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Supplementation With Vitamin D and Calcium in Long-Term Care Residents

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Vitamin D deficiency is a common finding in institutionalized older persons. Vitamin D–deficient elderly persons are at higher risk of falls and fractures. Long-term care residents should be considered at high risk of vitamin D deficiency and therefore vitamin D supplementation is highly recommended in this population. The minimal effective dose is 800 IU per day. It is recommended that vitamin D supplementation should be implemented in all patients in residential aged care facilities. In addition to vitamin D, calcium supplementation has shown to enhance the effect of vitamin D on bone. Calcium intake should be optimized (1200–1500 mg per day recommended) and supplementation offered to those with inadequate intake. The addition of calcium depends on tolerance, history of kidney stones, and emerging data regarding its cardiovascular safety.

Section snippets

The Basics of Vitamin D and Calcium

Vitamin D plays an integral role in the maintenance of calcium and phosphate homeostasis. The predominant role of vitamin D in calcium homeostasis is the regulation of intestinal calcium absorption.13 Without vitamin D, only 10% to 15% of dietary calcium and about 60% of phosphorus is absorbed. The presence of sufficient amounts of vitamin D can increase the efficiency of intestinal calcium absorption to 30% to 40% and phosphorus absorption to approximately 80%.14, 15, 16

In bone, vitamin D has

Bad Outcomes in Vitamin D Deficiency

Several studies have shown that vitamin D deficiency is strongly associated with a higher risk of falls and fractures.2, 24 Cross-sectional studies have supported a positive relationship between serum concentrations of 25(OH)D and BMD.25, 26, 27, 28 A positive relationship between serum 25(OH)D and BMD of the hip was also observed in middle-aged women in the United Kingdom (45–65 years)29 and in elderly women in New Zealand;29 however, most of these studies have been performed in

Measurement of Vitamin D and Calcium in Long-Term Care Residents

Vitamin D deficiency is highly prevalent in LTCI41 and contributes to falls and fractures in the elderly population living in this setting.42, 43 Considering that approximately 76% of institutionalized older persons have low concentrations of vitamin D,41, 42, 43 the cost-benefit of quantifying serum concentrations in LTCI residents remain uncertain. However, as patients with serum concentrations lower than 25 nmol/L would benefit from higher doses of vitamin D supplementation,43 quantification

Therapeutic Benefits of Vitamin D and Calcium

There is evidence that vitamin D supplementation is beneficial for most residents at LTCI.43 Benefits include prevention of falls and fractures. Cholecalciferol (vitamin D3) should be administered at a dosage of 800 IU per day or higher.36, 46, 47, 48 This is relatively inexpensive and achieves serum 25(OH) D concentrations higher than 50 nmol/L in most subjects, so can be implemented without follow-up measurement of serum 25(OH) D concentrations, which can be relatively expensive. In fact, for

Toxicity and Side Effects

Although vitamin D supplementation is generally considered to be safe, toxic effects may occur when circulating 25(OH)D concentrations exceed 350 to 400 nmol/L.7 This raises the question of whether intake of vitamin D above the recommended daily intake leads to toxicity. Overall, vitamin D intake above current reference intakes is well tolerated. A recent meta-analysis found only a nonsignificant increase in the risk of hypercalcemia and hypercalciuria in vitamin D–supplemented individuals when

Conclusion

In conclusion, vitamin D is an essential factor required for appropriate bone and muscle function. Vitamin D deficiency is highly prevalent in LTCI and therefore should be identified and treated. Considering the benefits of vitamin D supplementation and the low risks of toxicity and side effects, vitamin D supplementation should be established as a common practice in the nursing home setting. Table 1 describes a suggested approach to vitamin D and calcium supplementation in LTCI. The recent

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