Department of Community Medicine and Epidemiology, Carmel Medical Center, Clalit Health Services, Haifa, Israel.
Calcif Tissue Int. 2011 Nov;89(5):419-25. doi: 10.1007/s00223-011-9536-7. Epub 2011 Oct 2.
Vitamin D supplements are often recommended to restore sufficiency, although the adherence to treatment is low. This study assessed vitamin D status at different time intervals following the cessation of treatment. The database of Clalit-Health-Services (CHS), a not-for-profit HMO covering more than half of the Israeli population, was retrospectively searched for all members with available serum 25OHD test results in 2009 (245,493). We then identified those who filled any cholecalciferol prescription in 2008-2009 (121,817). Subjects were included in the final analysis only if they started treatment in 2009, had serum 25OHD < 50 nmol/l before the first prescription in 2009, and had at least one additional test result after the last dated prescription in 2009 (5,461). Serum 25OHD increased from 32 ± 11 nmol/l at baseline to 58.6 ± 22.3 nmol/l after treatment (P < 0.001). The proportion of subjects with sufficient vitamin D after treatment increased with increasing cholecalciferol daily dose and treatment duration (P < 0.001) and decreased with increasing time from cessation of treatment (P < 0.001). The effect of time from treatment cessation persisted after controlling for baseline serum 25OHD, daily cholecalciferol dose, treatment duration, seasonality, gender, age, ethnicity, and BMI; the ORs for sufficient vitamin D were 2.02 (95% CI 1.66-2.45), 1.67 (1.39-2.01), and 1.23 (1.04-1.47) for >30-60, 61-99, and 100-155 days compared to >155 days, respectively. Long-term vitamin D treatment is needed to maintain sufficient levels in those with baseline serum 25OHD below 50 nmol/l.
维生素 D 补充剂常被推荐用于恢复充足水平，尽管治疗的依从性较低。本研究评估了停止治疗后不同时间间隔的维生素 D 状态。回顾性地在 Clalit-Health-Services（CHS）数据库中搜索了 2009 年有可用血清 25OHD 检测结果的所有成员（245493 人），该数据库是一家非营利性 HMO，覆盖了以色列一半以上的人口。然后，我们确定了那些在 2008-2009 年期间服用任何胆钙化醇处方的人（121817 人）。只有在 2009 年开始治疗、2009 年首次处方前血清 25OHD<50nmol/L 且在 2009 年最后一次处方后至少有一次额外检测结果的患者，才被纳入最终分析（5461 人）。血清 25OHD 从基线时的 32±11nmol/L 增加到治疗后的 58.6±22.3nmol/L（P<0.001）。治疗后维生素 D 充足的患者比例随着胆钙化醇日剂量和治疗持续时间的增加而增加（P<0.001），随着治疗结束后时间的增加而降低（P<0.001）。在控制基线血清 25OHD、胆钙化醇日剂量、治疗持续时间、季节性、性别、年龄、种族和 BMI 后，治疗结束时间的影响仍然存在；维生素 D 充足的 OR 值分别为 2.02（95%CI 1.66-2.45）、1.67（1.39-2.01）和 1.23（1.04-1.47），>30-60、61-99 和 100-155 天与>155 天相比。对于基线血清 25OHD 低于 50nmol/L 的患者，需要长期维生素 D 治疗以维持充足水平。
