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


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.


Calcium Creatinine Parathyroid hormone Vitamin D 



This study was supported by an NHMRC grant and the Arthritis Foundation.


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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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