Vitamin D status and optimal supplementation in institutionalized adults with intellectual disability.
A daily 800 IU vitamin D pill beats a one-time mega shot for keeping levels normal in adults with ID.
01Research in Context
What this study did
Researchers gave vitamin D to adults with intellectual disability living in group homes. Half took a small pill every day. The other half got one big shot in the muscle.
The team wanted to know which method raised vitamin D levels best.
What they found
Daily pills won. Four out of ten pill users reached the target level. Only one out of ten shot users did.
Both groups saw some rise, but the steady daily dose worked better.
How this fits with other research
Reyer et al. (2006) used a four-month shot schedule before this study. They showed shots could fix low levels, but did not test daily dosing. The new data say daily is surer.
Williams et al. (2019) followed the same adults for seven years. People who kept taking any form of vitamin D kept stronger bones. The 2009 trial helps explain why staying on daily pills is the safer route.
de Wit et al. (2024) found young adults with autism also run low on vitamin D. The 2009 dosing guide can help BCBAs plan care for both ID and ASD groups.
Why it matters
Low vitamin D is common in residential services and can hurt bone health. This study gives you a clear plan: use 800 IU by mouth each day instead of waiting for big shots. Add a daily pill to the med sheet, track levels at annual physicals, and teach staff to offer the pill with breakfast. Small habit, big payoff.
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02At a glance
03Original abstract
BACKGROUND: Adults with intellectual disability (ID) have several risk factors for osteoporosis. Feeding problems with consequent nutritive deficiencies, and lack of sunshine exposure may lead to vitamin D deficiency. The purpose of this study was to evaluate vitamin D status in adults with ID living in nursing homes and to compare two different means to administer vitamin D in adults with ID. METHODS: The study included 138 adults (95 males and 43 females) with ID living in nursing homes of Pääjärvi Inter-Municipal Association. Clinical data on the etiology and severity of ID, other illnesses, medications, anthropometry and fractures during the preceding 5 years were collected from medical records. The participants were alternately allocated to receive vitamin D3 either per orally 800 IU daily for 6 months (PO group, n = 72) or as a single intramuscular injection of 150 000 IU (IM group, n = 66). Blood samples were obtained at baseline and at 6 months for parameters of calcium homeostasis, including serum concentrations of 25-hydroxyvitamin D (S-25-OHD) and parathyroid hormone (P-PTH). RESULTS: At baseline, the mean S-25-OHD was low, 40 nmol/L in the PO group and 41 nmol/L in the IM group. The low vitamin D levels were associated with secondary hyperparathyroidism in 17%. At 6 months the mean S-25-OHD was 82 nmol/L in the PO group (P < 0.001 for the difference from baseline) and 62 nmol/L in the IM group (P < 0.001). P-PTH decreased in both groups: from 51 ng/L to 33 ng/L in the PO group (P < 0.001) and from 54 ng/L to 34 ng/L in the IM group (P < 0.001). With daily dosing (800 IU/day) the recommended level (>80 nmol/L) was attained in 42%, but with intramuscular dose only in 12%. S-25-OHD was >100 nmol/L in 14 participants in the PO group and in one participant in the IM group; these high values were associated with hypercalcemia in two and hyperphosphatemia in six participants. Participants with S-25-OHD >100 nmol/L at 6 months were lighter (51.9 kg vs. 67.5 kg, P = 0.002) and had smaller body mass index than participants with lower S-25-OHD (20.5 kg/m(2) and 24.4 kg/m(2), P = 0.017). CONCLUSIONS: Vitamin D insufficiency was common in adults with ID living in nursing homes. Both oral and intramuscular administrations of vitamin D3 improved vitamin D status without adverse effects. The treatment response at 6 months was better in the PO group. High-dose intramuscular vitamin D3 injections may be a convenient way to maintain sufficient vitamin D status in adults with ID but further studies are needed to establish the optimal dose and interval as well as subsequent potential health benefits in these patients. Based on this study, vitamin D supplementation with per oral 800 IU/day is recommended to all adults with ID living in nursing homes.
Journal of intellectual disability research : JIDR, 2009 · doi:10.1111/j.1365-2788.2009.01218.x