Influence of daily regimen calcium and vitamin D supplementation on parathyroid hormone secretion

Calcium and vitamin D supplementation has been shown to reduce secondary hyperparathyroidism and play a role in the management of senile osteoporosis. In order to define the optimal regimen of calcium and vitamin D supplementation to produce the maximal inhibition of parathyroid hormone secretion. we have compared the administration of a similar amount of Ca and vitamin D, either as a single morning dose or split in two doses. taken 6 hours apart. Twelve healthy volunteers were assigned to three investigational procedures. at weekly intervals. After a much less thanblankmuch greater than control procedure. when they were not exposed to any drug intake. they received two calcium-vitamin D supplement regimens including either two doses of Orocal D3 (R) (500 mg Ca and 400 IU vitamin D) 6 hours apart or one water-soluble effervescent powder pack of Cacit D3 (R) in a single morning dose (1000 mg Ca and 880 IU vitamin D). During the three procedures (control and the two calcium-vitamin D supplementations). venous blood was drawn every 60 minutes for up to 9 hours. for serum Ca and serum PTH measurements. The order of administration of the two Ca and vitamin D supplementation sequences was allocated by randomization. No significant changes in serum Ca were observed during the study. During the 6 hours following Ca and vitamin D supplementation. a statistically significant decrease in serum PTH was observed with both regimens, compared with baseline and with the control procedure. Over this period of time, no differences were observed between the two treatment regimens. However, between the sixth and the ninth hour. serum PTH levels were still significantly decreased compared with baseline with split dose Orocal D3 (R) administration, while they returned to baseline value with the Cacit D3 (R) preparation. During this period. the percentage decrease in serum PTH compared with baseline was significantly more pronounced with Orocal D3 (R) than with Cacit D3 (R) (P = 0.0021). We therefore conclude that the administration of two doses of 500 mg of calcium and 400 IU of vitamin D3 6 hours apart provides a more prolonged decrease in serum PTH levels than the administration of the same total amount of Ca and vitamin D as a single morning dose in young healthy volunteers. This might have implications in terms of protection of the skeleton against secondary hyperparathyroidism and increased bone resorption and turnover in elderly subjects.