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