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Perspective: Vitamin D supplementation prevents rickets and acute respiratory infections when given as daily maintenance but not as intermittent bolus: implications for COVID-19

George Griffin, Martin Hewison, Julian Hopkin, Rose Anne Kenny, Richard Quinton, Jonathan Rhodes, Sreedhar Subramanian and David Thickett
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DOI: https://doi.org/10.7861/clinmed.2021-0035
Clin Med February 2021
George Griffin
ASt George's, University of London, London, UK
Roles: emeritus professor of infectious diseases and medicine
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Martin Hewison
BUniversity of Birmingham, Birmingham, UK
Roles: professor of molecular endocrinology
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Julian Hopkin
CSwansea University, Swansea, UK
Roles: rector of medicine and health and professor of experimental medicine
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Rose Anne Kenny
DTrinity College Dublin, Dublin, Ireland
Roles: professor of medical gerontology
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Richard Quinton
ENewcastle University, Newcastle upon Tyne, UK
Roles: senior lecturer in endocrinology
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Jonathan Rhodes
FUniversity of Liverpool, Liverpool, UK
Roles: emeritus professor of medicine
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Sreedhar Subramanian
GRoyal Liverpool University Hospital, Liverpool, UK
Roles: consultant gastroenterologist
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David Thickett
HUniversity of Birmingham, Birmingham, UK
Roles: professor in respiratory medicine
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ABSTRACT

The value of vitamin D supplementation in the treatment or prevention of various conditions is often viewed with scepticism as a result of contradictory results of randomised trials. It is now becoming apparent that there is a pattern to these inconsistencies. A recent large trial has shown that high-dose intermittent bolus vitamin D therapy is ineffective at preventing rickets – the condition that is most unequivocally caused by vitamin D deficiency. There is a plausible biological explanation since high-dose bolus replacement induces long-term expression of the catabolic enzyme 24-hydroxylase and fibroblast growth factor 23, both of which have vitamin D inactivating effects. Meta-analyses of vitamin D supplementation in prevention of acute respiratory infection and trials in tuberculosis and other conditions also support efficacy of low dose daily maintenance rather than intermittent bolus dosing. This is particularly relevant during the current COVID-19 pandemic given the well-documented associations between COVID-19 risk and vitamin D deficiency. We would urge that clinicians take note of these findings and give strong support to widespread use of daily vitamin D supplementation.

KEYWORDS
  • vitamin D
  • COVID-19
  • maintenance
  • dosing
  • efficacy
  • © Royal College of Physicians 2021. All rights reserved.
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Perspective: Vitamin D supplementation prevents rickets and acute respiratory infections when given as daily maintenance but not as intermittent bolus: implications for COVID-19
George Griffin, Martin Hewison, Julian Hopkin, Rose Anne Kenny, Richard Quinton, Jonathan Rhodes, Sreedhar Subramanian, David Thickett
Clinical Medicine Feb 2021, clinmed.2021-0035; DOI: 10.7861/clinmed.2021-0035

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Perspective: Vitamin D supplementation prevents rickets and acute respiratory infections when given as daily maintenance but not as intermittent bolus: implications for COVID-19
George Griffin, Martin Hewison, Julian Hopkin, Rose Anne Kenny, Richard Quinton, Jonathan Rhodes, Sreedhar Subramanian, David Thickett
Clinical Medicine Feb 2021, clinmed.2021-0035; DOI: 10.7861/clinmed.2021-0035
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