Clinical Rheumatology

, Volume 24, Issue 6, pp 576–582 | Cite as

Calcium metabolism in the frail elderly

  • Jane Zochling
  • Jian Sheng Chen
  • Markus Seibel
  • Jennifer Schwarz
  • Ian D. Cameron
  • Robert G. Cumming
  • Lyn March
  • Philip N. Sambrook
Original Article

Abstract

Elderly residents of aged care facilities are usually considered at high risk of osteoporosis not only due to their age, but also due to nutritional factors, poor sunlight exposure and renal insufficiency. This study aimed to describe calcium metabolism and related hormones in this high-risk population. A total of 1280 elderly residents of hostels and nursing homes in the northern Sydney area (aged 65 years or over) had serum analysis for clinical chemistry including serum 25-hydroxy vitamin D (25OHD) and parathyroid hormone (PTH). Moderate renal impairment (creatinine clearance 30–60 ml/min) was common (62%), but hypocalcaemia was uncommon (7.0%). Mild hypoalbuminaemia was common (34% below 40 g/l, but only 3.2% below 35 g/l); 77.5% of the cohort had low serum 25OHD levels (<39 nmol/l) and 41.7% had elevated PTH levels (>66 pg/ml). Independent predictors of low serum 25OHD levels included gender, age, serum PTH, season, mobility and creatinine clearance. Use of vitamin D supplementation conferred modestly higher serum 25OHD levels (45.5 vs 27.1 nmol/l in non-supplemented residents, p<0.0001) and lower PTH levels (50.0 vs 78.1 pg/ml, p<0.0001). Despite adequate overall nutrition, vitamin D deficiency is present in the majority of this population. Vitamin D deficiency remains a significant public health problem in the institutionalized frail elderly. Currently available supplements are not adequate or utilized frequently enough to address this problem.

Keywords

Calcium Creatinine Parathyroid hormone Vitamin D 

References

  1. 1.
    Chapuy MC, Preziosi P, Maamer M, Arnaud S, Galan P, Hercberg S, Meunier PJ (1997) Prevalence of vitamin D insufficiency in an adult normal population. Osteoporos Int 7:439–443CrossRefPubMedGoogle Scholar
  2. 2.
    Kudlacek S, Schneider B, Peterlik M, Leb G, Klaushofer K, Weber K, Woloszczuk W, Willvonseder R (2003) Assessment of vitamin D and calcium status in healthy adult Austrians. Eur J Clin Invest 33:323–331CrossRefPubMedGoogle Scholar
  3. 3.
    Harris SS, Soteriades E, Coolidge JA, Mudgal S, Dawson-Hughes B (2000) Vitamin D insufficiency and hyperparathyroidism in a low income, multiracial, elderly population. J Clin Endocrinol Metab 85:4125–4130CrossRefPubMedGoogle Scholar
  4. 4.
    Goswami R, Gupta N, Goswami D, Marwaha RK, Tandon N, Kochupillai N (2000) Prevalence and significance of low 25-hydroxyvitamin D concentrations in healthy subjects in Delhi. Am J Clin Nutr 72:472–475PubMedGoogle Scholar
  5. 5.
    Grover SR, Morle R (2001) Vitamin D deficiency in veiled or dark-skinned pregnant women. Med J Aust 175:251–252PubMedGoogle Scholar
  6. 6.
    Thomas MK, Lloyd-Jones DM, Thadhani RI, Shaw AC, Deraska DJ, Kitch BT, Vamvakas EC, Dick IM, Prince RL, Finkelstein JS (1998) Hypovitaminosis D in medical inpatients. N Engl J Med 338:777–783CrossRefPubMedGoogle Scholar
  7. 7.
    Kauppinen-Makelin R, Tahtela R, Loyttyniemi E, Karkkainen J, Valimaki MJ (2001) A high prevalence of hypovitaminosis D in Finnish medical in- and outpatients. J Intern Med 249:559–563CrossRefPubMedGoogle Scholar
  8. 8.
    Gloth FM, Gundberg CM, Hollis BW, Haddad JG, Tobin JD (1995) Vitamin D deficiency in homebound elderly persons. JAMA 274:1683–1686CrossRefPubMedGoogle Scholar
  9. 9.
    Inderjeeth CA, Nicklason F, Al Lahham Y, Greenaway TM, Jones G, Parameswaran VV, David R (2000) Vitamin D deficiency and secondary hyperparathyroidism: clinical and biochemical associations in older non-institutionalised southern Tasmanians. Aust N Z J Med 30:209–214PubMedGoogle Scholar
  10. 10.
    Gallagher JC, Kinyamu HK, Fowler SE, Dawson-Hughes B, Dalsky GP, Sherman SS (1998) Calciotropic hormones and bone markers in the elderly. J Bone Miner Res 13:475–482PubMedGoogle Scholar
  11. 11.
    Corless D, Gupta SP, Sattar DA, Switala S, Boucher BJ (1979) Vitamin D status of residents of an old people’s home and long-stay patients. Gerontology 25:350–355PubMedGoogle Scholar
  12. 12.
    Stein MS, Scherer SC, Walton SL, Gilbert RE, Ebeling PR, Flicker L, Wark JD (1996) Risk factors for secondary hyperparathyroidism in a nursing home population. Clin Endocrinol 44:375–383CrossRefGoogle Scholar
  13. 13.
    Vir SC, Love HG (1979) Nutritional status of institutionalized and noninstitutionalized aged in Belfast, Northern Ireland. Am J Clin Nutr 27:1934–1937Google Scholar
  14. 14.
    McMurtry CT, Young SE, Downs RW, Adler RA (1992) Mild vitamin D deficiency and secondary hyperparathyroidism in nursing home patients receiving adequate dietary vitamin D. J Am Geriatr Soc 40:343–347PubMedGoogle Scholar
  15. 15.
    Webb AR, Pilbeam C, Hanafin N, Holick MF (1990) An evaluation of the relative contributions of exposure to sunlight and of diet to the circulating concentrations of 25-hydroxyvitamin D in an elderly nursing home population in Boston. Am J Clin Nutr 51:1075–1081PubMedGoogle Scholar
  16. 16.
    Zochling J, Sitoh YY, Lau TC, Cameron ID, Cumming RG, Lord SR, Schwarz J, Trube A, March LM, Sambrook PN (2002) Quantitative ultrasound of the calcaneus and falls risk in the institutionalized elderly: sex differences and relationship to vitamin D status. Osteoporos Int 13:882–887CrossRefPubMedGoogle Scholar
  17. 17.
    Cockcroft DW, Gault MH (1976) Prediction of creatinine clearance from serum creatinine. Nephron 16:31–41PubMedGoogle Scholar
  18. 18.
    Cumming RG, Mitchell P, Craig JC, Knight JF (2004) Renal impairment and anemia in a population-based study of older people. Intern Med J 34:20–23CrossRefPubMedGoogle Scholar
  19. 19.
    Jones CA, McQuillan GM, Kusek JW, Eberhardt MS, Herman WH, Coresh J, Salive M, Jones CP, Agodoa LY (1998) Serum creatinine levels in the US population: third National Health and Nutrition Examination Survey. Am J Kidney Dis 32:992–999PubMedGoogle Scholar
  20. 20.
    Culleton BF, Larson MG, Evans JC, Wilson PW, Barrett BJ, Parfrey PS, Levy D (1999) Prevalence and correlates of elevated serum creatinine levels: the Framingham Heart Study. Arch Intern Med 159:1785–1790CrossRefPubMedGoogle Scholar
  21. 21.
    Salive ME, Jones CA, Guralnik JM, Agodoa LY, Pahor M, Wallace RB (1995) Serum creatinine levels in older adults: relationship with health status and medications. Age Ageing 24:142–150PubMedGoogle Scholar
  22. 22.
    Malmrose LC, Gray SL, Pieper CF, Blazer DG, Rowe JW, Seeman TE, Albert MS (1993) Measured versus estimated creatinine clearance in a high-functioning elderly sample. J Am Geriatr Soc 41:715–721PubMedGoogle Scholar
  23. 23.
    Holick MF (1994) Vitamin D—new horizons for the 21st century. Am J Clin Nutr 60:619–630PubMedGoogle Scholar
  24. 24.
    MacLaughlin J, Holick MF (1985) Aging decreases the capacity of human skin to produce vitamin D3. J Clin Invest 76:1536–1538PubMedGoogle Scholar
  25. 25.
    Jacques PF, Felson DT, Tucker KL, Mahnken B, Wilson PWF (1997) Plasma 25-hydroxyvitamin D and its determinants in an elderly population sample. Am J Clin Nutr 66:929–936PubMedGoogle Scholar
  26. 26.
    Seiler WO (2001) Clinical pictures of malnutrition in ill elderly subjects. Nutrition 17:496–498CrossRefPubMedGoogle Scholar
  27. 27.
    Morley JE, Glick Z, Rubenstein LZ (1995) Geriatric nutrition: a comprehensive review. Raven Press, New YorkGoogle Scholar
  28. 28.
    Selberg O, Sel S (2001) The adjunctive value of routine biochemistry in nutritional assessment of hospitalized patients. Clin Nutr 20:477–485CrossRefPubMedGoogle Scholar
  29. 29.
    Melin A, Wilske J, Ringertz H, Saaf M (2001) Seasonal variations in serum levels of 25-hydroxyvitamin D and parathyroid hormone but no detectable change in femoral neck bone density in an older population with regular outdoor exposure. J Am Geriatr Soc 49:1190–1196CrossRefPubMedGoogle Scholar
  30. 30.
    Lamberg-Allardt C (1984) Vitamin D intake, sunlight exposure and 25-hydroxyvitamin D levels in the elderly during one year. Ann Nutr Metab 28:144–150PubMedGoogle Scholar
  31. 31.
    Rapuri PB, Kinyamu HK, Gallagher JC, Haynatzka V (2002) Seasonal changes in calciotropic hormones, bone markers, and bone mineral density in elderly women. J Clin Endocrinol Metab 87:2024–2032CrossRefPubMedGoogle Scholar
  32. 32.
    Chapuy MC, Schott AM, Garnero P, Hans D, Delmas PD, Meunier PJ (1996) Healthy elderly French women living at home have secondary hyperparathyroidism and high bone turnover in winter. J Clin Endocrinol Metab 81:1129–1133CrossRefPubMedGoogle Scholar
  33. 33.
    van der Wielen RP, Lowik MR, van den Berg H, de Groot LC, Haller J, Moreiras O, van Staveren WA (1995) Serum vitamin D concentrations among elderly people in Europe. Lancet 346:207–210CrossRefPubMedGoogle Scholar
  34. 34.
    Dawson-Hughes B, Harris SS, Dallal GE (1997) Plasma calcidiol, season and serum parathyroid hormone concentrations in healthy elderly men and women. Am J Clin Nutr 65:67–71PubMedGoogle Scholar
  35. 35.
    Perry HM, Horowitz M, Morley JE, Patrick P, Vellas B, Baumgartner R, Garry PJ (1999) Longitudinal changes in serum 25-hydroxyvitamin D in older people. Metabolism 48:1028–1032CrossRefPubMedGoogle Scholar
  36. 36.
    Preece M, Tomlinson S, Ribot CA, Pietrek J, Korn HT, Davies DM (1975) Studies on human vitamin D deficiency in man. QJM 44:5575–5589Google Scholar
  37. 37.
    Lips P (2001) Vitamin D deficiency and secondary hyperparathyroidism in the elderly: consequences for bone loss and fractures and therapeutic implications. Endocr Rev 22:477-501CrossRefPubMedGoogle Scholar
  38. 38.
    Glendenning P, Vasikaran SD (2002) Vitamin D status and redefining serum PTH reference range in the elderly. J Clin Endocrinol Metab 87:946–947CrossRefGoogle Scholar
  39. 39.
    Hollis BW (2000) Comparison of commercially available 125 I-based RIA methods for the determination of circulating 25-hydroxyvitamin D. Clin Chem 46:1657–1661PubMedGoogle Scholar
  40. 40.
    Vieth R (2000) Problems with direct 25-hydroxyvitamin D assays and the target amount of vitamin D nutrition desirable for patients with osteoporosis. Osteoporos Int 11:635–636CrossRefPubMedGoogle Scholar
  41. 41.
    Brot C, Jorgensen N, Madsen OR, Jensen LB, Sorensen OH (1999) Relationships between bone mineral density, serum vitamin D metabolites and calcium: phosphorus intake in healthy perimenopausal women. J Intern Med 245:509–516CrossRefPubMedGoogle Scholar
  42. 42.
    Souberbielle J-C, Cormier C, Kindermans C, Gao P, Cantor T, Forette F, Baulieu EE (2001) Vitamin D status and redefining serum parathyroid hormone reference range in the elderly. J Clin Endocrinol Metab 86:3086–3090CrossRefPubMedGoogle Scholar
  43. 43.
    Vieth R, Ladak Y, Walfish PG (2003) Age-related changes in the 25-hydroxyvitamin D versus parathyroid hormone relationship suggest a different reason why older adults require more vitamin D. J Clin Endocrinol Metab 88:185–191CrossRefPubMedGoogle Scholar

Copyright information

© Clinical Rheumatology 2005

Authors and Affiliations

  • Jane Zochling
    • 1
  • Jian Sheng Chen
    • 1
  • Markus Seibel
    • 2
  • Jennifer Schwarz
    • 3
  • Ian D. Cameron
    • 4
  • Robert G. Cumming
    • 5
  • Lyn March
    • 6
  • Philip N. Sambrook
    • 7
  1. 1.Institute of Bone and Joint ResearchUniversity of SydneySydneyAustralia
  2. 2.Anzac Research InstituteUniversity of SydneySydneyAustralia
  3. 3.Department of RheumatologyRoyal North Shore HospitalSt LeonardsAustralia
  4. 4.Department of Rehabilitation MedicineUniversity of SydneySydneyAustralia
  5. 5.School of Public Health and Centre for Education and Research on AgeingUniversity of SydneySydneyAustralia
  6. 6.Institute of Bone and Joint ResearchRoyal North Shore HospitalSt LeonardsAustralia
  7. 7.Institute of Bone and Joint Research, Royal North Shore HospitalUniversity of SydneySt LeonardsAustralia

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