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Diminished and erratic absorption of ergocalciferol in adult cystic fibrosis patients^1,2,3

¹ From the Department of Orthopaedics and the Department of Medicine, Divisions of Endocrinology, Pulmonary Medicine, and Critical Care Medicine, University of North Carolina, Chapel Hill, and the Department of Pediatrics, Medical University of South Carolina, Charleston.

Background: Osteoporosis diminishes the quality of life in adults with cystic fibrosis (CF). Vitamin D deficiency resulting from malabsorption may be a factor in the etiology of low bone mineral density (BMD) in patients with CF.

Objective: Absorption of oral ergocalciferol (vitamin D₂) and the consequent response of 25-hydroxyvitamin D in 10 adults with CF and exocrine pancreatic insufficiency was compared with that of 10 healthy control subjects.

Design: In this pharmacokinetic study, CF patients and control subjects were pair-matched on age, sex, and race. Each subject consumed 2500 µg oral vitamin D₂ with a meal. The CF group also took pancreatic enzymes that provided 80000 U lipase. Blood samples were obtained at baseline and at 5, 10, 24, 30, and 36 h after vitamin D₂ consumption to measure serum vitamin D₂ and 25-hydroxyvitamin D concentrations.

Results: Vitamin D₂ concentrations in all subjects were near zero at baseline. CF patients absorbed less than one-half the amount of oral vitamin D₂ that was absorbed by control subjects (P < 0.001). Absorption by the CF patients varied greatly; 2 patients absorbed virtually no vitamin D₂. The rise in 25-hydroxyvitamin D in response to vitamin D₂ absorption was significantly lower over time in the CF group than in the control group (P = 0.0012).

Conclusions: Vitamin D₂ absorption was significantly lower in CF patients than in control subjects. These results may help explain the etiology of vitamin D deficiency in CF patients, which may contribute to their low BMD.

Key Words: Vitamin D • cystic fibrosis • malabsorption • ergocalciferol • 25-hydroxyvitamin D • bone mineral density • osteoporosis • pancreatic insufficiency • vitamin D₂

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