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      Clinical Interventions in Aging (submit here)

      This international, peer-reviewed Open Access journal by Dove Medical Press focuses on prevention and treatment of diseases in people over 65 years of age. Sign up for email alerts here.

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      Response to vitamin D and depression in geriatric primary care patients

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          Abstract

          Dear editor Lapid et al recently published an interesting article in Clinical Interventions in Aging entitled: “Vitamin D and depression in geriatric primary care patients”.1 Their conclusion that “lower vitamin D levels were associated with depression” was based on a study that analyzed the patients in primary care internal medicine “who had at least one total serum 25-hydroxyvitamin D [25(OH)D] level from 2004–2008. For those with multiple serum 25(OH)D measurements, authors used the index of first measurements”.1 25-hydroxyvitamin D is the major circulating form of vitamin D that has a half-life of approximately 2–3 weeks.2 Adams et al showed that the rate at which 25(OH)D declined among people who have taken high amounts of vitamin D supplements and subsequently abstained from supplements, is approximately 10.7 ± 3.0 nmol/L per month.3 Therefore, diverse transitory disorders, occurring about once a month before the time of the first serum 25(OH)D measurement, can modify total vitamin D concentration. For example: Patients on medications affecting vitamin D metabolism, eg, antibiotics – erythromycin, clotrimazole, rifampicin; antiretroviral drugs – ritononavir, saquinavir, histamine H2-receptor antagonist – cimetidine, aldosterone receptor antagonists – spironolactone, or current steroid therapy.4 Acute diseases of different etiology (eg, infectious, gastrointestinal upset, hepatic impairment, or serious allergic reactions), and surgical treatment.5 A sudden change in lifestyle such as limitation of daily physical activity, a change in diet and nutrition (including the number of meals per day), alcohol or medicinal product abuse.6 Although the authors point out that this was a retrospective cross-sectional study among “geriatric patients seen in the primary care setting”,1 in our opinion, it would be necessary to complete the data of patients (such as medical history, physical examination). This data should be used for choosing the proper study group.

          Most cited references5

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          Gains in bone mineral density with resolution of vitamin D intoxication.

          Vitamin D intoxication is associated with the mobilization of skeletal calcium. To ascertain how the resolution of vitamin D intoxication affects bone density. Case series. Referral service for metabolic bone disease in a tertiary care teaching hospital. Four patients with osteoporosis who were each using several nonprescription dietary supplements and were found to have fasting hypercalciuria. Discontinuation of use of dietary supplements. Serial measurement of serum levels of 25-hydroxyvitamin D, ratio of fasting urinary calcium to creatinine, and bone mineral density for 3 years. Discontinuation of use of dietary supplements resulted in the normalization of serum levels of 25-hydroxyvitamin D, the normalization of the ratio of urinary calcium to creatinine, and a mean annual increase in bone mineral density (+/- SD) of 1.9% +/- 0.5%. Occult vitamin D intoxication was detected in patients who were using dietary supplements that contained an unadvertised high level of vitamin D. Resolution of vitamin D intoxication was associated with a rebound in bone mineral density.
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            Vitamin D and depression in geriatric primary care patients

            Purpose: Vitamin D deficiency is common in the elderly. Vitamin D deficiency may affect the mood of people who are deficient. We investigated vitamin D status in older primary care patients and explored associations with depression. Patients and methods: A cross-sectional study was conducted and association analyses were performed. Primary care patients at a single academic medical center who were ≥60 years with serum total 25-hydroxyvitamin D (25[OH]D) levels were included in the analysis. The primary outcome was a diagnosis of depression. Frailty scores and medical comorbidity burden scores were collected as predictors. Results: There were 1618 patients with a mean age of 73.8 years (±8.48). The majority (81%) had optimal (≥25 ng/mL) 25(OH)D range, but 17% met mild-moderate (10–24 ng/mL) and 3% met severe (<10 ng/mL) deficiencies. Those with severe deficiency were older (P < 0.001), more frail (P < 0.001), had higher medical comorbidity burden (P < 0.001), and more frequent depression (P = 0.013). The 694 (43%) with depression had a lower 25(OH)D than the nondepressed group (32.7 vs 35.0, P = 0.002). 25(OH)D was negatively correlated with age (r = −0.070, P = 0.005), frailty (r = −0.113, P < 0.001), and medical comorbidity burden (r = −0.101, P < 0.001). A 25(OH)D level was correlated with depression (odds ratio = 0.990 and 95% confidence interval [CI] = 0.983–0.998, P = 0.012). Those with severe vitamin D deficiency were twice as likely to have depression (odds ratio = 2.093 with 95% CI 1.092–4.011, P = 0.026). Conclusion: Vitamin D deficiency was present in a fifth of this older primary care population. Lower vitamin D levels were associated with depression. Those with severe deficiency were older and more likely had depression.
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              Serum 25-hydroxyvitamin D is a reliable indicator of vitamin D status.

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                Author and article information

                Journal
                Clin Interv Aging
                Clin Interv Aging
                Clinical Interventions in Aging
                Dove Medical Press
                1176-9092
                1178-1998
                2013
                2013
                03 July 2013
                : 8
                : 825-827
                Affiliations
                Department of Internal Medicine, Silesian Medical University, Katowice, Poland
                [1 ]Division of Outpatient Consultation, Department of Psychiatry and Psychology, Rochester, Minnesota, USA
                [2 ]Division of Biomedical Statistics and Informatics, Department of Health Sciences Research, Rochester, Minnesota, USA
                [3 ]Division of Primary Care Internal Medicine, Department of Medicine, Mayo Clinic, Rochester, Minnesota, USA
                Author notes
                Correspondence: Małgorzata Muc-Wierzgoń, Department of Internal Medicine, Silesian Medical University, 41-902 Bytom Żeromskiego 7 St, Poland Tel +48 32 281 2122, Email mwierzgon@ 123456sum.edu.pl
                Article
                cia-8-825
                10.2147/CIA.S48703
                3704303
                23861582
                ce341298-b68b-48b5-95c5-abe70cd8c8da
                © 2013 Muc-Wierzgoń et al, publisher and licensee Dove Medical Press Ltd

                This is an Open Access article which permits unrestricted noncommercial use, provided the original work is properly cited.

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                Health & Social care

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