An interventional study of Vitamin D3 50,000 IU and Vitamin D3 placebo in HIV Infection, sponsored by University of North Carolina, Chapel Hill. Completed at 17 sites in 2 countries. Open to participants aged 16 Years to 24 Years. Per ClinicalTrials.gov, last updated 2019-03-27.
Sponsored by University of North Carolina, Chapel Hill · Not applicable, Interventional, and Diagnostic
This is a 48 week randomized double-blind, placebo-controlled prospective cohort study of adolescents and young adults with HIV infection in the Adolescent Medicine Trials Network for HIV/AIDS Interventions (ATN) who are currently being treated with cART that includes tenofovir disoproxil fumarate (TDF) as one component of the regimen that includes at least three Food and Drug Administration (FDA)-approved antiretroviral (ARV) drugs for at least 180 days.
This is a 48 week randomized double-blind, placebo-controlled prospective cohort study of adolescents and young adults with HIV infection in the ATN who are currently being treated with cART that includes TDF as one component of the regimen that includes at least three Food and Drug Administration (FDA)-approved ARVs for at least 180 days. Subjects must have at least one documented viral load that is below 200 copies/mL that is collected following initiation of TDF containing cART and greater than 90 days prior to randomization; no viral load above 200 copies/mL if measured within the 90 days prior to randomization; and an HIV viral load obtained at screening that is below 200 copies/mL.
Treatment assignments will be balanced by subject sex at birth, age (\<20 years vs. >=20 years), and race (African American vs. other). Enrolled subjects will be randomized to receive vitamin D3 50000 IU or matching placebo, given orally every four weeks by DOT. In addition to the randomized study agent, all subjects will receive a MVI to be taken orally once daily. This "standard" MVI will contain ingredients not to exceed 600 IU of vitamin D3 and 200 mg Ca.
Dual energy x-ray absorptiometry (DXA) measurement of bone mineral content (BMC)/bone mineral density (BMD) of whole body, spine, and hip, will be performed at baseline and study weeks 24 and 48. Blood and urine sampling to assess the Ca-phosphorous (PO4) axis, parathyroid hormone (PTH)-FGF23-vitamin D signaling, bone turnover, and renal glomerular and tubular function will occur at baseline and study weeks 12, 24, and 48. Blood samples to measure Gluc homeostasis will be drawn at baseline and week 48, and will be run by batch analysis.
Safety, measured by serum calcium (SCa) and serum creatinine (SCr), will be monitored by subject's record review at study sites since these labs will generally be measured as a part of routine clinical care. The Adolescent Medicine Trials Network for HIV/AIDS Interventions 109 (ATN 109) study will use the SCa and SCr values obtained within 10 weeks at the time of the visit beginning at the baseline visit. If these evaluations were not performed within the prior 10 weeks they will be drawn at the time of each visit. Viral load and cluster of differentiation 4 (CD4) cell count results will be recorded for this study, ATN 109, at screening, baseline and study weeks 12, 24, 48, and Post-Week 48 provided the evaluations were done within the protocol specified timeframe. If the evaluations were not performed within the protocol specified timeframes they will be drawn at the time of the visit.
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To be considered eligible for enrollment, an individual must meet the criteria listed below at the time of randomization:
NOTE: If the DXA scan is scheduled prior to randomization, all eligibility criteria must be met prior to performing the DXA scan.
HIV-1 infection as documented in subject's medical record by at least one of the following criteria:
Exclusion Criteria:
To be considered eligible for enrollment, an individual must not meet any of the criteria listed below at the time of randomization:
NOTE: If the DXA scan is scheduled prior to randomization, all eligibility criteria must be met prior to performing the DXA scan.
Subjects randomized to Group A will receive Vitamin D3 50,000 IU orally every four weeks by directly observed therapy (DOT). In addition all subjects receive a multivitamin (MVI) that contains ingredients not to exceed 600 IU of vitamin D3 and 200 mg of Calcium (Ca). Subjects will self-administer one MVI tablet orally once daily.
Dietary Supplement: Vitamin D3 50,000 IU
Subjects randomized to Group B will receive Vitamin D3 placebo orally every four weeks by DOT. In addition all subjects receive a MVI that contains ingredients not to exceed 600 IU of vitamin D3 and 200 mg of Ca. Subjects will self-administer one MVI tablet orally once daily.
Dietary Supplement: Vitamin D3 placebo
Group A: Vitamin D3 50,000 IU orally every four weeks by DOT
Also known as: Vitamin D3
Group B: Vitamin D3 placebo orally every four weeks by DOT
Also known as: Placebo
Percent Change From Baseline to Week 48 in Dual Energy X-ray Absorptiometry (DXA)-Measured BMD at the Spine for the Randomized Study Groups
Percent change from baseline to week (wk) 48 in DXA-measured BMD at the spine for the randomized study groups. Lumbar spine BMD (L1 - L4) (g/cm2) change from Baseline to wk 48 visit.
Time frame: Baseline and wk 48
Percent Change From Baseline to Week 24 of BMC of Whole Body for the Randomized Study Groups
Time frame: Baseline and week 24
Percent Change From Baseline to Week 48 of BMC of Whole Body for the Randomized Study Groups
Time frame: Baseline and week 48
Percent Change From Baseline to Week 24 of Lumbar Spine (L1-L4) BMD for the Randomized Study Groups
Time frame: Baseline and week 24
Change From Baseline to Week 24 of Lumbar Spine (L1-L4) BMD Z-score for the Randomized Study Groups
The Z-score is the standard deviation around mean bone mineral density in the lumbar spine, adjusted for sex, age, and race/ethnicity. An average Z-score of zero would be expected to be seen in healthy populations. A negative Z-score indicates lower than average bone mineral density. Low bone mineral density is a frequent finding in HIV-infected individuals, including adolescents and young adults.
Time frame: Baseline and week 24
Change From Baseline to Week 48 of Lumbar Spine (L1-L4) BMD Z-score for the Randomized Study Groups
The Z-score is the standard deviation around mean bone mineral density in the lumbar spine, adjusted for sex, age, and race/ethnicity. An average Z-score of zero would be expected to be seen in healthy populations. A negative Z-score indicates lower than average bone mineral density. Low bone mineral density is a frequent finding in HIV-infected individuals, including adolescents and young adults.
Time frame: Baseline and week 48
Percent Change From Baseline to Week 24 of Femoral Neck BMD for the Randomized Study Groups
Time frame: Baseline and week 24
Percent Change From Baseline to Week 48 of Femoral Neck BMD for the Randomized Study Groups
Time frame: Baseline and week 48
Change From Baseline to Week 24 of Femoral Neck BMD Z-score for the Randomized Study Groups
The Z-score is the standard deviation around mean bone mineral density in the femoral neck, adjusted for sex, age, and race/ethnicity. An average Z-score of zero would be expected to be seen in healthy populations. A negative Z-score indicates lower than average bone mineral density. Low bone mineral density is a frequent finding in HIV-infected individuals, including adolescents and young adults.
Time frame: Baseline and week 24
Change From Baseline to Week 48 of Femoral Neck BMD Z-score for the Randomized Study Groups
The Z-score is the standard deviation around mean bone mineral density in the femoral neck, adjusted for sex, age, and race/ethnicity. An average Z-score of zero would be expected to be seen in healthy populations. A negative Z-score indicates lower than average bone mineral density. Low bone mineral density is a frequent finding in HIV-infected individuals, including adolescents and young adults.
Time frame: Baseline and week 48
Percent Change From Baseline to Week 24 of Total Hip BMD for the Randomized Study Groups
Time frame: Baseline and week 24
Percent Change From Baseline to Week 48 of Total Hip BMD for the Randomized Study Groups
Time frame: Baseline and week 48
Change From Baseline to Week 24 of Total Hip BMD Z-score for the Randomized Study Groups
The Z-score is the standard deviation around mean bone mineral density in the total hip, adjusted for sex, age, and race/ethnicity. An average Z-score of zero would be expected to be seen in healthy populations. A negative Z-score indicates lower than average bone mineral density. Low bone mineral density is a frequent finding in HIV-infected individuals, including adolescents and young adults.
Time frame: Baseline and week 24
Change From Baseline to Week 48 of Total Hip BMD Z-score for the Randomized Study Groups
The Z-score is the standard deviation around mean bone mineral density in the total hip, adjusted for sex, age, and race/ethnicity. An average Z-score of zero would be expected to be seen in healthy populations. A negative Z-score indicates lower than average bone mineral density. Low bone mineral density is a frequent finding in HIV-infected individuals, including adolescents and young adults.
Time frame: Baseline and week 48
Change in SCr From Baseline to Week 12.
To assess renal glomerular safety by measuring change in SCr from baseline to week 12 by randomized study group;
Time frame: Baseline and week 12
Change in SCr From Baseline to Week 24.
To assess renal glomerular safety by measuring change in SCr from baseline to week 24 by randomized study group;
Time frame: Baseline and week 24
Change in SCr From Baseline to Week 48.
To assess renal glomerular safety by measuring change in SCr from baseline to week 48 by randomized study group;
Time frame: Baseline and week 48
Change From Baseline to Week 48 in Glucose Homeostasis (Fasting Insulin)
Time frame: Baseline and 48 weeks
Change From Baseline to Week 48 in Glucose Homeostasis (Fasting Glucose)
Time frame: Baseline and week 48
Change From Baseline to Week 48 in Glucose Homeostasis (Homeostasis Model Assessment of Insulin Resistance (HOMA-IR))
HOMA-IR is calculated as fasting glucose (mg/dL) X fasting glucose (uIU/mL) / 405. An increase in HOMA-IR means that an individual has become more resistant (less sensitive) to the effects of insulin and thus would be a negative outcome. A reduction in HOMA-IR means that an individual has become more sensitive to the effects of insulin and would be considered a positive outcome.There are no set minimum or maximum scores for HOMA-IR, since it is based on measurements of insulin and glucose, the assays for which may vary. Several studies suggest a cut-off of \>2 for any insulin resistance, but "normal" values appear to vary greatly by population (https://www.mdcalc.com/homa-ir-homeostatic-model-assessment-insulin-resistance).
Time frame: Baseline and week 48
Change From Baseline to Week 12 in Serum Calcium (SCa)
Time frame: Baseline and wk 12
Change From Baseline to Week 24 in Serum Calcium (SCa)
Time frame: 24 weeks
Change From Baseline to Week 48 in Serum Calcium (SCa)
Time frame: Baseline and wk 48
Change From Baseline to Week 12 in CTX
Time frame: Baseline and week 12
Change From Baseline to Week 24 in CTX
Time frame: Baseline and week 24
Change From Baseline to Week 48 in CTX
Time frame: Baseline and week 48
Change From Baseline to Week 12 in OC
Time frame: Baseline and week 12
Change From Baseline to Week 24 in OC
Time frame: Baseline and week 24
Change From Baseline to Week 48 in OC
Time frame: Baseline and wk 48
Change From Baseline to Week 12 in BAP
Time frame: Baseline and wk 12
Change From Baseline to Week 24 in BAP
Time frame: Baseline and wk 24
Change From Baseline to Week 48 in BAP
Time frame: Baseline and wk 48
Change From Baseline to Week 12 in FGF23
Time frame: Baseline and wk 12
Change From Baseline to Week 24 in FGF23
Time frame: Baseline and wk 24
Change From Baseline to Week 48 in FGF23
Time frame: Baseline and wk 48
Change From Baseline to Week 12 in PTH
Time frame: Baseline and wk 12
Change From Baseline to Week 24 in PTH
Time frame: Baseline and wk 24
Change From Baseline to Week 48 in PTH
Time frame: Baseline and wk 48
Change From Baseline to Week 12 in Actual Free 1,25-OHD
Vitamin D serum concentration (1,25 (OH)DTotal) (pmol/L) multiplied by F times 1,000, where F is defined as F = 1/(1 + Kd \* \[VDBP\] + Ka \*\[albumin\]) where the binding constant for VDBP = Kd = 4.2 x 107 M-1, and for albumin is Ka = 5.4 x 104 M-1 and the concentrations of VDBP and albumin are in moles/L
Time frame: Baseline and wk 12
Change From Baseline to Week 24 in Actual Free 1,25-OHD
Vitamin D serum concentration (1,25 (OH)DTotal) (pmol/L) multiplied by F times 1,000, where F is defined as F = 1/(1 + Kd \* \[VDBP\] + Ka \*\[albumin\]) where the binding constant for VDBP = Kd = 4.2 x 107 M-1, and for albumin is Ka = 5.4 x 104 M-1 and the concentrations of VDBP and albumin are in moles/L
Time frame: Baseline and wk 24
Change From Baseline to Week 48 in Actual Free 1,25-OHD
Vitamin D serum concentration (1,25 (OH)DTotal) (pmol/L) multiplied by F times 1,000, where F is defined as F = 1/(1 + Kd \* \[VDBP\] + Ka \*\[albumin\]) where the binding constant for VDBP = Kd = 4.2 x 107 M-1, and for albumin is Ka = 5.4 x 104 M-1 and the concentrations of VDBP and albumin are in moles/L
Time frame: Baseline and wk 48
Change From Baseline to Week 12 in 1,25-OHD
Time frame: Baseline and wk 12
Change From Baseline to Week 24 in 1,25-OHD
Time frame: Baseline and wk 24
Change From Baseline to Week 48 in 1,25-OHD
Time frame: Baseline and wk 48
Change From Baseline to Week 12 in 25-OHD
Time frame: Baseline and wk 12
Change From Baseline to Week 24 in 25-OHD
Time frame: Baseline and wk 24
Change From Baseline to Week 48 in 25-OHD
Time frame: Baseline and wk 48
Change From Baseline to Week 12 in TRP %
Time frame: Baseline and wk 12
Change From Baseline to Week 24 in TRP %
Time frame: Baseline and wk 24
Change From Baseline to Week 48 in TRP %
Time frame: Baseline and wk 48
Change From Baseline to Week 12 in SPO4
Time frame: Baseline and wk 12
Change From Baseline to Week 24 in SPO4
Time frame: Baseline and wk 24
Change From Baseline to Week 48 in SPO4
Time frame: Baseline and wk 48
Change From Baseline to Week 12 in UCa/Ucr
Time frame: Baseline and wk 12
Change From Baseline to Week 24 in UCa/Ucr
Time frame: Baseline and wk 24
Change From Baseline to Week 48 in UCa/Ucr
Time frame: Baseline and wk 48
Change in Estimated GFR From Baseline to Week 12.
To assess renal glomerular safety by measuring change in estimated GFR from baseline to week 12 by randomized study group. eGFR calculated by the CKD-Epi equation for subjects \>=18 years of age, and by bedside Schwartz formula for subjects \<18 years of age
Time frame: Baseline and wk 12
Change in Estimated GFR From Baseline to Week 24.
To assess renal glomerular safety by measuring change in estimated GFR from baseline to week 24 by randomized study group;
Time frame: Baseline and wk 24
Change in Estimated GFR From Baseline to Week 48.
To assess renal glomerular safety by measuring change in estimated GFR from baseline to week 48 by randomized study group;
Time frame: Baseline and wk 48
Change in UGluc From Baseline to Week 48
To assess renal tubular function by measuring change in urine glucose (UGluc) by randomized study group;
Time frame: Baseline and wk 48
Change in URBP/UCr Ratio From Baseline to Week 48
To assess renal tubular function by measuring change in urine retinol binding protein to urine creatinine (URBP/UCr) ratio by randomized study group;
Time frame: Baseline and wk 48
Change in UB2MG From Baseline to Week 48
To assess renal tubular function by measuring change in urine beta-2 microglobulin (UB2MG) by randomized study group;
Time frame: Baseline and wk 48
Change in UProt/ UCr Ratio From Baseline to Week 48
To assess renal tubular function by measuring change in urinary protein to creatinine ratio by randomized study group;
Time frame: Baseline and wk 48
25-OHD Serum Concentration by Randomized Study Group at Week 12
Time frame: Week 12
25-OHD Serum Concentration by Randomized Study Group at Week 24
Time frame: Week 24
25-OHD Serum Concentration by Randomized Study Group at Week 48
Time frame: Week 48
Effect of Concurrent Treatment With Efavirenz on 25-OHD Serum Concentration: Concentration at Baseline by Efavirenz Use
Mean Vitamin D serum concentration (25-(OH)D) Total) in those with efavirenz use vs. those without efavirenz use
Time frame: Baseline
Effect of Concurrent Treatment With Efavirenz on 25-OHD Serum Concentration: Concentration at Week 48 by Efavirenz Use
Mean Vitamin D serum concentration (25-(OH)D) Total) in those with efavirenz use vs. those without efavirenz use
Time frame: Week 48
Effect of Concurrent Treatment With Efavirenz on 25-OHD Serum Concentration: Change in Concentration From Baseline to Week 48 by Efavirenz Use
Mean Vitamin D serum concentration (25-(OH)D) Total) in those with efavirenz use vs. those without efavirenz use
Time frame: Baseline and wk 48
Effect of Concurrent Treatment With Ritonavir on 25-OHD Serum Concentration: Concentration at Baseline by Ritonavir Use
Mean Vitamin D serum concentration (25-(OH)D) Total) in those with ritonavir use vs. those without ritonavir use
Time frame: Baseline
Effect of Concurrent Treatment With Ritonavir on 25-OHD Serum Concentration: Concentration at Week 48 by Ritonavir Use
Mean Vitamin D serum concentration (25-(OH)D) Total) in those with ritonavir use vs. those without ritonavir use
Time frame: Week 48
Effect of Concurrent Treatment With Ritonavir on 25-OHD Serum Concentration: Change in Concentration From Baseline to Week 48 by Ritonavir Use
Mean Vitamin D serum concentration (25-(OH)D) Total) in those with ritonavir use vs. those without ritonavir use
Time frame: Baseline and wk 48
This research was conducted at 17 clinical sites, with accrual opening 10/2012. Due to budgetary constraints, accrual to protocol Version 1.0 was placed on hold 9/1/2013; follow-up visits for subjects on study continued while accrual was on hold. Version 2.0 opened to accrual on 2/2/2015. The study was closed to accrual on 6/3/1015.
| Milestone | Group A: Vitamin D3 50,000 IU | Group B: Vitamin D3 Placebo |
|---|---|---|
| Started | 109 | 105 |
| Completed | 98 | 87 |
| Not completed | 11 | 18 |
| Withdrew: Lost to follow-up | 5 | 1 |
| Withdrew: Withdrawal by subject | 0 | 4 |
| Withdrew: Starting hormone therapy | 1 | 0 |
| Withdrew: Missed 4 or more consecutive dot visits | 2 | 3 |
| Withdrew: Inadvertent enrollment | 1 | 1 |
| Withdrew: Moved out of the area | 1 | 5 |
| Withdrew: Inability to attend required visits | 0 | 1 |
| Withdrew: Off study due to multiple obligations | 0 | 1 |
| Withdrew: Fails to comply with study requirements | 0 | 1 |
| Withdrew: Childcare issues | 1 | 1 |
Percent change from baseline to week (wk) 48 in DXA-measured BMD at the spine for the randomized study groups. Lumbar spine BMD (L1 - L4) (g/cm2) change from Baseline to wk 48 visit.
| percent change | Group A: Vitamin D3 50,000 IU | Group B: Vitamin D3 Placebo |
|---|---|---|
| Percent Change From Baseline to Week 48 in Dual Energy X-ray Absorptiometry (DXA)-Measured BMD at the Spine for the Randomized Study Groups | 0.19 (-1.54 to 1.48) | 0.09 (-1.49 to 2.61) |
| percent change | Group A: Vitamin D3 50,000 IU | Group B: Vitamin D3 Placebo |
|---|---|---|
| Percent Change From Baseline to Week 24 of BMC of Whole Body for the Randomized Study Groups | 0.25 (-1.23 to 1.44) | 0.07 (-0.82 to 1.09) |
| percent change | Group A: Vitamin D3 50,000 IU | Group B: Vitamin D3 Placebo |
|---|---|---|
| Percent Change From Baseline to Week 48 of BMC of Whole Body for the Randomized Study Groups | 0.08 (-1.47 to 1.47) | 0.07 (-1.47 to 0.98) |
| percent change | Group A: Vitamin D3 50,000 IU | Group B: Vitamin D3 Placebo |
|---|---|---|
| Percent Change From Baseline to Week 24 of Lumbar Spine (L1-L4) BMD for the Randomized Study Groups | 0.94 (-0.72 to 2.16) | 0.42 (-1.02 to 1.91) |
The Z-score is the standard deviation around mean bone mineral density in the lumbar spine, adjusted for sex, age, and race/ethnicity. An average Z-score of zero would be expected to be seen in healthy populations. A negative Z-score indicates lower than average bone mineral density. Low bone mineral density is a frequent finding in HIV-infected individuals, including adolescents and young adults.
| z-score | Group A: Vitamin D3 50,000 IU | Group B: Vitamin D3 Placebo |
|---|---|---|
| Change From Baseline to Week 24 of Lumbar Spine (L1-L4) BMD Z-score for the Randomized Study Groups | 0.00 (-0.10 to 0.20) | 0.00 (-0.10 to 0.10) |
The Z-score is the standard deviation around mean bone mineral density in the lumbar spine, adjusted for sex, age, and race/ethnicity. An average Z-score of zero would be expected to be seen in healthy populations. A negative Z-score indicates lower than average bone mineral density. Low bone mineral density is a frequent finding in HIV-infected individuals, including adolescents and young adults.
| z-score | Group A: Vitamin D3 50,000 IU | Group B: Vitamin D3 Placebo |
|---|---|---|
| Change From Baseline to Week 48 of Lumbar Spine (L1-L4) BMD Z-score for the Randomized Study Groups | 0.00 (-0.10 to 0.10) | -0.10 (-0.30 to 0.20) |
| percent change | Group A: Vitamin D3 50,000 IU | Group B: Vitamin D3 Placebo |
|---|---|---|
| Percent Change From Baseline to Week 24 of Femoral Neck BMD for the Randomized Study Groups | -0.10 (-2.49 to 1.65) | -0.04 (-2.16 to 2.13) |
| percent change | Group A: Vitamin D3 50,000 IU | Group B: Vitamin D3 Placebo |
|---|---|---|
| Percent Change From Baseline to Week 48 of Femoral Neck BMD for the Randomized Study Groups | -0.30 (-2.63 to 1.73) | -0.11 (-2.45 to 1.96) |
The Z-score is the standard deviation around mean bone mineral density in the femoral neck, adjusted for sex, age, and race/ethnicity. An average Z-score of zero would be expected to be seen in healthy populations. A negative Z-score indicates lower than average bone mineral density. Low bone mineral density is a frequent finding in HIV-infected individuals, including adolescents and young adults.
| z-score | Group A: Vitamin D3 50,000 IU | Group B: Vitamin D3 Placebo |
|---|---|---|
| Change From Baseline to Week 24 of Femoral Neck BMD Z-score for the Randomized Study Groups | 0.00 (-0.20 to 0.10) | 0.00 (-0.10 to 0.20) |
The Z-score is the standard deviation around mean bone mineral density in the femoral neck, adjusted for sex, age, and race/ethnicity. An average Z-score of zero would be expected to be seen in healthy populations. A negative Z-score indicates lower than average bone mineral density. Low bone mineral density is a frequent finding in HIV-infected individuals, including adolescents and young adults.
| z-score | Group A: Vitamin D3 50,000 IU | Group B: Vitamin D3 Placebo |
|---|---|---|
| Change From Baseline to Week 48 of Femoral Neck BMD Z-score for the Randomized Study Groups | 0.00 (-0.20 to 0.10) | 0.00 (-0.20 to 0.10) |
| percent change | Group A: Vitamin D3 50,000 IU | Group B: Vitamin D3 Placebo |
|---|---|---|
| Percent Change From Baseline to Week 24 of Total Hip BMD for the Randomized Study Groups | -0.27 (-1.08 to 1.53) | 0.00 (-1.14 to 1.46) |
| percent change | Group A: Vitamin D3 50,000 IU | Group B: Vitamin D3 Placebo |
|---|---|---|
| Percent Change From Baseline to Week 48 of Total Hip BMD for the Randomized Study Groups | -0.17 (-2.12 to 1.73) | -0.42 (-1.66 to 0.71) |
The Z-score is the standard deviation around mean bone mineral density in the total hip, adjusted for sex, age, and race/ethnicity. An average Z-score of zero would be expected to be seen in healthy populations. A negative Z-score indicates lower than average bone mineral density. Low bone mineral density is a frequent finding in HIV-infected individuals, including adolescents and young adults.
| z-score | Group A: Vitamin D3 50,000 IU | Group B: Vitamin D3 Placebo |
|---|---|---|
| Change From Baseline to Week 24 of Total Hip BMD Z-score for the Randomized Study Groups | 0.00 (-0.10 to 0.10) | 0.00 (-0.10 to 0.10) |
The Z-score is the standard deviation around mean bone mineral density in the total hip, adjusted for sex, age, and race/ethnicity. An average Z-score of zero would be expected to be seen in healthy populations. A negative Z-score indicates lower than average bone mineral density. Low bone mineral density is a frequent finding in HIV-infected individuals, including adolescents and young adults.
| z-score | Group A: Vitamin D3 50,000 IU | Group B: Vitamin D3 Placebo |
|---|---|---|
| Change From Baseline to Week 48 of Total Hip BMD Z-score for the Randomized Study Groups | 0.00 (-0.10 to 0.10) | 0.00 (-0.10 to 0.10) |
To assess renal glomerular safety by measuring change in SCr from baseline to week 12 by randomized study group;
| mg/dL | Group A: Vitamin D3 50,000 IU | Group B: Vitamin D3 Placebo |
|---|---|---|
| Change in SCr From Baseline to Week 12. | 0.03 (-0.03 to 0.08) | 0.02 (-0.03 to 0.07) |
To assess renal glomerular safety by measuring change in SCr from baseline to week 24 by randomized study group;
| mg/dL | Group A: Vitamin D3 50,000 IU | Group B: Vitamin D3 Placebo |
|---|---|---|
| Change in SCr From Baseline to Week 24. | 0.02 (-0.03 to 0.08) | 0.02 (-0.04 to 0.06) |
To assess renal glomerular safety by measuring change in SCr from baseline to week 48 by randomized study group;
| mg/dL | Group A: Vitamin D3 50,000 IU | Group B: Vitamin D3 Placebo |
|---|---|---|
| Change in SCr From Baseline to Week 48. | 0.03 (-0.02 to 0.08) | 0.01 (-0.03 to 0.07) |
| uIU/mL | Group A: Vitamin D3 50,000 IU | Group B: Vitamin D3 Placebo |
|---|---|---|
| Change From Baseline to Week 48 in Glucose Homeostasis (Fasting Insulin) | 0.45 (-2.21 to 3.48) | -0.83 (-3.02 to 3.43) |
| mg/dL | Group A: Vitamin D3 50,000 IU | Group B: Vitamin D3 Placebo |
|---|---|---|
| Change From Baseline to Week 48 in Glucose Homeostasis (Fasting Glucose) | 0.05 (-5.05 to 4.20) | -0.20 (-4.85 to 3.85) |
HOMA-IR is calculated as fasting glucose (mg/dL) X fasting glucose (uIU/mL) / 405. An increase in HOMA-IR means that an individual has become more resistant (less sensitive) to the effects of insulin and thus would be a negative outcome. A reduction in HOMA-IR means that an individual has become more sensitive to the effects of insulin and would be considered a positive outcome.There are no set minimum or maximum scores for HOMA-IR, since it is based on measurements of insulin and glucose, the assays for which may vary. Several studies suggest a cut-off of \>2 for any insulin resistance, but "normal" values appear to vary greatly by population (https://www.mdcalc.com/homa-ir-homeostatic-model-assessment-insulin-resistance).
| units on a scale | Group A: Vitamin D3 50,000 IU | Group B: Vitamin D3 Placebo |
|---|---|---|
| Change From Baseline to Week 48 in Glucose Homeostasis (Homeostasis Model Assessment of Insulin Resistance (HOMA-IR)) | 0.07 (-0.56 to 0.82) | -0.15 (-0.80 to 0.83) |
| mg/dL | Group A: Vitamin D3 50,000 IU | Group B: Vitamin D3 Placebo |
|---|---|---|
| Change From Baseline to Week 12 in Serum Calcium (SCa) | -0.02 (-0.26 to 0.20) | 0.08 (-0.14 to 0.25) |
| mg/dL | Group A: Vitamin D3 50,000 IU | Group B: Vitamin D3 Placebo |
|---|---|---|
| Change From Baseline to Week 24 in Serum Calcium (SCa) | -0.04 (-0.26 to 0.16) | 0.08 (-0.16 to 0.30) |
| mg/dL | Group A: Vitamin D3 50,000 IU | Group B: Vitamin D3 Placebo |
|---|---|---|
| Change From Baseline to Week 48 in Serum Calcium (SCa) | 0.00 (-0.22 to 0.25) | 0.04 (-0.12 to 0.26) |
| mcg/L | Group A: Vitamin D3 50,000 IU | Group B: Vitamin D3 Placebo |
|---|---|---|
| Change From Baseline to Week 12 in CTX | -0.03 (-0.21 to 0.13) | -0.02 (-0.19 to 0.15) |
| mcg/L | Group A: Vitamin D3 50,000 IU | Group B: Vitamin D3 Placebo |
|---|---|---|
| Change From Baseline to Week 24 in CTX | -0.03 (-0.24 to 0.18) | -0.02 (-0.16 to 0.15) |
| mcg/L | Group A: Vitamin D3 50,000 IU | Group B: Vitamin D3 Placebo |
|---|---|---|
| Change From Baseline to Week 48 in CTX | -0.08 (-0.25 to 0.10) | -0.09 (-0.27 to 0.02) |
| mcg/L | Group A: Vitamin D3 50,000 IU | Group B: Vitamin D3 Placebo |
|---|---|---|
| Change From Baseline to Week 12 in OC | 0.15 (-0.78 to 1.67) | -0.10 (-1.15 to 1.66) |
| mcg/L | Group A: Vitamin D3 50,000 IU | Group B: Vitamin D3 Placebo |
|---|---|---|
| Change From Baseline to Week 24 in OC | 0.09 (-1.06 to 1.46) | -0.22 (-1.43 to 1.12) |
| mcg/L | Group A: Vitamin D3 50,000 IU | Group B: Vitamin D3 Placebo |
|---|---|---|
| Change From Baseline to Week 48 in OC | -0.93 (-2.10 to 0.62) | -0.48 (-1.95 to 0.41) |
| U/L | Group A: Vitamin D3 50,000 IU | Group B: Vitamin D3 Placebo |
|---|---|---|
| Change From Baseline to Week 12 in BAP | -1.05 (-4.33 to 1.85) | -1.74 (-3.82 to 0.88) |
| U/L | Group A: Vitamin D3 50,000 IU | Group B: Vitamin D3 Placebo |
|---|---|---|
| Change From Baseline to Week 24 in BAP | -2.54 (-5.31 to 0.07) | -2.03 (-4.50 to 0.35) |
| U/L | Group A: Vitamin D3 50,000 IU | Group B: Vitamin D3 Placebo |
|---|---|---|
| Change From Baseline to Week 48 in BAP | -2.71 (-6.44 to -0.51) | -2.19 (-5.58 to 1.06) |
| pg/ML | Group A: Vitamin D3 50,000 IU | Group B: Vitamin D3 Placebo |
|---|---|---|
| Change From Baseline to Week 12 in FGF23 | 3.31 (-2.99 to 9.21) | 3.90 (-2.28 to 9.21) |
| pg/ML | Group A: Vitamin D3 50,000 IU | Group B: Vitamin D3 Placebo |
|---|---|---|
| Change From Baseline to Week 24 in FGF23 | 2.93 (-4.07 to 8.35) | 3.65 (-4.45 to 10.53) |
| pg/ML | Group A: Vitamin D3 50,000 IU | Group B: Vitamin D3 Placebo |
|---|---|---|
| Change From Baseline to Week 48 in FGF23 | 4.77 (-2.78 to 10.31) | 3.15 (-3.75 to 10.15) |
| pg/ML | Group A: Vitamin D3 50,000 IU | Group B: Vitamin D3 Placebo |
|---|---|---|
| Change From Baseline to Week 12 in PTH | -2.17 (-10.26 to 4.00) | -0.82 (-7.79 to 3.95) |
| pg/ML | Group A: Vitamin D3 50,000 IU | Group B: Vitamin D3 Placebo |
|---|---|---|
| Change From Baseline to Week 24 in PTH | -0.25 (-10.38 to 6.70) | -1.71 (-7.78 to 5.65) |
| pg/ML | Group A: Vitamin D3 50,000 IU | Group B: Vitamin D3 Placebo |
|---|---|---|
| Change From Baseline to Week 48 in PTH | -2.21 (-10.13 to 4.25) | -0.96 (-9.28 to 4.93) |
Vitamin D serum concentration (1,25 (OH)DTotal) (pmol/L) multiplied by F times 1,000, where F is defined as F = 1/(1 + Kd \* \[VDBP\] + Ka \*\[albumin\]) where the binding constant for VDBP = Kd = 4.2 x 107 M-1, and for albumin is Ka = 5.4 x 104 M-1 and the concentrations of VDBP and albumin are in moles/L
| fmol/L | Group A: Vitamin D3 50,000 IU | Group B: Vitamin D3 Placebo |
|---|---|---|
| Change From Baseline to Week 12 in Actual Free 1,25-OHD | 106.50 (-12.50 to 222.13) | 53.23 (-28.51 to 148.88) |
Vitamin D serum concentration (1,25 (OH)DTotal) (pmol/L) multiplied by F times 1,000, where F is defined as F = 1/(1 + Kd \* \[VDBP\] + Ka \*\[albumin\]) where the binding constant for VDBP = Kd = 4.2 x 107 M-1, and for albumin is Ka = 5.4 x 104 M-1 and the concentrations of VDBP and albumin are in moles/L
| fmol/L | Group A: Vitamin D3 50,000 IU | Group B: Vitamin D3 Placebo |
|---|---|---|
| Change From Baseline to Week 24 in Actual Free 1,25-OHD | 98.61 (-29.77 to 242.62) | 59.36 (-41.94 to 162.45) |
Vitamin D serum concentration (1,25 (OH)DTotal) (pmol/L) multiplied by F times 1,000, where F is defined as F = 1/(1 + Kd \* \[VDBP\] + Ka \*\[albumin\]) where the binding constant for VDBP = Kd = 4.2 x 107 M-1, and for albumin is Ka = 5.4 x 104 M-1 and the concentrations of VDBP and albumin are in moles/L
| fmol/L | Group A: Vitamin D3 50,000 IU | Group B: Vitamin D3 Placebo |
|---|---|---|
| Change From Baseline to Week 48 in Actual Free 1,25-OHD | 63.73 (-19.39 to 202.54) | 25.66 (-100.82 to 118.45) |
| pg/ML | Group A: Vitamin D3 50,000 IU | Group B: Vitamin D3 Placebo |
|---|---|---|
| Change From Baseline to Week 12 in 1,25-OHD | 15.61 (-0.32 to 35.18) | 6.06 (-7.63 to 25.52) |
| pg/ML | Group A: Vitamin D3 50,000 IU | Group B: Vitamin D3 Placebo |
|---|---|---|
| Change From Baseline to Week 24 in 1,25-OHD | 12.90 (-7.57 to 36.58) | 8.58 (-8.96 to 27.02) |
| pg/ML | Group A: Vitamin D3 50,000 IU | Group B: Vitamin D3 Placebo |
|---|---|---|
| Change From Baseline to Week 48 in 1,25-OHD | 10.52 (-2.05 to 31.47) | 2.74 (-14.73 to 24.48) |
| ng/ML | Group A: Vitamin D3 50,000 IU | Group B: Vitamin D3 Placebo |
|---|---|---|
| Change From Baseline to Week 12 in 25-OHD | 16.33 (9.33 to 21.19) | 6.91 (2.34 to 11.55) |
| ng/ML | Group A: Vitamin D3 50,000 IU | Group B: Vitamin D3 Placebo |
|---|---|---|
| Change From Baseline to Week 24 in 25-OHD | 18.60 (10.53 to 25.58) | 6.78 (1.35 to 11.24) |
| ng/ML | Group A: Vitamin D3 50,000 IU | Group B: Vitamin D3 Placebo |
|---|---|---|
| Change From Baseline to Week 48 in 25-OHD | 17.80 (11.83 to 24.03) | 2.64 (-1.66 to 7.52) |
| percent | Group A: Vitamin D3 50,000 IU | Group B: Vitamin D3 Placebo |
|---|---|---|
| Change From Baseline to Week 12 in TRP % | -0.71 (-3.46 to 2.03) | 0.04 (-2.78 to 3.37) |
| percent | Group A: Vitamin D3 50,000 IU | Group B: Vitamin D3 Placebo |
|---|---|---|
| Change From Baseline to Week 24 in TRP % | -0.59 (-4.43 to 1.79) | -0.88 (-3.001 to 2.32) |
| percent | Group A: Vitamin D3 50,000 IU | Group B: Vitamin D3 Placebo |
|---|---|---|
| Change From Baseline to Week 48 in TRP % | -1.55 (-4.71 to 1.84) | 0.62 (-2.92 to 3.06) |
| mg/dL | Group A: Vitamin D3 50,000 IU | Group B: Vitamin D3 Placebo |
|---|---|---|
| Change From Baseline to Week 12 in SPO4 | 0.00 (-0.34 to 0.26) | 0.02 (-0.33 to 0.38) |
| mg/dL | Group A: Vitamin D3 50,000 IU | Group B: Vitamin D3 Placebo |
|---|---|---|
| Change From Baseline to Week 24 in SPO4 | -0.06 (-0.42 to 0.29) | 0.03 (-0.34 to 0.34) |
| mg/dL | Group A: Vitamin D3 50,000 IU | Group B: Vitamin D3 Placebo |
|---|---|---|
| Change From Baseline to Week 48 in SPO4 | -0.03 (-0.33 to 0.36) | -0.12 (-0.47 to 0.31) |
| ratio | Group A: Vitamin D3 50,000 IU | Group B: Vitamin D3 Placebo |
|---|---|---|
| Change From Baseline to Week 12 in UCa/Ucr | 0.00 (-0.02 to 0.04) | 0.00 (-0.01 to 0.04) |
| ratio | Group A: Vitamin D3 50,000 IU | Group B: Vitamin D3 Placebo |
|---|---|---|
| Change From Baseline to Week 24 in UCa/Ucr | 0.01 (-0.01 to 0.05) | 0.01 (-0.01 to 0.02) |
| ratio | Group A: Vitamin D3 50,000 IU | Group B: Vitamin D3 Placebo |
|---|---|---|
| Change From Baseline to Week 48 in UCa/Ucr | 0.00 (-0.01 to 0.03) | 0.01 (-0.01 to 0.04) |
To assess renal glomerular safety by measuring change in estimated GFR from baseline to week 12 by randomized study group. eGFR calculated by the CKD-Epi equation for subjects \>=18 years of age, and by bedside Schwartz formula for subjects \<18 years of age
| ml/min/1.73m^2 | Group A: Vitamin D3 50,000 IU | Group B: Vitamin D3 Placebo |
|---|---|---|
| Change in Estimated GFR From Baseline to Week 12. | 0.00 (-12.11 to 6.29) | 0.00 (-7.49 to 7.18) |
To assess renal glomerular safety by measuring change in estimated GFR from baseline to week 24 by randomized study group;
| ml/min/1.73m^2 | Group A: Vitamin D3 50,000 IU | Group B: Vitamin D3 Placebo |
|---|---|---|
| Change in Estimated GFR From Baseline to Week 24. | 0.00 (-15.24 to 2.43) | 0.00 (-10.42 to 7.71) |
To assess renal glomerular safety by measuring change in estimated GFR from baseline to week 48 by randomized study group;
| ml/min/1.73m^2 | Group A: Vitamin D3 50,000 IU | Group B: Vitamin D3 Placebo |
|---|---|---|
| Change in Estimated GFR From Baseline to Week 48. | -1.91 (-15.67 to 3.70) | 0.00 (-10.96 to 5.65) |
To assess renal tubular function by measuring change in urine glucose (UGluc) by randomized study group;
| mg/dL | Group A: Vitamin D3 50,000 IU | Group B: Vitamin D3 Placebo |
|---|---|---|
| Change in UGluc From Baseline to Week 48 | -0.42 (-3.27 to 3.23) | -0.43 (-3.17 to 2.62) |
To assess renal tubular function by measuring change in urine retinol binding protein to urine creatinine (URBP/UCr) ratio by randomized study group;
| mcg/g | Group A: Vitamin D3 50,000 IU | Group B: Vitamin D3 Placebo |
|---|---|---|
| Change in URBP/UCr Ratio From Baseline to Week 48 | -1.06 (-37.77 to 32.56) | -4.72 (-33.97 to 18.15) |
To assess renal tubular function by measuring change in urine beta-2 microglobulin (UB2MG) by randomized study group;
| mcg/L | Group A: Vitamin D3 50,000 IU | Group B: Vitamin D3 Placebo |
|---|---|---|
| Change in UB2MG From Baseline to Week 48 | 5.19 (-95.04 to 111.85) | 10.75 (-90.69 to 157.26) |
To assess renal tubular function by measuring change in urinary protein to creatinine ratio by randomized study group;
| ratio | Group A: Vitamin D3 50,000 IU | Group B: Vitamin D3 Placebo |
|---|---|---|
| Change in UProt/ UCr Ratio From Baseline to Week 48 | 0.00 (-0.02 to 0.01) | 0.00 (-0.01 to 0.01) |
| ng/mL | Group A: Vitamin D3 50,000 IU | Group B: Vitamin D3 Placebo |
|---|---|---|
| 25-OHD Serum Concentration by Randomized Study Group at Week 12 | 35.14 (29.79 to 39.76) | 23.97 (18.35 to 30.19) |
| ng/mL | Group A: Vitamin D3 50,000 IU | Group B: Vitamin D3 Placebo |
|---|---|---|
| 25-OHD Serum Concentration by Randomized Study Group at Week 24 | 37.04 (30.41 to 44.12) | 23.30 (17.92 to 28.49) |
| ng/mL | Group A: Vitamin D3 50,000 IU | Group B: Vitamin D3 Placebo |
|---|---|---|
| 25-OHD Serum Concentration by Randomized Study Group at Week 48 | 36.89 (30.46 to 42.38) | 20.55 (14.35 to 25.80) |
Mean Vitamin D serum concentration (25-(OH)D) Total) in those with efavirenz use vs. those without efavirenz use
| ng/mL | Efavirenz Use | No Efavirenz Use |
|---|---|---|
| Effect of Concurrent Treatment With Efavirenz on 25-OHD Serum Concentration: Concentration at Baseline by Efavirenz Use | 17.02 ± 8.69 | 19.61 ± 9.96 |
Mean Vitamin D serum concentration (25-(OH)D) Total) in those with efavirenz use vs. those without efavirenz use
| ng/mL | Efavirenz Use | No Efavirenz Use |
|---|---|---|
| Effect of Concurrent Treatment With Efavirenz on 25-OHD Serum Concentration: Concentration at Week 48 by Efavirenz Use | 28.24 ± 11.22 | 29.68 ± 11.52 |
Mean Vitamin D serum concentration (25-(OH)D) Total) in those with efavirenz use vs. those without efavirenz use
| ng/mL | Efavirenz Use | No Efavirenz Use |
|---|---|---|
| Effect of Concurrent Treatment With Efavirenz on 25-OHD Serum Concentration: Change in Concentration From Baseline to Week 48 by Efavirenz Use | 10.97 ± 12.00 | 9.79 ± 11.68 |
Mean Vitamin D serum concentration (25-(OH)D) Total) in those with ritonavir use vs. those without ritonavir use
| ng/mL | Ritonavir Use | No Ritonavir Use |
|---|---|---|
| Effect of Concurrent Treatment With Ritonavir on 25-OHD Serum Concentration: Concentration at Baseline by Ritonavir Use | 18.62 ± 8.79 | 18.69 ± 10.13 |
Mean Vitamin D serum concentration (25-(OH)D) Total) in those with ritonavir use vs. those without ritonavir use
| ng/mL | Ritonavir Use | No Ritonavir Use |
|---|---|---|
| Effect of Concurrent Treatment With Ritonavir on 25-OHD Serum Concentration: Concentration at Week 48 by Ritonavir Use | 29.46 ± 10.70 | 28.92 ± 11.89 |
Mean Vitamin D serum concentration (25-(OH)D) Total) in those with ritonavir use vs. those without ritonavir use
| ng/mL | Ritonavir Use | No Ritonavir Use |
|---|---|---|
| Effect of Concurrent Treatment With Ritonavir on 25-OHD Serum Concentration: Change in Concentration From Baseline to Week 48 by Ritonavir Use | 10.55 ± 11.07 | 10.02 ± 12.28 |
Collected over Adverse events were collected between Baseline through Week 48 or premature discontinuation from study.. Non-serious events are listed at a 0% frequency threshold.
| Group | Deaths | Serious | Other |
|---|---|---|---|
| Group A: Vitamin D3 50,000 IU | 0/109 (0%) | 5/109 (4.6%) | 6/109 (5.5%) |
| Group B: Vitamin D3 Placebo | 0/105 (0%) | 6/105 (5.7%) | 8/105 (7.6%) |
| Event | Group A: Vitamin D3 50,000 IU | Group B: Vitamin D3 Placebo |
|---|---|---|
| Suicidal ideationPsychiatric disorders | 0/109 | 2/105 |
| CellulitisInfections and infestations | 0/109 | 2/105 |
| Acute psychosisPsychiatric disorders | 0/109 | 1/105 |
| Cellulitis StreptococcalInfections and infestations | 0/109 | 1/105 |
| Suicide attemptPsychiatric disorders | 1/109 | 0/105 |
| Mental Status ChangesPsychiatric disorders | 1/109 | 0/105 |
| AsthmaRespiratory, thoracic and mediastinal disorders | 1/109 | 0/105 |
| Tooth abscessInfections and infestations | 1/109 | 0/105 |
| GastroenteritisInfections and infestations | 1/109 | 0/105 |
| Event | Group A: Vitamin D3 50,000 IU | Group B: Vitamin D3 Placebo |
|---|---|---|
| ColitisGastrointestinal disorders | 2/109 | 0/105 |
| Head injuryInjury, poisoning and procedural complications | 0/109 | 1/105 |
| LacerationInjury, poisoning and procedural complications | 0/109 | 1/105 |
| Soft tissue injuryInjury, poisoning and procedural complications | 0/109 | 1/105 |
| Tendon RuptureInjury, poisoning and procedural complications | 0/109 | 1/105 |
| Alanine Aminotransferase IncreasedInvestigations | 0/109 | 1/105 |
| Aspartate Aminotransferase IncreasedInvestigations | 0/109 | 1/105 |
| Blood Bilirubin IncreasedInvestigations | 0/109 | 1/105 |
| Blood Creatinine IncreasedInvestigations | 1/109 | 1/105 |
| Blood Glucose IncreasedInvestigations | 0/109 | 1/105 |
The baseline analysis population includes all participants randomized to Group A or Group B who received the intervention, with the exception of two participants (one in each group) who were later determined to have been inadvertent enrollments who did not meet eligibility criteria.
| Age, Continuous(years) | Group A: Vitamin D3 50,000 IU | Group B: Vitamin D3 Placebo | Total |
|---|---|---|---|
| Mean | 21.84 ± 1.95 | 21.85 ± 1.55 | 21.84 ± 1.76 |
| Sex: Female, Male(Participants) | Group A: Vitamin D3 50,000 IU | Group B: Vitamin D3 Placebo | Total |
|---|---|---|---|
| Female | 18 | 15 | 33 |
| Male | 90 | 89 | 179 |
| Race/Ethnicity, Customized(Participants) | Group A: Vitamin D3 50,000 IU | Group B: Vitamin D3 Placebo | Total |
|---|---|---|---|
| Race — Black | 78 | 79 | 157 |
| Race — Non-black | 30 | 25 | 55 |
| Race/Ethnicity, Customized(Participants) | Group A: Vitamin D3 50,000 IU | Group B: Vitamin D3 Placebo | Total |
|---|---|---|---|
| Ethnicity — Hispanic or Latino | 21 | 24 | 45 |
| Ethnicity — Non-Hispanic or Non-Latino | 87 | 79 | 166 |
| Ethnicity — Unknown/Not reported | 0 | 1 | 1 |
| Season Enrolled(Participants) | Group A: Vitamin D3 50,000 IU | Group B: Vitamin D3 Placebo | Total |
|---|---|---|---|
| Winter | 44 | 39 | 83 |
| Spring | 43 | 42 | 85 |
| Summer | 15 | 18 | 33 |
| Fall | 6 | 5 | 11 |
| Lumbar spine bone mineral density (BMD)(g/cm^2) | Group A: Vitamin D3 50,000 IU | Group B: Vitamin D3 Placebo | Total |
|---|---|---|---|
| Median | 1.06 (0.99 to 1.19) | 1.08 (0.98 to 1.20) | 1.07 (0.99 to 1.19) |
| Lumbar spine BMD (L1-L4) (Z-score)(z-score) | Group A: Vitamin D3 50,000 IU | Group B: Vitamin D3 Placebo | Total |
|---|---|---|---|
| Median | -0.65 (-1.40 to 0.00) | -0.70 (-1.60 to 0.20) | -0.70 (-1.50 to 0.10) |
| Total Hip BMD(g/cm^2) | Group A: Vitamin D3 50,000 IU | Group B: Vitamin D3 Placebo | Total |
|---|---|---|---|
| Median | 1.06 (0.95 to 1.16) | 1.05 (0.95 to 1.17) | 1.06 (0.95 to 1.17) |
27 further baseline measures are reported on the registry.
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