Efficacy of Parenteral versus Oral Vitamin D Replacement in Hypovitaminosis D.

Abstract

The study was to compare efficacy of parenteral versus oral vitamin D replacement in hypovitaminosis. Study Design: Randomized trial. Setting: Medical Outpatient Clinics of Madinah Teaching Hospital, Chiniot General Hospital and Maqsooda Zia Hospital, Faisalabad. Period: 6 months (Oct 2017 – Apr 2018). Material & Methods:  84 patients were included in the study. Baseline 25(OH) D levels were determined, and followed-up at 3^rd and 6^th weeks following vitamin D replacement. After giving the first dose of vitamin D (parenteral or oral), patients were given maintenance dose of calcium and vitamin D supplement as per recommended daily allowance (RDA). Patients with significant clinical improvement were also noted in both groups. Results: The change in vitamin D level after 3 weeks and 6 weeks of replacement through oral route and intramuscular (IM) route was compared; which was found to be statistically significant in both groups (p value < 0.05). Mean change in vitamin D levels after 6 weeks of replacement in all the patients was 17.96 + 13.0. In oral group, it was 13.5 + 10.07 and in IM group, it was 22.40 + 14.18. This clearly shows that it was higher in the IM group compared to the oral group. This difference was statistically significant (p=0.001). The percentage change in the serum 25-OH D level was 53% and 79% for oral group compared to 103% and 207% for the IM group, y after 3 and 6 weeks of replacement respectively. Conclusion: While managing hypovitaminosis D, IM route of administration is more effective. There was significant improvement in the serum 25OHD levels in the IM group. A larger randomized control trial should be done comparing the efficacy of oral and IM route of vitamin D replacement.