiluminescent immunoassay. We have also observed low levels of Vitamin D even in asymptomatic individuals. The reason for this remains elusive, though studies on Vitamin D receptor polymorphisms and free Vitamin D levels may throw light.

Senior citizens are vulnerable to Vitamin D deficiency and consequent fractures. The Endocrine Society recommends Vitamin D levels above 30 ng/ml, while the Institute of Medicine's suggests levels above 20 ng/ml. The recommendation of the endocrine society is to provide at least 600 IU for those aged 50–70 and 800 IU in those above 70.[3] A dose of 1500–2000 units a day is required to raise the levels to 30 ng/dl, which in turn will prevent fractures. In Indians, a daily dose of 2000 units is recommended.[4] The dangers of over-treatment was reported by a case series from India recently.[5] In order to correct deficiency 50,000 units/week for 8 weeks or equivalent daily doses is suggested.[3] Parenteral administration may also be considered at the same dose as the effectiveness remains mostly similar.[6]

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  References Top

Nallasivan S. Comment on: Supplementing Vitamin D: Dangers of Too Much of a Good Thing. Ind J Rheumatol 2017;12:58.  Back to cited text no. 1
Fathima S, Tomas K, Shoba V, Idiculla J. Supplementing Vitamin D: Dangers of too much of a good thing. Indian J Rheumatol 2016;11:226-7.  Back to cited text no. 2
  Medknow Journal  
Evaluation, Treatment and Prevention of Vitamin D Deficiency – Endocrine Society. Available from:>publications. [Last accessed on 2016 Dec 30].  Back to cited text no. 3
Mudur G. Indian endocrinologists set guidance to combat Vitamin D deficiency. BMJ 2015;351:h5997.  Back to cited text no. 4
Kaur P, Mishra SK, Mithal A. Vitamin D toxicity resulting from overzealous correction of Vitamin D deficiency. Clin Endocrinol (Oxf) 2015;83:327-31.  Back to cited text no. 5
Zabihiyeganeh M, Jahed A, Nojomi M. Treatment of hypovitaminosis D with pharmacologic doses of cholecalciferol, oral vs. intramuscular; an open labeled RCT. Clin Endocrinol (Oxf) 2013;78:210-6.  Back to cited text no. 6


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