Vitamin D deficiency in elderly: Risk factors and drugs impact on vitamin D status

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Abstract

Introduction:

Vitamin D (VD) deficiency is a major public health problem worldwide. In spite of its high prevalence, particularly among elderly people, VD deficiency is still underestimated by many physicians. Increasingly, VD deficiency is associated with several known geriatric syndromes.

Methods:

The study sample consisted of 125 patients, aged 75 years and older, admitted to the acute geriatric unit. The plausible association between the serum 25-hydroxyvitamin D [25(OH)D] level and patient age, sex, body mass index, renal function, cholecystectomy history, and the prescribed drugs had been investigated. The Fisher's exact test was used to conduct the statistical analysis of data.

Results:

Surprisingly, furosemide treatment was correlated with normal 25(OH)D levels and an increased incidence of secondary hyperparathyroidism. Unlike the other four parameters mentioned above, our data showed that only the patient sex exhibited a significant association with 25(OH)D level as elderly males suffered from a serious VD deficiency as compared to elderly females.

Conclusion:

Old age is an independent risk factor for VD deficiency. The supplementary dose of VD should be precisely defined to achieve the optimal serum 25(OH)D level in elderly people. The definition of the normal serum 25(OH)D threshold in elderly furosemide-treated patients is worth of further studies.

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Most cited references 67

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Clinical practice. Vitamin D insufficiency.

Clifford Rosen (2011)

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Vitamin D and musculoskeletal health, cardiovascular disease, autoimmunity and cancer: Recommendations for clinical practice.

Jean-Claude Souberbielle, Jean-Jacques Body, Joan Lappe … (2010)

There is increasing evidence that, in addition to the well-known effects on musculoskeletal health, vitamin D status may be related to a number of non-skeletal diseases. An international expert panel formulated recommendations on vitamin D for clinical practice, taking into consideration the best evidence available based on published literature today. In addition, where data were limited to smaller clinical trials or epidemiologic studies, the panel made expert-opinion based recommendations. Twenty-five experts from various disciplines (classical clinical applications, cardiology, autoimmunity, and cancer) established draft recommendations during a 2-day meeting. Thereafter, representatives of all disciplines refined the recommendations and related texts, subsequently reviewed by all panelists. For all recommendations, panelists expressed the extent of agreement using a 5-point scale. Recommendations were restricted to clinical practice and concern adult patients with or at risk for fractures, falls, cardiovascular or autoimmune diseases, and cancer. The panel reached substantial agreement about the need for vitamin D supplementation in specific groups of patients in these clinical areas and the need for assessing their 25-hydroxyvitamin D (25(OH)D) serum levels for optimal clinical care. A target range of at least 30 to 40 ng/mL was recommended. As response to treatment varies by environmental factors and starting levels of 25(OH)D, testing may be warranted after at least 3 months of supplementation. An assay measuring both 25(OH)D(2) and 25(OH)D(3) is recommended. Dark-skinned or veiled individuals not exposed much to the sun, elderly and institutionalized individuals may be supplemented (800 IU/day) without baseline testing. Copyright 2010 Elsevier B.V. All rights reserved.

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Association of vitamin D deficiency with heart failure and sudden cardiac death in a large cross-sectional study of patients referred for coronary angiography.

Stefan Pilz, Winfried März, Britta Wellnitz … (2008)

Vitamin D has been shown to influence cardiac contractility and myocardial calcium homeostasis. We aimed to elucidate whether insufficient vitamin D status is associated with heart failure and sudden cardiac death (SCD). We measured 25-hydroxyvitamin D [25(OH)D] levels in 3299 Caucasian patients who were routinely referred to coronary angiography at baseline (1997-2000). The main outcome was cross-sectional associations of 25(OH)D levels with measures of heart failure and Cox proportional hazard ratios for deaths due to heart failure and for SCD according to vitamin D status. 25(OH)D was negatively correlated with N-terminal pro-B-type natriuretic peptide and was inversely associated with higher New York Heart Association classes and impaired left ventricular function. During a median follow-up time of 7.7 yr, 116 patients died due to heart failure and 188 due to SCD. After adjustment for cardiovascular risk factors, the hazard ratios (with 95% confidence intervals) for death due to heart failure and for SCD were 2.84 (1.20-6.74) and 5.05 (2.13-11.97), respectively, when comparing patients with severe vitamin D deficiency [25(OH)D or =75 nmol/liter]. In all statistical analyses, we obtained similar results with 25(OH)D and with 1,25-dihydroxyvitamin D. Low levels of 25(OH)D and 1,25-dihydroxyvitamin D are associated with prevalent myocardial dysfunction, deaths due to heart failure, and SCD. Interventional trials are warranted to elucidate whether vitamin D supplementation is useful for treatment and/or prevention of myocardial diseases.

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Author and article information

Journal

Journal ID (nlm-ta): Avicenna J Med

Journal ID (iso-abbrev): Avicenna J Med

Journal ID (publisher-id): AJM

Title: Avicenna Journal of Medicine

Publisher: Medknow Publications & Media Pvt Ltd (India )

ISSN (Print): 2231-0770

ISSN (Electronic): 2249-4464

Publication date (Print): Oct-Dec 2018

Volume: 8

Issue: 4

Pages: 139-146

Affiliations

[1] Department of Geriatric Medicine, Hospital of Pierre Oudot, Bourgoin-Jallieu City, Isère Department, Region of Auvergne-Rhône-Alpes, France

[1 ] Department of Ophthalmology and Visual Sciences, University of British Columbia, Vancouver, British Columbia, Canada

Author notes

Address for correspondence: Dr. Hasan Kweder, Hospital of Pierre Oudot, Bourgoin-Jallieu, France. E-mail: hasanisla@ 123456hotmail.com

Article

Publisher ID: AJM-8-139

DOI: 10.4103/ajm.AJM_20_18

PMC ID: 6178567

PubMed ID: 30319955

SO-VID: 1ff5e3bb-5aab-49fe-b788-4646618e5e42

License:

This is an open access journal, and articles are distributed under the terms of the Creative Commons Attribution-NonCommercial-ShareAlike 4.0 License, which allows others to remix, tweak, and build upon the work non-commercially, as long as appropriate credit is given and the new creations are licensed under the identical terms.

Vitamin D deficiency in elderly: Risk factors and drugs impact on vitamin D status

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Abstract

Introduction:

Methods:

Results:

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Hogrefe Medicine

Most cited references 67

Clinical practice. Vitamin D insufficiency.

Vitamin D and musculoskeletal health, cardiovascular disease, autoimmunity and cancer: Recommendations for clinical practice.

Association of vitamin D deficiency with heart failure and sudden cardiac death in a large cross-sectional study of patients referred for coronary angiography.

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