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Defining Hypovitaminosis D in the Elderly

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Nutritional Aspects of Osteoporosis

Part of the book series: Proceedings in the Serono Symposia USA Series ((SERONOSYMP))

Abstract

Since the advent of assays for serum 25-hydroxyvitamin D (25[OH]D) many studies have reported a high prevalence of hypovitaminosis D in the elderly (1). It is essential to set criteria for hypovitaminosis D so that the means to exceed this level can be established and the progression to vitamin D deficiency requiring pharmacologic intervention averted. Definition of hypovitaminosis D as judged by assay of serum 25(OH)D poses many questions. Should the reference range for the elderly be adjusted-seasonally, and should it be similar to the values found in young adults in countries of similar latitude? Should the cut-off point be the lowest value seen in young or elderly healthy adults in summertime? Should the cut-off point be the serum 25(OH)D concentration that is associated with parathyroid hormone (PTH) levels in the young healthy adults? Should the duration of exposure to the lowest level of serum 25(OH)D be taken into consideration? Should the cut-off point be tempered by different levels of calcium intake, both from basal diet and calcium supplemented intake? Finally, should the cut-off be that which is associated with evidence of diminished fracture rate or with the improvement in bone remodeling balance?

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References

  1. McKenna MJ. Differences of vitamin D status between various countries in young adults and the elderly. Am J Med 1992; 93: 69–77.

    Article  PubMed  CAS  Google Scholar 

  2. Parfitt AM, Gallagher JC, Heaney RP, Johnston CC, Neer P, Whedon G. Vitamin D and bone disease in the elderly. Am J Clin Nutr 1982; 36: 1014–31.

    PubMed  CAS  Google Scholar 

  3. Preece MA, Tomlinson S, Ribot CA, Pietrek J, Korn HT, Davies DM, et al. Studies on vitamin D deficiency in man. Q J Med 1975; 44: 575–89.

    PubMed  CAS  Google Scholar 

  4. Peacock M, Selby PL, Francis RM, Brown WB, Hordon L. Vitamin D deficiency, insufficiency and intoxication. What do they mean? In: Norman AW, Schaefer K, Grigoleit HG, Herrath DV, eds. Vitamin D. Chemical, biochemical and clinical update. Berlin: Walter de Gruyter, 1985: 569–70.

    Google Scholar 

  5. Heaney RP. Calcium, bone health and osteoporosis. Bone and mineral research/4. Amsterdam: Elsevier, 1986: 255–301.

    Google Scholar 

  6. Chapuy MC, Arlot ME, Duboeuf F, Brun J, Crouzet B, Arnaud S, et al. Vitamin D3 and calcium to prevent hip fractures in elderly women. N Engl J Med 1992; 327: 1637–42.

    Article  PubMed  CAS  Google Scholar 

  7. Freaney R, McBrinn Y, McKenna MJ. Secondary hyperparathyroidism in elderly people: combined effect of renal insufficiency and vitamin D deficiency. Am J Clin Nutr 1993; 58: 187–91.

    PubMed  CAS  Google Scholar 

  8. Dawson-Hughes B. Vitamin D intake and supplementation in the elderly. Burckhardt P, Heaney RP, eds. Nutritional aspects of osteoporosis ‘84. Rome: Ares-Serono Symposia, 1994: 317–23.

    Google Scholar 

  9. Dawson-Hughes B, Harris SS, Dallal GT. Plasma calcidiol, season and parathyroid hormone concentrations in healthy elderly men and women. Am J Clin Nutr 1997; 65: 67–71.

    PubMed  CAS  Google Scholar 

  10. Wood PJ. The measurement of parathyroid hormone. Ann Clin Biochem 1992; 29: 11–21.

    PubMed  CAS  Google Scholar 

  11. Jongen MJ, Van Ginkel FC, van der Vijgh WJF, Kuiper S, Netelenbos JC, Lips P. An international comparison of vitamin D metabolites measurements. Clin Chem 1984; 30: 399–403.

    PubMed  CAS  Google Scholar 

  12. Rao DS, Villanueva A, Mathews M, Pumo B, Frame B, Kleerekoper M, et al. Histologic evolution of vitamin D depletion in patients with intestinal malabsorption or dietary deficiency. In: Frame B, Potts JT, Jr, eds. Amsterdam: Excerpta Medica, 1983: 224–6.

    Google Scholar 

  13. Parfitt AM. Osteomalacia and related disorders. In: Avioli LV, Krane SM, eds. Metabolic bone disease and clinically related disorders. 2nd ed. Philadelphia: WB Saunders, 1990: 329–96.

    Google Scholar 

  14. Bisballe S, Eriksen EF, Melsen F, Mosekilde L, Sörensen DH, Hassov I. Osteopenia and osteomalacia after gastrectomy: interrelationships between biochemical markers of bone remodeling, vitamin D metabolites and bone histomorphometry. Gut 1991; 32: 1303–7.

    Article  PubMed  CAS  Google Scholar 

  15. Garnero P, Sornay-Rendu E, Chapuy MC, Delmas P. Increased bone turnover in late postmenopausal women is a major determinant of osteoporosis. J Bone Miner Res 1996; 11: 337–49.

    Article  PubMed  CAS  Google Scholar 

  16. Chapuy MC, Schott AM, Garnero P, Hans D, Delmas PD, Meunier PJ and Epidos Study Group. Healthy elderly women living at home have secondary hyperparathyroidism and high bone turnover in winter. J Clin Endocrinol Metab 1996; 81: 1129–33.

    Article  PubMed  CAS  Google Scholar 

  17. Rosen CJ, Morrison A, Zhou H, Storm D, Hunter SJ, Musgrave K, et al. Elderly women in Northern New England exhibit seasonal changes in bone mineral density and calciotrophic hormones. Bone Miner 1994; 25: 83–92.

    Article  PubMed  CAS  Google Scholar 

  18. 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.

    PubMed  CAS  Google Scholar 

  19. McKane WR, Khosla S, Egan KS, Robins SP, Burritt MF, Riggs BL. Role of calcium intake in modulating age-related increases in parathyroid function and bone resorption. J Clin Endocrinol Metab 1996; 81: 1699–703.

    Article  PubMed  CAS  Google Scholar 

  20. Benhamou CL, Tourliere D, Gauvain JB, Picaper G, Audran M, Jallet P. Calciotrophic hormones in elderly people with and without hip fracture. Osteoporos Int 1995; 5: 103–7.

    Article  PubMed  CAS  Google Scholar 

  21. Dawson-Hughes B, Dallal GE, Krall EA, Harris S, Sokoll LJ, Falconer G. Effect of vitamin D supplementation on wintertime and overall bone loss in healthy postmenopausal women. Ann Intern Med 1991; 115: 505–12.

    PubMed  CAS  Google Scholar 

  22. Himmelstein S, Clemens T, Rubin A, Lindsay R. Vitamin D supplementation in elderly nursing home residents increases 25(OH)D but not 1,25(OH)D2. Am J Clin Nutr 1990; 52: 701–6.

    PubMed  CAS  Google Scholar 

  23. Takeuchi A, Okano T, Ishida Y, Kobayashi T. Dietary vitamin D intake and vitamin D nutritional status in the healthy young and institutionalised elderly people. In: Burckhardt P, Heaney RP, eds. Nutritional aspects of osteoporosis ‘84. Rome: Ares-Serono Symposia, 1995: 351–5.

    Google Scholar 

  24. Prince RL, Dick IM, Lemmon J, Randell D. The pathogenesis of age-related osteoporotic fracture: effects of dietary calcium deprivation. J Clin Endocrinol Metab 1997; 82: 260–4.

    Article  PubMed  CAS  Google Scholar 

  25. Gloth FM, Gunberg CM, Hollis BW, Haddad JG, Tobin JD. Vitamin D deficiency in homebound elderly persons. JAMA 1995; 274: 1683–6.

    Article  PubMed  Google Scholar 

  26. Stein MS, Scherer SC, Walton SL, Gilbert RE, Ebeling PR, Flicker L, et al. Risk factors for secondary hyperparathryoidism in a nursing home population. Clin Endocrinol 1996; 44: 375–83.

    Article  CAS  Google Scholar 

  27. Kipen E, Helme RD, Ward JD, Flicker L. Bone density, vitamin D nutrition and parathyroid hormone level women with dementia. J Am Geriatr Soc 1995; 43: 1088–91.

    PubMed  CAS  Google Scholar 

  28. Sorva A, Risetli L, Välimäki M, Tilvis R. Effect of vitamin D and calcium on markers of bone metabolism in geriatric patients with low serum 25-hydroxyvitamin D levels. Calcif Tissue Int 1991; 49: 588–9.

    Article  Google Scholar 

  29. Ooms ME, Roos JC, Bezemer D, Van der Vijgh WJF, Bouter LM, Lips P. Prevention of bone loss by vitamin D supplementation in elderly women: a randomised double-blind trial. J Clin Endocrinol Metab 1995; 80: 1052–8.

    Article  PubMed  CAS  Google Scholar 

  30. Brazier M, Kamel S, Malmer M, Agbomson F, Elesper I, Garabedien M, et al. Markers of bone remodelling in the elderly: effect of vitamin D insufficiency and its correction. J Bone Miner Res 1995; 11: 1753–61.

    Google Scholar 

  31. Kamel S, Brazier M, Rogez JC, Vincent O, Maamer M, Desmet G, et al. Different responses of free and peptide-bound cross-links to vitamin D and calcium supplementation in elderly women with vitamin D insufficiency. J Clin Endocrinol Metab 1996; 81: 3717–21.

    Article  PubMed  CAS  Google Scholar 

  32. Prestwood KM, Pannullo AM, Kenny AM, Pilbeam CC, Raisz LG. The effect of a short course of calcium and vitamin Don bone turnover in older women. Osteoporos Int 1996; 6: 314–9.

    Article  PubMed  CAS  Google Scholar 

  33. Heikinheimo RJ, Inkovaara JA, Jäntti PO, Mäki-Jokela PL, Rajala SA, Sievänen H. In: Burckhardt P, Heaney RP, eds. Nutritional aspects of osteoporosis ‘84. Rome: Ares-Serono Symposia, 1995: 335–9.

    Google Scholar 

  34. McBrinn Y, Murray B, Freaney R, Keating D, McKenna MJ. Secondary hyperparathyroidism in elderly subjects with hypovitaminosis D: prevalence and correction. Ir J Med Sci 1995; 164: 4.

    Article  Google Scholar 

  35. Freaney R, Eriksen E, McBrinn Y, Murry B, McKenna MJ. Vitamin D status and bone resorption in osteoporosis. Bone 1997; 20 (4S): 26S.

    Google Scholar 

  36. Chapuy MC, Preziosi P, Maamer M, Arnaud S, Galan P, Herrberg S, et al. Prevalence of vitamin D insufficiency in an adult population. Osteoporos Int 1997; 7: 439–43.

    Article  PubMed  CAS  Google Scholar 

  37. Guillemant J, Cabrol S, Allemandou A, Peres G, Guillemant S. Vitamin D-dependent seasonal variation of PTH in growing male adolescents. Bone 1995; 17: 513–6.

    Article  PubMed  CAS  Google Scholar 

  38. Oliveri MB, Ladizesky M, Mautalen CA, Alonso A, Martinez L. Seasonal variations of 25-hydroxyvitamin D and parathyroid hormone in Ushuaia (Argentina), the southernmost city of the world. Bone Miner 1993; 20: 99–108.

    Article  PubMed  CAS  Google Scholar 

  39. Chapuy MC, Meunier PJ. Prevention of secondary hyperparathyroidism and hip fracture in elderly women with calcium and vitamin D3 supplements. Osteoporos Int 1996;6 Suppl 3: 560–3.

    Google Scholar 

  40. van der Wielen RP, Löwik MRH, van den Berg H, De Groot LC, Haller J, Moreiras O, et al. Serum vitamin D concentrations among elderly people in Europe. Lancet 1995; 346: 207–10.

    Article  PubMed  Google Scholar 

  41. Keane EM, Rochfort A, Cox J, McGovern D, Coakely D, Walsh JB. Vitamin Dfortified liquid milk—highly effective method of vitamin D administration for house-bound and institutionalised elderly. Gerontology 1992; 38: 280–4.

    Article  PubMed  CAS  Google Scholar 

  42. McKenna MJ, Freaney R, Byrne P, McBrinn Y, Murray B, Kelly M, et al. Safety and efficacy of increasing wintertime vitamin D and calcium intake by milk fortification. Q J Med 1995; 88: 895–8.

    CAS  Google Scholar 

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Authors
  1. Malachi J. McKenna
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  2. Rosemarie Freaney
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Editor information

Editors and Affiliations

  1. University Hospital, CHUV, CH-1011, Lausanne, Switzerland

    Peter Burckhardt M.D.

  2. USDA Nutrition Center at Tufts, 711 Washington Street, 02111, Boston, MA, USA

    Bess Dawson-Hughes M.D.

  3. The Clayton Foundation, Creighton University, 601 N. 30th Street, Suite 4841, 68131, Omaha, NE, USA

    Robert P. Heaney M.D.

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© 1998 Springer-Verlag New York, Inc.

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McKenna, M.J., Freaney, R. (1998). Defining Hypovitaminosis D in the Elderly. In: Burckhardt, P., Dawson-Hughes, B., Heaney, R.P. (eds) Nutritional Aspects of Osteoporosis. Proceedings in the Serono Symposia USA Series. Springer, New York, NY. https://doi.org/10.1007/978-1-4612-2228-6_30

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  • DOI: https://doi.org/10.1007/978-1-4612-2228-6_30

  • Publisher Name: Springer, New York, NY

  • Print ISBN: 978-1-4612-7463-6

  • Online ISBN: 978-1-4612-2228-6

  • eBook Packages: Springer Book Archive

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