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Part of the book series: Human Health Handbooks ((HHH,volume 4))

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Abstract

Vitamin D is a hormone with multiple biological activities that are essential for normal functioning of many biological systems including bone, skeletal muscle, brain and heart. The estimated worldwide prevalence of vitamin D deficiency among the elderly is of about 50 % and, because of the demographic expansion, vitamin D deficiency is becoming very important for public health. Vitamin D status has been studied in all continents and most countries over the world. Vitamin D deficiency in adults is highly prevalent especially in the Middle-East and Asia. In this chapter, we explore potential mechanism which vitamin D could influence the muscle-skeletal system and increase risk of falling. In particular, we propose an array of mechanisms for the increased risk of falling secondary to low vitamin D. These mechanisms can be directly or indirectly related to sarcopenia (defined as reduced muscle mass with age in older persons) – and are implicated in the genesis of osteoporotic fractures. Although we mention all therapeutic options for treatment of vitamin D deficiency, we recognize that in a recent Cochrane review addressing the relationship between vitamin D and mortality, only low vitamin D3 levels were significantly associated with high risk of death whereas vitamin D2, alfacalcidol, or calcitriol were not. Therefore, the treatment of choice for vitamin D deficiency should be cholecalciferol, also known as vitamin D3. Supplementation with 1000 IU per day still remains the treatment of choice of vitamin D supplementation.

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Abbreviations

1,25(OH)2D:

1,25-dihydroxyvitamin D

25(OH)D:

25-hydroxyvitamin D

BMD:

Bone mineral density

CI:

Confidence interval

OR:

Odds ratio

RR:

Relative risk

VDR:

Vitamin D receptor

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Correspondence to F. Lauretani .

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Ronald Ross Watson

Appendices

Key facts

  • The estimated worldwide prevalence of vitamin D deficiency among the elderly is of about 50 %.

  • Vitamin D deficiency in adults is highly prevalent especially in the Middle-East and Asia.

  • Low vitamin D3 has been associated with significant reduction of mortality in older persons.

  • A cycle for increasing risk for falling in older persons with low vitamin D has been hypothesized and reported.

  • Vitamin D supplementation should be performed daily with at least 1000 UI.

Summary points

  • The estimated worldwide prevalence of vitamin D deficiency among the elderly is of about 50 %. Vitamin D deficiency in adults is highly prevalent especially in the Middle-East and Asia.

  • The Institute of Medicine has recently recommended that serum 25-hydroxyvitamin D is adequate when it is higher than 50 nmol/l, which is similar to the recommendation of the Standing Committee of Europe Doctors (www.cpme.eu).

  • A recent Cochrane review studying the relationship between vitamin-D and mortality reported that when the different forms of vitamin D are assessed separately, only low vitamin D3 levels significantly predict mortality, whereas vitamin D2, alfacalcidol, or calcitriol do not.

  • The mechanism by which vitamin D deficiency could influence the muscle-skeletal system and can produce an increased risk for falling is described. We propose in older persons a vicious circle induced by low vitamin-D. Sarcopenia, altered cortical bone, and subsequent falls all contribute to osteoporotic fractures.

  • Supplementation with cholecalciferol 1000 IU per day still remains the treatment of choice of vitamin D supplementation.

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Lauretani, F., Maggio, M., Ruggiero, C., Ceda, G.P., Ferrucci, L. (2013). Vitamin D in health of seniors. In: Watson, R.R. (eds) Handbook of vitamin D in human health. Human Health Handbooks, vol 4. Wageningen Academic Publishers, Wageningen. https://doi.org/10.3920/978-90-8686-765-3_2

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