Background: Vitamin D is a dietary micronutrient responsible for
calcium and phosphorus metabolism and multiple extraskeletal actions. The
assessment of vitamin D status is commonly based on measurement of 25(OH)D total
concentration in serum. However, the usage of liquid chromatography with tandem mass spectrometry (LC-MS/MS) technique allows to
reliably assess a panel of vitamin D metabolites in serum or plasma, which may
help to investigate the metabolic paths of vitamin D, especially in populations
at risk of deficiency. Methods: A randomized, two-arms, open study was
conducted on 58 patients (28 female and 30 male; aged from 61 to 96 years old).
The primary aim was to assess the effects of a single, high, oral dose of vitamin
D (120,000 IU) on serum 25(OH)D, 25(OH)D,
24,25(OH)D, 3-epi-25(OH)D, 1,25(OH)D,
24,25(OH)D/25(OH)D ratio, and 25(OH)D/3-epi-25(OH)D
ratio concentration (measured by LC-MS/MS) at baseline, 3 days and 7 days after
administration, compared to control group. The secondary aim was assessment of
influence of percentage of fat tissue on serum metabolites of vitamin D and their
changes after bolus dose. Results: 56.6% study group attained a serum
25(OH)D concentration 30 ng/mL. All subjects, except for one patient
achieved a serum 25(OH)D concentration 20 ng/mL after administration. No
one exceed reference value of vitamin D (30–50 ng/mL). Among participants who
received vitamin D there were significant increase in 25(OH)D,
3-epi-25(OH)D, 1,25(OH)D, 24,25(OH)D on 3rd day
after administration. 24,25(OH)D concentration gradually grew,
achieving the highest concentration on 7th day. The percentage increase of
25(OH)D was negatively correlated with baseline 25(OH)D (r = –0.688,
p = 0.001). Positive correlation between percentage increase in
25(OH)D and a percentage increase serum concentration of
24,25(OH)D (r = 0.954, p 0.001), 3-epi-25(OH)D (r
= 8.03, p 0.001) and 1,25(OH)D (r = 0.789, p 0.001) were found. None of the study participants developed hypercalcemia. The
baseline concentration of analyzed metabolites of vitamin D in serum and their
percentage increase were neither dependent on BMI nor percentage of fat tissue.
Conclusions: High dose of vitamin D rapidly increases 25(OH)D
concentration in the elderly patients. The response to the bolus of vitamin D
includes activation of 3-epimerase, followed by production of
24,25(OH)D, which protects from excessive increase of active form of
vitamin D.