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interest. Need et al. (2008) studied fractional calcium absorption in 319 men (66 ± 10 years) with serum 25OHD levels less than 40 nmol/L. Fractional calcium absorption was 0.36 in men with the lowest quartile serum 25OHD levels (< 10 nmol/L) and rose significantly to 0.56 in the second quartile (11 to 20 nmol/L). No further change in fractional calcium absorption occurred with 25OHD levels of 21 to 30 or 31 to 40 nmol/L (Need et al., 2008). Kinyamu et al. (1998) performed a cross–sectional study of 376 healthy women (71 ± 4 years) and compared calcium absorption in those who took vitamin D supplements with that in non-supplemented women. Serum 25OHD level was significantly higher in women who took vitamin D (87.9 ± 28.2 nmol/L vs. 73.6 ± 23.0 nmol/L), whereas fractional calcium absorption did not differ between the two groups (Kinyamu et al., 1998). In addition, Devine et al. (2002) used a single isotope of calcium in a study of 120 older women and plotted a linear relationship between intestinal calcium absorption and serum 25OHD level. Intestinal calcium absorption rose from 35 percent at a mean serum 25OHD level of 15 nmol/L to 50 percent at 150 nmol/L. However, there were few data points at any serum 25OHD level, and an alternative fit to the data suggested an increase to 50 nmol/L and a plateau thereafter.

Hansen et al. (2008) studied 18 postmenopausal women before and after 15 days of supplementation with 50,000 IU of vitamin D2 daily. Serum 25OHD level rose markedly from 55 ± 10 nmol/L to 160 ± 53 nmol/L (p < 0.001), while fractional calcium absorption changed only modestly from 24 ± 7 percent at baseline to 27 ± 6 percent after vitamin D repletion (p < 0.04), indicating that the large rise in serum 25OHD levels was statistically significant, as was the small rise in intestinal calcium absorption. The 3 percent absolute increase in fractional calcium absorption was considered by the authors to be a minor increment given the large increase in serum 25OHD level (Hansen et al., 2008).

In a randomized controlled study, postmenopausal women with a mean baseline serum 25OHD level of 44 nmol/L receiving 1,000 mg of calcium citrate daily were randomized to daily placebo or 1,000 IU of vitamin D2 (Zhu et al., 2008a). Using a single-isotope method, this research group found a 36 nmol/L rise in serum 25OHD level and no increase in calcium absorption. This outcome is consistent with findings from their longer-term study (over 5 years), also demonstrating no rise in absorption (Zhu et al., 2008a). In both placebo and vitamin D groups, the calcium absorption decreased compared with baseline, most likely as a result of greater calcium intake (1 g calcium supplementation in both treatment arms). Also, Francis et al. (1996) found that 500 to 1,000 IU of vitamin D2 did not increase calcium absorption in elderly women. In a randomized double-blind controlled pilot trial in women (mean age = 57 years; dual-isotope method) with a baseline serum 25OHD level of 52 nmol/L, it was found that 400 IU

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