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In Reply We agree that high-dose monthly vitamin D is not necessarily harmful among seniors with vitamin D deficiency. However, everyone treated with 24 000 IU vitamin D per month (equivalent to 800 IU/day) achieved the replete range of above 20 ng/mL 25(OH)D (to convert 25[OH]D level to nanomoles per liter, multiply by 2.496), with none reaching a 25(OH)D level above 45 ng/mL.1 The group treated with 24 000 IU per month included 59.7% of participants with deficient 25(OH)D starting levels less than 20 ng/mL and 40.3% with replete 25(OH)D starting levels greater than 20 ng/mL (range, 20.1-43.5 ng/mL). Thus, at starting levels throughout the wide range of 4.9 to 43.5 ng/mL, 24 000 IU vitamin D per month appears to be effective in safely bringing 25(OH)D levels into what currently appears to be the desirable range for fall prevention.1 This does not mean that measuring 25(OH)D status is never indicated but suggests that wide spread assessments by serum analysis or algorithm may not be necessary.
Bischoff-Ferrari HA, Orav EJ, Dawson-Hughes B. Estimating Vitamin D Status and the Choice of Supplementation Dose—Reply. JAMA Intern Med. 2016;176(6):865-866. doi:10.1001/jamainternmed.2016.1629