key: cord-0886279-v69ck44y
authors: Wimalawansa, Sunil J.; Whittle, Robin
title: Vitamin D: A single initial dose is not bogus if followed by an appropriate maintenance intake
date: 2022-02-18
journal: JBMR Plus
DOI: 10.1002/jbm4.10606
sha: b5f8e55cc3ca7d544af71de6aea9d66c6fb8f88b
doc_id: 886279
cord_uid: v69ck44y

nan

We read the review by Mazess and colleagues (1) in JBMR Plus with interest. We have several points for comment and discussion.

First, a bolus dose is a single dose of a substance given over a short period, also called a loading dose. (2) However, in the review, (1) the term "bolus" dose refers to the nutrient cholecalciferol, vitamin D3 supplement as a longer-term micronutrient, in larger quantities than accepted daily doses with intervals of over a month duration between intakes.

Second, although the authors rightly critique overly long intervals between vitamin D3 supplementation intakes (ie, >1-month intervals), they were mistaken to refer to these as "bolus doses" and so mischaracterize bolus dosing as "bogus."

In those with coronavirus disease(s) (e.g., COVID-19), sepsis or other medical emergencies, achieving and mainteaning serum 25-hydroxyvitamin D [25(OH)D] concentration of above 50 ng/ mL is crucial for achieving proper immune function (3) (also toreplete body stores) within days with a single bolus dose of vitamin D 3 , such as 5 to 10 mg (200,000 to 400,000 IU), or within 4 hours using a single, 0.5-mg to 1-mg oral dose of calcifediol (0.014 mg/ kg body weight). (4) However, to maintain the boosted serum 25 (OH)D concentrations, D 3 supplements should be taken daily or once a week in larger quantities (taking less frequently than this, is less effective). (5) Third, the review's critique of the Murai study should not be considered a general critique of bolus D3 dosing. This trial resulted in poor clinical outcomes due to the faulty study design of using a bolus dose of D 3 in seriously ill patients. Earlier administration of vitamon D 3 and/or the use of rapidly acting calcifediol, would have been more effective in patients with advanced COVID-19 and in sepsis. (6) Finally, the circulatory 1,25-dihydroxyvitamin D [1,25-(OH) 2 D; calcitriol] levels and 24-hydroxylase enzyme activity used in this review as indicators of immune system functions are not relevant to vitamin D status or to the critical, autocrine and paracrine signaling system of immune cells.

Vitamin D: bolus is bogus-a narrative review

National Cancer Institute. Definition of the bolus dose

Association between preoperative 25-hydroxyvitamin D level and hospitalacquired infections following Roux-en-Y gastric bypass surgery

Calcifediol soft capsules

Long-term effects of giving nursing home residents bread fortified with 125 microg (5000 IU) vitamin D(3) per daily serving

Effect of a single high dose of vitamin D3 on hospital length of stay in patients with moderate to severe COVID-19: a randomized clinical trial

The authors declares no conflicts of interest.

The peer review history for this article is available at https:// publons.com/publon/10.1002/jbm4.10606.