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Glucocorticoid users twice as likely to be deficient in vitamin D

Posted on: October 29, 2011   by  John Cannell, MD


About 1% of Americans are on glucocorticoids, usually for asthma or autoimmune diseases. These steroids lower inflammation, much like vitamin D, but do so at a cost in that people on glucocorticoids are more susceptible to a host of diseases, including infection and osteoporosis. So looking at vitamin D levels in people on glucocorticoids is important. We have some data from small studies that indicate patients on glucocorticoids have low vitamin D levels but no big population studies exist.

Dr. Amy Skversky and colleagues from the Albert Einstein School of Medicine changed that when she studied 22,000 people to find 181 individuals taking glucocorticoids. Those 181 people were twice as likely to have severe vitamin D deficiency, levels less than 10 ng/ml.

Skversky AL, Kumar J, Abramowitz MK, Kaskel FJ, Melamed ML. Association of Glucocorticoid Use and Low 25-Hydroxyvitamin D Levels: Results from the National Health and Nutrition Examination Survey (NHANES): 2001-2006. J Clin Endocrinol Metab. 2011 Sep 28.

Patients on steroids often come repeatedly to their doctor with chronic pain and get prescribed powerful and addicting pain medications. If the doctor would only push his knuckle on their sternum or tibia, he would elicit severe pain, which is a sign of adult rickets or osteomalacia.

About 3 million Americans are on glucocorticoids, so we can infer from this study that about 300,000 of them have vitamin D levels less than 10 ng/ml (11%). I worry about these people because osteomalacia usually accompanies such levels. Besides their asthma or autoimmune disorders, doctors often diagnose them with fibromyalgia, or even as “crocks,” a deriding term doctors use when they cannot find the source of someone’s complaint. All they need is some vitamin D.

The authors also pinned down the reason people of glucocorticoids have low vitamin D levels. The enzyme increases expression of the 24-hydroxylase (the enzyme that destroys vitamin D), and 24-hydroxylase lowers vitamin D levels very quickly. People on glucocorticoids should take at least 5,000 IU/day and sometimes 10,000 IU per day to keep their 25(OH)D level around 50 ng/ml. Children on glucocorticoids need 2,000 IU per every 25 pounds of body weight.

I would be very interested to hear any reports from patients on glucocorticoids who take vitamin D. Were you able to get off the glucocorticoids? Do the higher vitamin D levels help the symptoms of asthma, rheumatoid arthritis, Crohn’s disease, or lupus? I know of three case reports where parents of asthmatic children reported that their child’s asthma slowly became better on vitamin D. I wonder if anyone else has such a report?

5 Responses to Glucocorticoid users twice as likely to be deficient in vitamin D

  1. [email protected]

    Having read your articles on Asthma/VitD3, I decided to try increasing my daily dose(5000 IU
    at that time) to 10,000 IU daily for several months. Unfortunately this had no effect & so I have
    had to continue with the medication (Seretide 250[propionate de fluticasone salmeterol], 2 ‘puffs’
    per day, at the same time as reducing my VitD to 7,000IU (based on both my body weight & also
    blood levels)
    Pamela Randolph

  2. whiteshepherd

    I have been taking vitamin d3 at 5000i.u. per day for approximately 6 months and paired this with magnesium citrate 6 weeks ago. I also inhale tiotropium 18mcg dry powder once daily together with budesonide/formoterol fumarate 400mcg/12 mcg dry powder twice daily to control asthma and COPD. Prior to commencing vitamin d3 I was using the steroid inhaler 4 and sometimes 5 times per day together with regular usage of terbutaline sulphate 500mcg as needed.

    It was my intention to publish full details of my vitamin d3 experience after 12 months but as you are asking for users of gluco-corticoids to respond to this blog I thought I would give my initial results to date prior to giving the complete 12 month picture.
    I live in West Cumbria UK close to the Lake District not particularly good for sunlight.

  3. Brant Cebulla

    Thanks for sharing guys. Pamela, do you get your 25(OH)D tested every once in awhile?

    whiteshepard, we’ll look forward to what you have to say down the road!

  4. DFM

    My 11 year old son has asthma and eczema. His pulmonologist initially prescribed Pulmicort as a preventative and Albuterol as a treatment if wheezing occurred and later substituted Advair for the Pulmicort. Over the past couple of years I have supplemented him daily with 5,000 IUs of Vitamin D, 2,300 mg of EDPA/DHA, and a probiotic. He no longer uses the Advair and needs the Alubuterol perhaps 5 times a year. He recently needed it but I believe that was simply because we were out of power for a week and had to use our wood burning fireplace. His Vit D level last checked was 54 ng/mL. His eczema is barely visible, if at all, and does not bother him. The short of it is he has significantly reduced his need for asthma medication but I suspect all three supplements have had a hand in his improvement.

  5. whiteshepherd

    A recent dried blood spot analysis gives the following result: 25(OH)D3 – 112.3 nmol/L.
    25(OH)D2 – 3.6 nmol/L. This on a maintained daily dose of 5000 iu over a 7 month period.
    Read in conjunction with my earlier posting.

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