One Year Cholecalciferol and Calcium Supplementation Improve BMD But Not Trabecular Bone Score in Asymptomatic Hypovitaminosis D

CONTEXT: The bone health significance of incidentally detected low serum 25(OH)D in clinically asymptomatic individuals is debatable. We investigated the changes in bone mineral density (BMD) and trabecular bone score (TBS) after 1 year of cholecalciferol and calcium supplementation in asymptomatic individuals with low serum 25(OH)D and TBS. DESIGN AND SETTING: Interventional longitudinal study at the tertiary-care centre. SUBJECTS AND MEASUREMENTS: and M:F = 29:21) with serum 25(OH)D < 50 nmol/L and low TBS (< 1.310) followed from an earlier study designed for generating TBS norms for Asian Indians. Participants received supervised 60,000 IU of cholecalciferol/week for 8 weeks, followed by 60,000 IU/month for the next 10 months and 500 mg daily elemental calcium. Serum 25(OH)D and related biochemical parameters, BMD, and TBS were evaluated before and after 6- and 12-months of supplementation. Changes were analysed using a generalised estimating equation. RESULTS: Mean serum 25(OH)D (nmol/L) showed a significant rise following supplementation (29.1 ± 11.7 at baseline to 68.8 ± 47.4 and 63.2 ± 22.2 at 6- and 12-months, respectively). Serum intact PTH, osteocalcin, and alkaline phosphatase showed a significant decrease within 6 months of supplementation. BMD improved significantly from baseline at lumbar-spine, total-hip, and femoral-neck at 6- and 12-months after supplementation (p < 0.01 for all). However, the mean TBS showed no significant change following cholecalciferol and calcium supplementation. CONCLUSIONS: One year of cholecalciferol and calcium supplementation in asymptomatic individuals resulted in a significant rise in serum 25(OH)D, which was associated with increased BMD but not TBS.