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Itkonen ST, Erkkola M, Lamberg-Allardt CJE. Vitamin D Fortification of Fluid Milk Products and Their Contribution to Vitamin D Intake and Vitamin D Status in Observational Studies-A Review. Nutrients 2018; 10:nu10081054. [PMID: 30096919 PMCID: PMC6116165 DOI: 10.3390/nu10081054] [Citation(s) in RCA: 81] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2018] [Revised: 08/04/2018] [Accepted: 08/07/2018] [Indexed: 12/01/2022] Open
Abstract
Fluid milk products are systematically, either mandatorily or voluntarily, fortified with vitamin D in some countries but their overall contribution to vitamin D intake and status worldwide is not fully understood. We searched the PubMed database to evaluate the contribution of vitamin D-fortified fluid milk products (regular milk and fermented products) to vitamin D intake and serum or plasma 25-hydroxyvitamin D (25(OH)D) status in observational studies during 1993–2017. Twenty studies provided data on 25(OH)D status (n = 19,744), and 22 provided data on vitamin D intake (n = 99,023). Studies showed positive associations between the consumption of vitamin D-fortified milk and 25(OH)D status in different population groups. In countries with a national vitamin D fortification policy covering various fluid milk products (Finland, Canada, United States), milk products contributed 28–63% to vitamin D intake, while in countries without a fortification policy, or when the fortification covered only some dairy products (Sweden, Norway), the contribution was much lower or negligible. To conclude, based on the reviewed observational studies, vitamin D-fortified fluid milk products contribute to vitamin D intake and 25(OH)D status. However, their impact on vitamin D intake at the population level depends on whether vitamin D fortification is systematic and policy-based.
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Affiliation(s)
- Suvi T Itkonen
- Department of Food and Nutrition, P.O. Box 66, 00014 University of Helsinki, 00790 Helsinki, Finland.
| | - Maijaliisa Erkkola
- Department of Food and Nutrition, P.O. Box 66, 00014 University of Helsinki, 00790 Helsinki, Finland.
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Buckinx F, Reginster JY, Cavalier E, Petermans J, Ricour C, Dardenne C, Bruyère O. Determinants of vitamin D supplementation prescription in nursing homes: a survey among general practitioners. Osteoporos Int 2016; 27:881-886. [PMID: 26733374 DOI: 10.1007/s00198-015-3469-3] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2015] [Accepted: 12/16/2015] [Indexed: 01/06/2023]
Abstract
SUMMARY A total of 119 GPs participated to a survey aimed to assess the profile and determinants of vitamin D supplementation prescription in nursing homes. Among the respondent GPs, 65 (54.6%) systematically prescribe vitamin D to their institutionalized patients and the 54 (45.4%) others prescribe only sometimes. INTRODUCTION The aim of this study is to assess the profile and determinants of vitamin D supplementation prescription in nursing homes. METHODS General practitioners (GPs) having at least one patient in a nursing home in Liège, Belgium, were asked to complete the survey. RESULTS A total of 119 GPs participated in the survey. Among the respondent GPs, 65 (54.6 %) systematically prescribe vitamin D to their institutionalized patients and the 54 (45.4%) others prescribe only sometimes. The main reasons for prescribing vitamin D cited by GPs who do so systematically are as follows: because they believe nursing home residents are mostly deficient in vitamin D status (92.1%), because they believe that vitamin D supplementation prevents osteoporotic fractures (77.8%), and because vitamin D supplementation is recommended by various scientific societies (38.1%). GPs who only prescribe vitamin D supplementation in some patients mainly do so following a diagnosis of osteoporosis (82.4%), on the basis the 25(OH)D level (78.4%), in the case of history of fracture (54.9%) or after a recent fracture (43.4%). Surprisingly, 16 physicians (31.4%) only prescribe vitamin D when they think of it. Interestingly, while 40.7% of GPs always prescribe the same dose of vitamin D, the remaining 59.3% prescribe a dose that will mainly depend on the results of the 25(OH)D level (94.0%), the patient's bone health (49.3%), or history of fracture (43.3%). CONCLUSIONS More than half of GPs systematically prescribe vitamin D to their patients living in nursing homes. The other GPs usually prescribe vitamin D following the result of the vitamin D status or after a diagnosis of osteoporosis.
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Affiliation(s)
- F Buckinx
- Department of Public health, Epidemiology and health Economics, University of Liège, CHU - Sart Tilman, Bât. B23, Quartier Hôpital, Avenue Hippocrate, 13, 4000, Liège, Belgium.
- Support Unit in Epidemiology and Biostatistics, University of Liège, Liège, Belgium.
| | - J Y Reginster
- Department of Public health, Epidemiology and health Economics, University of Liège, CHU - Sart Tilman, Bât. B23, Quartier Hôpital, Avenue Hippocrate, 13, 4000, Liège, Belgium
- Support Unit in Epidemiology and Biostatistics, University of Liège, Liège, Belgium
| | - E Cavalier
- Department of Medical Chemistry, CHU of Liège, Liège, Belgium
| | - J Petermans
- Geriatric Department, CHU of Liège, Liège, Belgium
| | - C Ricour
- Geriatric Department, CHU of Liège, Liège, Belgium
| | - C Dardenne
- "Maison Médicale Oxygène", Seraing, Belgium
| | - O Bruyère
- Department of Public health, Epidemiology and health Economics, University of Liège, CHU - Sart Tilman, Bât. B23, Quartier Hôpital, Avenue Hippocrate, 13, 4000, Liège, Belgium
- Support Unit in Epidemiology and Biostatistics, University of Liège, Liège, Belgium
- Department of Motricity Sciences, University of Liège, Liège, Belgium
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O'Dowd KJ, Clemens TL, Kelsey JL, Lindsay R. In Reply. J Am Geriatr Soc 2015. [DOI: 10.1111/j.1532-5415.1993.tb06492.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Rolland Y, de Souto Barreto P, Abellan Van Kan G, Annweiler C, Beauchet O, Bischoff-Ferrari H, Berrut G, Blain H, Bonnefoy M, Cesari M, Duque G, Ferry M, Guerin O, Hanon O, Lesourd B, Morley J, Raynaud-Simon A, Ruault G, Souberbielle JC, Vellas B. Vitamin D supplementation in older adults: searching for specific guidelines in nursing homes. J Nutr Health Aging 2013; 17:402-12. [PMID: 23538667 DOI: 10.1007/s12603-013-0007-x] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND The prevalence of vitamin D insufficiency is very high in the nursing home (NH) population. Paradoxically, vitamin D insufficiency is rarely treated despite of strong clinical evidence and recommendations for supplementation. This review aims at reporting the current knowledge of vitamin D supplementation in NH and proposing recommendations adapted to the specificities of this institutional setting. DESIGN Current literature on vitamin D supplementation for NH residents was narratively presented and discussed by the French Group of Geriatrics and Nutrition. RESULT Vitamin D supplementation is a safe and well-tolerated treatment. Most residents in NH have vitamin D insufficiency, and would benefit from vitamin D supplement. However, only few residents are actually treated. Current specific and personalized protocols for vitamin D supplementation may not be practical for use in NH settings (e.g., assessment of serum vitamin D concentrations before and after supplementation). Therefore, our group proposes a model of intervention based on the systematic supplementation of vitamin D (1,000 IU/day) since the patient's admission to the NH and throughout his/her stay without the need of a preliminary evaluation of the baseline levels. Calcium should be prescribed only in case of poor dietary calcium intake. CONCLUSION A population-based rather than individual-based approach may probably improve the management of vitamin D insufficiency in the older population living in NH, without increasing the risks of adverse health problems. The clinical relevance and cost effectiveness of this proposal should be assessed under NH real-world conditions to establish its feasibility.
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Affiliation(s)
- Y Rolland
- Department of Geriatric Medicine, CHU Toulouse, Institute of aging, F-31059 Toulouse, France.
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Dinizulu T, Griffin D, Carey J, Mulkerrin E. Vitamin D supplementation versus combined calcium and vitamin D in older female patients - an observational study. J Nutr Health Aging 2011; 15:605-8. [PMID: 21968853 DOI: 10.1007/s12603-011-0094-5] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
BACKGROUND In most developed countries overt vitamin D deficiency, characterized by rickets or osteomalacia, is now uncommon. However, subclinical vitamin D insufficiency is extremely common and may contribute to the development of skeletal and non-skeletal problems. Standard practice involves supplementation with a combination of vitamin D and calcium although the benefit of adding calcium to vitamin D supplements has not been fully established and may reduce adherence due to its bulky and chalky consistency. PURPOSE OF STUDY To compare the effects of vitamin D alone versus vitamin D/calcium supplements on vitamin D levels, bone profile and parathyroid hormone level. POPULATION Older (> 65 years) female patients living in the community and long term care institutions. INTERVENTIONS Either 800 iu of vitamin D3 or a composite supplement of 800 iu vitamin D3 and 1000 mg calcium were given to patients in an open-labelled observational study. Serum 25-hydroxy-vitamin D, parathyroid hormone, calcium, phosphate and alkaline phosphatase levels were assessed at baseline and after 3 months of treatment. RESULTS Serum 25-hydroxy-vitamin D levels rose from baseline levels of 25 ± 16 to 79 ± 16 in those treated with vitamin D alone and from 35 ± 24 nmol/L to 70 ± 24 nmol/L in those treated with vitamin D and calcium. Serum PTH levels fell by similar amounts in both groups. In both community dwellers and institutionalised patients, those treated with vitamin D alone were at least as likely to achieve normalisation of serum vitamin D levels as those on combined calcium/vitamin D treatment. CONCLUSION Vitamin D alone appears as effective as combined calcium/vitamin D treatment in restoring serum vitamin D levels in older community dwelling and institutionalised patients. A prospective randomised trial would help confirm these findings.
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Affiliation(s)
- T Dinizulu
- Department of Medicine for the Elderly, University Hospital Galway
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Braddy KK, Imam SN, Palla KR, Lee TA. Vitamin d deficiency/insufficiency practice patterns in a veterans health administration long-term care population: a retrospective analysis. J Am Med Dir Assoc 2010; 10:653-7. [PMID: 19883889 DOI: 10.1016/j.jamda.2009.08.010] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2009] [Accepted: 08/26/2009] [Indexed: 01/07/2023]
Abstract
OBJECTIVES To evaluate the prevalence of vitamin D deficiency/insufficiency in long-term care patients at a Veterans Health Administration (VHA) hospital and to assess treatment and follow-up of low vitamin D levels. DESIGN Observational cohort study. SETTING VA hospital extended care center (ECC). PARTICIPANTS 2218 ECC patients between January 2001 and December 2006 were screened. MEASUREMENT Serum 25-hydroxyvitamin D (25[OH]D) level, vitamin D therapy regimen, time to follow-up, documented adverse event to vitamin D therapy. RESULTS Of 2218 patients admitted to the ECC during the study period, 229 (10%) had a vitamin D level measured. Among these 229 patients, 49% were vitamin D sufficient (25[OH]D > or =30 ng/mL), 14% were insufficient (25[OH]D=21-29 ng/mL), and 37% were deficient (25[OH]D < or =20 ng/mL). Sixty-nine percent of patients with low vitamin D levels received some form of vitamin D therapy, whereas 43% received treatment as well as follow-up evaluation of vitamin D status within 3 months. Only 13% received a formulation of vitamin D appropriate for the severity of their deficiency/insufficiency with concurrent calcium supplementation and had a repeat vitamin D level within 3 months. CONCLUSION Vitamin D levels were measured infrequently in long-term care patients. Among those monitored, the rate of vitamin D deficiency/insufficiency is high. Few patients with low vitamin D status received proper treatment and follow-up. These data support the need to educate physicians regarding the high prevalence of vitamin D insufficiency/deficiency among long-term care patients to ensure that patients with low vitamin D levels are identified and treated appropriately.
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Vieth R. Vitamin D Nutrition and its Potential Health Benefits for Bone, Cancer and Other Conditions. ACTA ACUST UNITED AC 2009. [DOI: 10.1080/13590840120103120] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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Faulkner MA, Ryan-Haddad AM, Lenz TL, Degner K. Osteoporosis in Long-Term Care Residents with Multiple Sclerosis. ACTA ACUST UNITED AC 2009; 20:128-36. [PMID: 16548616 DOI: 10.4140/tcp.n.2005.128] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
OBJECTIVE To assess the fracture risk of long-term care residents with multiple sclerosis (MS) using ultrasound heel-scan technology and identification of risk factors and areas where intervention by a pharmacist might affect patient outcomes. DESIGN Bilateral-heel scans were performed on all patients who consented to take part in the study. A retrospective review of each subject's medical records was performed to identify known risk factors for osteoporosis. SETTING A long-term care facility in Omaha, Nebraska. PARTICIPANTS All patients with a primary diagnosis of MS residing at the facility were eligible for participation. Of 11 patients identified, 10 consented to participate. MAIN OUTCOME MEASURES T-scores of the right and left heel as determined by ultrasound-heel scan were used to determine if study participants met criteria for osteopenia or osteoporosis as set forth by the World Health Organization. CONCLUSION Patients in our population who have MS are at high risk for fracture. There are several areas in which pharmacists can intervene to prevent fracture and improve patient outcomes, including administration of heel scans for persons believed to be at risk, recommendation of over-the-counter supplements, and education of both patients and health care practitioners.
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Affiliation(s)
- Michele A Faulkner
- Creighton University School of Pharmacy and Health Professions, Omaha, Nebraska 68178, USA.
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Cashman KD, Wallace JM, Horigan G, Hill TR, Barnes MS, Lucey AJ, Bonham MP, Taylor N, Duffy EM, Seamans K, Muldowney S, Fitzgerald AP, Flynn A, Strain JJ, Kiely M. Estimation of the dietary requirement for vitamin D in free-living adults >=64 y of age. Am J Clin Nutr 2009; 89:1366-74. [PMID: 19297462 DOI: 10.3945/ajcn.2008.27334] [Citation(s) in RCA: 131] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND Older adults may be more prone to developing vitamin D deficiency than younger adults. Dietary requirements for vitamin D in older adults are based on limited evidence. OBJECTIVE The objective was to establish the dietary intake of vitamin D required to maintain serum 25-hydroxyvitamin D [25(OH)D] concentrations above various cutoffs between 25 and 80 nmol/L during wintertime, which accounted for the effect of summer sunshine exposure and diet. DESIGN A randomized, placebo-controlled, double-blind, 22-wk intervention was conducted in men and women aged >/=64 y (n = 225) at supplemental levels of 0, 5, 10, and 15 microg vitamin D(3)/d from October 2007 to March 2008. RESULTS Clear dose-related increments (P < 0.0001) in serum 25(OH)D were observed with increasing supplemental vitamin D(3) intakes. The slope of the relation between total vitamin D intake and serum 25(OH)D was 1.97 nmol . L(-1) . microg intake(-1). The vitamin D intake that maintained serum 25(OH)D concentrations >25 nmol/L in 97.5% of the sample was 8.6 microg/d. Intakes were 7.9 and 11.4 microg/d in those who reported a minimum of 15 min daily summer sunshine exposure or less, respectively. The intakes required to maintain serum 25(OH)D concentrations of >37.5, >50, and >80 nmol/L in 97.5% of the sample were 17.2, 24.7, and 38.7 microg/d, respectively. CONCLUSION To ensure that the vitamin D requirement is met by the vast majority (>97.5%) of adults aged >/=64 y during winter, between 7.9 and 42.8 microg vitamin D/d is required, depending on summer sun exposure and the threshold of adequacy of 25(OH)D. This trial was registered at http://www.controlled-trials.com/ISRCTN20236112 as ISRCTN registration no. ISRCTN20236112.
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Affiliation(s)
- Kevin D Cashman
- Department of Food and Nutritional Sciences, University College, Cork, Ireland
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Johnson MA, Davey A, Park S, Hausman DB, Poon LW. Age, race and season predict vitamin D status in African American and white octogenarians and centenarians. J Nutr Health Aging 2008; 12:690-5. [PMID: 19043643 PMCID: PMC2978665 DOI: 10.1007/bf03028616] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
OBJECTIVE Poor vitamin D status has been associated with osteoporosis, falls, cardiovascular diseases, cancer, autoimmune diseases, pain, nursing home placement, and other age-related conditions, but little is known about the prevalence and predictors of vitamin D status in those aged 80 and older. Thus, this study tested the hypothesis that vitamin D status would be 1) poorer in a population-based multi-ethnic sample of centenarians as compared with octogenarians and 2) predicted by specific dietary, demographic or environmental factors. DESIGN Cross-sectional population-based analyses. SETTING Northern Georgia in the United States. PARTICIPANTS Men and women aged 80 to 89 (octogenarians, n=80) and 98 and older (centenarians, n=237). MEASUREMENTS Regression analyses were used to examine the associations of serum 25-hydroxyvitamin D [25(OH)D] with age, gender, race, living arrangements, dairy food intake, supplement intake, and season. RESULTS The prevalence of vitamin D insufficiency [25(OH)D<50 nmol/L] was higher in centenarians than in octogenarians (p<0.02). In logistic regression analyses, the risk of being vitamin D insufficient was significantly increased by being a centenarian vs. octogenarian (p<0.005) and by being African American vs. white (p<0.001) and decreased by taking a supplement with vitamin D (p<0.001) or by having vitamin D status measured in the summer or fall (each p<0.05), compared with spring. CONCLUSIONS Centenarians and octogenarians are at high risk for vitamin D insufficiency for many of the same reasons identified in younger populations. Given the numerous potential adverse consequences of poor vitamin D status, efforts are needed to ensure vitamin D adequacy in these older adults.
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Affiliation(s)
- M A Johnson
- The University of Georgia, Department of Foods and Nutrition, 280 Dawson Hall, Athens, GA 30602, USA.
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Vitamin D and Secondary Hyperparathyroidism in the Institutionalized Elderly. ACTA ACUST UNITED AC 2008; 26:119-38. [DOI: 10.1300/j052v26n03_06] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
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Saraiva GL, Cendoroglo MS, Ramos LR, Araújo LMQ, Vieira JGH, Maeda SS, Borba VZC, Kunii I, Hayashi LF, Lazaretti-Castro M. Prevalência da deficiência, insuficiência de vitamina D e hiperparatiroidismo secundário em idosos institucionalizados e moradores na comunidade da cidade de São Paulo, Brasil. ACTA ACUST UNITED AC 2007; 51:437-42. [PMID: 17546243 DOI: 10.1590/s0004-27302007000300012] [Citation(s) in RCA: 59] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2005] [Accepted: 11/17/2006] [Indexed: 12/31/2022]
Abstract
A ocorrência de fraturas osteoporóticas em idosos está relacionada às concentrações reduzidas de vitamina D e conseqüente hiperparatiroidismo secundário, sendo os institucionalizados de maior risco. No Brasil, por seu alto grau de insolação, infere-se que a quantidade de vitamina D da população seja adequada. Neste estudo, objetivamos avaliar as concentrações plasmáticas de 25-hidroxivitamina D (25OHD), paratormônio (PTH) e cálcio ionizado (Cai), assim como analisar a prevalência de hipovitaminose D e de hiperparatiroidismo secundário em idosos moradores da cidade de São Paulo. Estudamos 177 pacientes institucionalizados (125 mulheres e 52 homens) com idade média (DP) de 76,6 (9,0) anos, e 243 idosos ambulatoriais (168 mulheres e 75 homens) com 79,1 (5,9) anos. Nesta avaliação, 71,2% do grupo institucionalizado e 43,8% do ambulatorial possuíam valores de 25OHD menores do que o mínimo recomendado (50 nmol/l), sendo que as mulheres apresentaram valores consideravelmente mais baixos que os homens. O hiperparatiroidismo secundário ocorreu em 61,7% dos pacientes institucionalizados e em 54% dos ambulatoriais. Considerando os resultados obtidos, recomendamos a suplementação com doses eficientes de vitamina D para a população idosa brasileira, alem de sugerir uma discussão para a implementação de políticas de fortificação alimentar com vitamina D, especialmente direcionada àqueles com maior risco.
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Broe KE, Chen TC, Weinberg J, Bischoff-Ferrari HA, Holick MF, Kiel DP. A Higher Dose of Vitamin D Reduces the Risk of Falls in Nursing Home Residents: A Randomized, Multiple-Dose Study. J Am Geriatr Soc 2007; 55:234-9. [PMID: 17302660 DOI: 10.1111/j.1532-5415.2007.01048.x] [Citation(s) in RCA: 304] [Impact Index Per Article: 17.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVES To determine the effect of four vitamin D supplement doses on falls risk in elderly nursing home residents. DESIGN Secondary data analysis of a previously conducted randomized clinical trial. SETTING Seven hundred twenty-five-bed long-term care facility. PARTICIPANTS One hundred twenty-four nursing home residents (average age 89). INTERVENTION Participants were randomly assigned to receive one of four vitamin D supplement doses (200 IU, 400 IU, 600 IU, or 800 IU) or placebo daily for 5 months. MEASUREMENTS Number of fallers and number of falls assessed using facility incident tracking database. RESULTS Over the 5-month study period, the proportion of participants with falls was 44% in the placebo group (11/25), 58% (15/26) in the 200 IU group, 60% (15/25) in the 400 IU group, 60% (15/25) in the 600 IU group, and 20% (5/23) in the 800 IU group. Participants in the 800 IU group had a 72% lower adjusted-incidence rate ratio of falls than those taking placebo over the 5 months (rate ratio=0.28; 95% confidence interval=0.11-0.75). No significant differences were observed for the adjusted fall rates compared to placebo in any of the other supplement groups. CONCLUSION Nursing home residents in the highest vitamin D group (800 IU) had a lower number of fallers and a lower incidence rate of falls over 5 months than those taking lower doses. Adequate vitamin D supplementation in elderly nursing home residents could reduce the number of falls experienced by this high falls risk group.
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Affiliation(s)
- Kerry E Broe
- Institute for Aging Research, Hebrew SeniorLife, Boston, Massachusetts 02131, USA.
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Atli T, Gullu S, Uysal AR, Erdogan G. The prevalence of Vitamin D deficiency and effects of ultraviolet light on Vitamin D levels in elderly Turkish population. Arch Gerontol Geriatr 2005; 40:53-60. [PMID: 15531023 DOI: 10.1016/j.archger.2004.05.006] [Citation(s) in RCA: 64] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2004] [Revised: 05/10/2004] [Accepted: 05/19/2004] [Indexed: 11/22/2022]
Abstract
Vitamin D deficiency is commonly found in the elderly and is associated with osteoporosis and hip fractures. In this study, Vitamin D status of 138 female and 87 male subjects living in old age homes (OAH) and 171 female and 24 male subjects living in own homes (OH) from Central Anatolia were assessed. A questionnaire was applied to collect information about wearing features and degree of sunlight exposure and benefiting from ultraviolet index calculated (BFUI). We have found Vitamin D deficiency in 33.4% among our subjects. Also, 40.1% of subjects living in OAH (54.1% of females and 18.4% of males) and 24.4% of subjects living in OH (27.9% of females and 4.2% of males) were Vitamin D deficient. Vitamin D deficiency was significantly higher in subjects living in OAH than subjects living in OH (P = 0.001) and also higher in females than males (40.7% versus 15.3%, P < 0.001). Subjects with Vitamin D deficiency were older (P < 0.001), BFUI was lower (P < 0.001) and parathyroid hormone (PTH) was higher (P < 0.001) than those having normal level of 25(OH)D. There was a significant negative correlation between 25(OH)D levels and age (P < 0.001, r = -0.248) PTH and 25(OH)D (P = 0.004, r = -0.340), and positive correlation between 25(OH)D and BFUI (P < 0.001, r = 0.340). Vitamin D deficiency is very common in Turkish elderly subjects especially living in OAH and there is a significant low exposure to sunlight among them. Simply by asking clothing habits and exposure to sunlight, we can able to identify risk of Vitamin D insufficiency in elderly subjects.
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Affiliation(s)
- T Atli
- Department of Geriatric Medicine, Ankara University School of Medicine, Cebeci, Ankara 06100, Turkey.
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Abstract
Global high prevalence of vitamin D insufficiency and re-emergence of rickets and the growing scientific evidence linking low circulating 25-hydroxyvitamin D to increased risk of osteoporosis, diabetes, cancer, and autoimmune disorders have stimulated recommendations to increase sunlight (UVB) exposure as a source of vitamin D. However, concern over increased risk of melanoma with unprotected UVB exposure has led to the alternative recommendation that sufficient vitamin D should be supplied through dietary sources alone. Here, we examine the adequacy of vitamin D intake worldwide and evaluate the ability of current fortification policies and supplement use practices among various countries to meet this recommendation. It is evident from our review that vitamin D intake is often too low to sustain healthy circulating levels of 25-hydroxyvitamin D in countries without mandatory staple food fortification, such as with milk and margarine. Even in countries that do fortify, vitamin D intakes are low in some groups due to their unique dietary patterns, such as low milk consumption, vegetarian diet, limited use of dietary supplements, or loss of traditional high fish intakes. Our global review indicates that dietary supplement use may contribute 6-47% of the average vitamin D intake in some countries. Recent studies demonstrate safety and efficacy of community-based vitamin D supplementation trials and food staple fortification introduced in countries without fortification policies. Reliance on the world food supply as an alternative to UVB exposure will necessitate greater availability of fortified food staples, dietary supplement use, and/or change in dietary patterns to consume more fish.
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Affiliation(s)
- Mona S Calvo
- Office of Applied Research and Safety Assessment, Center for Food Safety and Applied Nutrition, Food and Drug Administration, Laurel, MD, USA.
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Gottschlich MM, Mayes T, Khoury J, Warden GD. Hypovitaminosis D in acutely injured pediatric burn patients. ACTA ACUST UNITED AC 2004; 104:931-41, quiz 1031. [PMID: 15175591 DOI: 10.1016/j.jada.2004.03.020] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
PROBLEM The prevalence of vitamin D insufficiency, its etiology, and associated sequelae among acutely injured burn patients is unknown. OBJECTIVE This study assessed vitamin D and endocrine status, as well as the effect of anabolic agents, in pediatric patients who had sustained burns in excess of 25% total body surface area (TBSA). SUBJECTS Sixty-nine patients with a mean TBSA burn of 50.6+/-2.2% (range 27% to 94%) and full thickness injury of 41.3+/-3.0% (range 0% to 94%) were studied. Subjects ranged in age from 0.6 to 18 years (mean, 5.8+/-0.6 years). Main outcome measures Blood samples were obtained for serum 25-hydroxyvitamin D (D25), 1,25-dihydroxyvitamin D (D1,25), albumin, cortisol, triiodothyronine (T3), tetraiodothyronine (T(4)), thyroid stimulating hormone (TSH), and parathormone (PTH). RESULTS Two hundred eighty morning blood samples of D25 and D1,25 demonstrated that 45% and 26.2% were low and 8.9% and 11% were very low, respectively. At least one low D25 or D1,25 level occurred in 62.3% of all subjects. Very low levels were noted in 23.2% of all patients. There was an increased incidence of hyperparathyroidism in patients with very low serum D25. Vitamin D25 and D1,25 levels were lower in subjects with larger burns or inhalation injury, as well as those treated with thyroxine or oxandrolone. Serum albumin, cortisol, T(4), and TSH were not correlated with concentration of vitamin D. CONCLUSIONS Demonstration of a high incidence of low serum vitamin D indicates vitamin D status may be significantly compromised in burned children. It is unclear why vitamin D deficiency exists in this population. The most effective way to improve vitamin D status remains elusive at this time.
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Elliott ME, Binkley NC, Carnes M, Zimmerman DR, Petersen K, Knapp K, Behlke JM, Ahmann N, Kieser MA. Fracture risks for women in long-term care: high prevalence of calcaneal osteoporosis and hypovitaminosis D. Pharmacotherapy 2003; 23:702-10. [PMID: 12820811 DOI: 10.1592/phco.23.6.702.32182] [Citation(s) in RCA: 50] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
STUDY OBJECTIVES To determine the prevalence of osteoporosis as assessed by peripheral bone mineral density (BMD) in women living in a nursing home, to determine how many women with low BMD had received a diagnosis of osteoporosis, to assess the prevalence of vitamin D deficiency, and to seek reasons for vitamin D deficiency. DESIGN Measurement of calcaneal BMD and serum 25-hydroxyvitamin D. SETTING Skilled nursing facility. PATIENTS Forty-nine women aged 68-100 years. MEASUREMENTS AND MAIN RESULTS Bilateral calcaneal BMD was measured by dual-energy x-ray absorptiometry and serum 25-hydroxyvitamin D by radioimmunoassay. Medical records were reviewed to assess osteoporosis risk factors, previous documentation of osteoporosis or malabsorption, and supplemental vitamin D intake. Fifty-nine percent of the 39 women with calcaneal BMD measurements (95% confidence interval [CI] 44-74%) exhibited calcaneal osteoporosis (T score < -2.5). Sixty percent (95% CI 46-74%) had 25-hydroxyvitamin D levels of 20 ng/ml or less, which is associated with secondary hyperparathyroidism; only 4% of women had levels above 30 ng/ml, recently recommended as optimal. Vitamin D status was suboptimal even in most women taking multivitamins. Osteoporosis was documented in the records of 17% of 23 women with calcaneal osteoporosis. CONCLUSION Osteoporosis was prevalent but poorly documented in women living in the nursing home. Peripheral BMD measurements have the potential to improve the recognition and management of osteoporosis in women in long-term care facilities. The high prevalence of vitamin D deficiency, even in those taking multivitamins, indicates that practical new approaches for vitamin D repletion in this population are urgently needed.
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Affiliation(s)
- Mary E Elliott
- School of Pharmacy, University of Wisconsin, Madison 53705, USA.
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Scherr D, Swindle PW, Scardino PT. National Comprehensive Cancer Network guidelines for the management of prostate cancer. Urology 2003; 61:14-24. [PMID: 12667883 DOI: 10.1016/s0090-4295(02)02395-6] [Citation(s) in RCA: 129] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Guidelines for the management of prostate cancer issued by the National Comprehensive Cancer Network provide a basis for rational treatment decisions. These guidelines represent consensus recommendations by a panel of experts that are evidence based and are designated according to the degree of consensus within the expert panel. The initial stratification point is the patient's life expectancy (>5 or <5 years). If life expectancy is >5 years, the recommended intervention is based on clinical stage, prostate-specific antigen (PSA) level, and Gleason score, as well as the presence of symptoms. These assessments establish the patient's risk of recurrence after therapy. Specific initial therapies are then recommended according to whether the risk category is low, intermediate, high, or very high. The guidelines also describe the appropriate use of observation ("watchful waiting") versus active intervention in certain patients. After definitive therapy, patients should be monitored with PSA determinations, digital rectal examination, and bone scans, as outlined in the guidelines. Patients who exhibit increasing PSA levels after prostatectomy are candidates for salvage therapy with androgen ablation, radiotherapy, or observation. If PSA levels begin to increase after radiotherapy, surgery may then be an additional option. Systemic salvage therapy generally consists of androgen ablation; the benefit of total androgen blockade versus initial monotherapy remains controversial. Relapse after initial androgen ablation is treated with an antiandrogen, if none had been administered previously. Patients refractory to further hormonal manipulations are observed or receive palliative therapy, including chemotherapy. The treatment of prostate cancer is complex. Optimal treatment is risk-adapted to the specific characteristics of the cancer and the expected longevity and personal preferences of the patient.
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Affiliation(s)
- Douglas Scherr
- Department of Urology, Weill Medical College of Cornell University, New York, New York, USA
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Abstract
Proper vitamin nutrition is essential for all people but especially for elderly persons, because they are at higher risk for deficiency than younger adults. A review of the clinical effects of vitamin deficiency shows how easily deficiency can masquerade as other morbidities, such as skin, neurologic, and gait abnormalities. Given the numerous readily available forms and sources of supplementation, their low cost, and their rather limited potential for harm, the goal of good vitamin nutrition for the elderly is easily attainable. To be successful in this goal, physicians must look for patients at risk and for those with features of frank vitamin deficiency. Laboratory testing is most helpful with respect to vitamin B12 and folate deficiency. Given the great value of clinical assessment, the low cost of vitamins, and the higher cost of laboratory testing, the authors do not recommend testing before instituting multivitamin use or extra supplementation with individual vitamins unless the diagnosis of deficiency is in question or the use of supplementation would put the patient at risk. The authors' general recommendations are * one multivitamin daily * extra vitamin E for patients with cardiovascular risk factors or Alzheimer's dementia * extra vitamin D for patients with known osteoporosis, osteoporosis risk factors, or strong risk factors for vitamin D deficiency * extra folate for patients with cardiovascular risk factors (especially smokers) and alcoholics * extra thiamine for alcoholics.
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Affiliation(s)
- Karin A Johnson
- Donald W. Reynolds Department of Geriatric Medicine, University of Oklahoma, College of Medicine, 921 North East 13th Street (11G), Oklahoma City, OK 73104, USA.
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Lee LT, Drake WM, Kendler DL. Intake of calcium and vitamin D in 3 Canadian long-term care facilities. JOURNAL OF THE AMERICAN DIETETIC ASSOCIATION 2002; 102:244-7. [PMID: 11846119 DOI: 10.1016/s0002-8223(02)90057-x] [Citation(s) in RCA: 20] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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Lips P. Vitamin D deficiency and secondary hyperparathyroidism in the elderly: consequences for bone loss and fractures and therapeutic implications. Endocr Rev 2001; 22:477-501. [PMID: 11493580 DOI: 10.1210/edrv.22.4.0437] [Citation(s) in RCA: 1038] [Impact Index Per Article: 45.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Vitamin D deficiency is common in the elderly, especially in the housebound and in geriatric patients. The establishment of strict diagnostic criteria is hampered by differences in assay methods for 25-hydroxyvitamin D. The synthesis of vitamin D3 in the skin under influence of UV light decreases with aging due to insufficient sunlight exposure, and a decreased functional capacity of the skin. The diet contains a minor part of the vitamin D requirement. Vitamin D deficiency in the elderly is less common in the United States than elsewhere due to the fortification of milk and use of supplements. Deficiency in vitamin D causes secondary hyperparathyroidism, high bone turnover, bone loss, mineralization defects, and hip and other fractures. Less certain consequences include myopathy and falls. A diet low in calcium may cause an increased turnover of vitamin D metabolites and thereby aggravate vitamin D deficiency. Prevention is feasible by UV light exposure, food fortification, and supplements. Vitamin D3 supplementation causes a decrease of the serum PTH concentration, a decrease of bone turnover, and an increase of bone mineral density. Vitamin D3 and calcium may decrease the incidence of hip and other peripheral fractures in nursing home residents. Vitamin D3 is recommended in housebound elderly, and it may be cost-effective in hip fracture prevention in selected risk groups.
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Affiliation(s)
- P Lips
- Department of Endocrinology, Institute for Endocrinology, Reproduction and Metabolism, EVM-Institute, Vrije Universiteit Medical Center, 1007 MB Amsterdam, The Netherlands.
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Abstract
1alpha,25-dihydroxyvitamin D(3) [1,25(OH)(2)D(3)] has been shown to act on novel target tissues not related to calcium homeostasis. There have been reports characterizing 1,25(OH)(2)D(3) receptors and activities in diverse tissues such as brain, pancreas, pituitary, skin, muscle, placenta, immune cells and parathyroid. The receptor hormone complex becomes localized in the nucleus, and undergoes phosphorylation by reacting with a kinase. This form of the receptor then interacts with the Vitamin D responsive element of target gene and modifies the transcription of those genes to develop the action. The modulation of gene transcription results in either the induction or repression of specific messenger RNAs (m-RNAs), ultimately resulting in changes in protein expression needed to produce biological responses. Genes for carbonic anhydrase that are expressed at high levels in osteoclast are known to be involved in bone resorption and Id genes role in osteoblast-osteoclast differentiation reflects the genomic effect of Vitamin D on bones. Genomic action of Vitamin D also explains the biosynthesis of oncogenes, polyamines, lymphokines and calcium binding proteins. However, there is a possibility that some of the actions of 1,25(OH)(2)D(3) may be mediated by non-genomic mechanisms and may not require the binding to Vitamin D receptor (VDR). Vitamin D offers a protection from genotoxic effects of Vitamin D deficiency by increasing the insulin receptor gene expression and BSP (bone sialoprotein), bone-remodeling by decreasing the osteopontin (OPN) m-RNAs, maintaining the normal epidermal structure and enamel matrix. Gonadal insufficiency in Vitamin D deficiency was corrected by vitamin mediated direct regulation of the expression of aramotase gene. The supportive role of Vitamin D in placental function is also evident by its influence on human placental lactogen (hpl) gene transcription accompanied by increase hpl m-RNA levels. Further role of Vitamin D is envisaged in identifying cyclin C as an important target for Vitamin D in cell-cycle regulation. Vitamin D at physiological concentration has been found to protect cell proteins and membranes against oxidative stress by inhibiting the peroxidative attack on membrane lipids. Vitamin D, at a concentration range of 2x10(-8)-5x10(-8)M, induces apoptosis in most cancer cells, stabilizes chromosomal structure and prevents DNA double-strand breaks induced either by endogenous or exogenous factors. Vitamin D is also effective in stimulating DNA synthesis in adult alveolar II cells and provides a novel mechanism of modulation of epithelial cell proliferation in the context of lung development and repair against injury. The regulation of various proto-oncogenes (c-myc, c-fos, c-jun), differentiation inducing properties, antiproliferative effects on keratinocytes and inhibitory effects in several human malignancy ranks Vitamin D as a novel hormone that may have physiological and clinical implication in the carcinogenic process.
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Affiliation(s)
- M Chatterjee
- Department of Pharmaceutical Technology, Division of Biochemistry, Jadavpur University, 700032, Calcutta, India.
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Harris SS, Soteriades E, Coolidge JA, Mudgal S, Dawson-Hughes B. Vitamin D insufficiency and hyperparathyroidism in a low income, multiracial, elderly population. J Clin Endocrinol Metab 2000; 85:4125-30. [PMID: 11095443 DOI: 10.1210/jcem.85.11.6962] [Citation(s) in RCA: 74] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
This report examines the wintertime vitamin D and PTH status of 308 participants in the Boston Low Income Elderly Osteoporosis Study of noninstitutionalized low income elderly men and women (age, 64-100 yr) living in subsidized housing in Boston, MA. Twenty-one percent of the 136 black subjects and 11% of the 110 whites had very low plasma 25-hydroxyvitamin D (25OHD) concentrations (<25 nmol/L), and 73% of the blacks and 35% of the whites had 25OHD concentrations less than 50 nmol/L. The mean 25OHD levels of the smaller Hispanic and Asian subsets were generally similar to those of the white subjects. In addition to race, significant predictors of 25OHD included vitamin D intake (positive association) and smoking (inverse association), but not sex or age. Low 25OHD concentrations were associated with increased PTH and reduced serum calcium. The PTH level in the black subjects was substantially higher than that in the white subjects, and this difference was only partially explained by the racial difference in 25OHD. Elderly individuals who live in northern areas, particularly African-Americans, should be strongly encouraged to increase their vitamin D intake, especially in winter.
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Affiliation(s)
- S S Harris
- Jean Mayer U.S. Department of Agriculture Human Nutrition Research Center on Aging, Tufts University, Boston, Massachusetts 02111, USA
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Abstract
For adults, the 5-microg (200 IU) vitamin D recommended dietary allowance may prevent osteomalacia in the absence of sunlight, but more is needed to help prevent osteoporosis and secondary hyperparathyroidism. Other benefits of vitamin D supplementation are implicated epidemiologically: prevention of some cancers, osteoarthritis progression, multiple sclerosis, and hypertension. Total-body sun exposure easily provides the equivalent of 250 microg (10000 IU) vitamin D/d, suggesting that this is a physiologic limit. Sailors in US submarines are deprived of environmentally acquired vitamin D equivalent to 20-50 microg (800-2000 IU)/d. The assembled data from many vitamin D supplementation studies reveal a curve for vitamin D dose versus serum 25-hydroxyvitamin D [25(OH)D] response that is surprisingly flat up to 250 microg (10000 IU) vitamin D/d. To ensure that serum 25(OH)D concentrations exceed 100 nmol/L, a total vitamin D supply of 100 microg (4000 IU)/d is required. Except in those with conditions causing hypersensitivity, there is no evidence of adverse effects with serum 25(OH)D concentrations <140 nmol/L, which require a total vitamin D supply of 250 microg (10000 IU)/d to attain. Published cases of vitamin D toxicity with hypercalcemia, for which the 25(OH)D concentration and vitamin D dose are known, all involve intake of > or = 1000 microg (40000 IU)/d. Because vitamin D is potentially toxic, intake of >25 microg (1000 IU)/d has been avoided even though the weight of evidence shows that the currently accepted, no observed adverse effect limit of 50 microg (2000 IU)/d is too low by at least 5-fold.
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Affiliation(s)
- R Vieth
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Mount Sinai Hospital, Ontario, Canada.
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Implementing a Structured Exercise Program for Frail Nursing Home Residents with Dementia: Issues and Challenges. J Aging Phys Act 1995. [DOI: 10.1123/japa.3.4.383] [Citation(s) in RCA: 25] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
This pilot study evaluated (a) the feasibility of a group exercise program in an institutionalized population with dementia; (b) the effects of such a program on physical performance measures; and (c) the potential additional effects of vitamin D supplementation on gait and muscle strength. Nursing home residents (N= 25) with chronic dementia and mobility impairments attended a thrice weekly exercise class for 8 weeks. They were randomly assigned to receive either a vitamin D supplement or no supplement throughout the program. Between-group differences in the effectiveness of the exercise intervention were analyzed. Pre-to-post changes were also assessed for both groups combined. In postexercise comparisons of both groups, knee extensor torque at 0°/sec declined by 18.6% while performance of 1-RM for hip extension increased by 16.1%. Balance also improved. Although vitamin D levels increased significantly in the supplement group, the two groups did not differ in their response to the exercise intervention.
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Feiner CF. Vitamin D status in the elderly. J Am Geriatr Soc 1993; 41:1370-1. [PMID: 8227922 DOI: 10.1111/j.1532-5415.1993.tb06491.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
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Komar L, Nieves J, Cosman F, Rubin A, Shen V, Lindsay R. Calcium homeostasis of an elderly population upon admission to a nursing home. J Am Geriatr Soc 1993; 41:1057-64. [PMID: 8409150 DOI: 10.1111/j.1532-5415.1993.tb06452.x] [Citation(s) in RCA: 72] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
OBJECTIVE To evaluate the skeletal health, calcium, and vitamin D homeostasis of patients upon their entry to a long-term-care facility. Factors that could contribute to the risk of future osteoporotic fractures were also evaluated. DESIGN Cross-sectional study. PATIENTS Two hundred eighty-seven consecutive admissions were invited to participate; 109 patients were recruited into the study. MEASUREMENTS A high prevalence of low to low-normal circulating levels of 25(OH)D was found in nursing home residents upon their admission to the nursing home, with 86% of the patients having circulating 25(OH)D levels of less than 50 nmol/L and 41% having levels below 25 nmol/L. Frankly elevated parathyroid hormone levels were found in 16% of the patients. Additionally, alkaline phosphatase and osteocalcin levels were elevated in 23% and 13% of the patients, respectively. Bone mineral measurements were in the osteoporotic range for 85% of the nursing home residents. Bone density results for females with a history of any classic osteoporotic fracture were significantly lower than for those with no fracture history (68.5 arbitrary units (AU) for those with no fracture history, 58.8 AU in those with history of hip fracture; P < 0.05). The bone mineral measurements were higher in women with adequate 25(OH)D compared with women with deficient or borderline 25(OH)D with and without fracture history. Levels of 25(OH)D were positively correlated with urine calcium/creatinine (r = .24; P = 0.03) and 1,25(OH)2D (r = .28; P = 0.01) and were negatively correlated with 1-84 PTH (r = -.24; P = 0.02). CONCLUSION Hypovitaminosis D is prevalent among elderly patients entering a nursing home with secondary hyperparathyroidism and apparently increased bone turnover present in patients with circulating 25(OH)D levels below 50 nmol/L. Bone density measurements showed that a majority of the individuals entering a nursing home are osteoporotic. There is a positive association between 25(OH)D levels and bone mass and a negative association between 25(OH)D levels and a history of fracture.
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Affiliation(s)
- L Komar
- Regional Bone Center, Helen Hayes Hospital, West Haverstraw, NY 10993-1195
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