Bones and fractures
Henry J. Woodford in Essential Geriatrics, 2022
Vitamin D is not a true vitamin because most of it is normally created within the skin by the action of ultraviolet light from the sun on 7-dehydroxycholesterol to form colecalciferol. The remainder comes from dietary intake (10–20%).1 If sunlight exposure is inadequate (NB reduced effect in people with darker skin or through sunscreen use) then intestinal absorption becomes more important. Dietary sources include oily fish, eggs, red meat, liver and some fortified foods (e.g. breakfast cereals and fat spreads). This precursor is then converted to 25-hydroxycolecalciferol (25OHD) in the liver. This is further hydroxylated, mainly in the kidney, to form 1,25-hydroxycolecalciferol (1,25(OH)2D, also known as ‘calcitriol'), which is the active form of vitamin D (maintained by rising PTH). The main actions of vitamin D are on the bowel and on bone. In the bowel it causes a rise in both calcium and phosphate absorption through increasing binding proteins in the intestinal epithelial cells. Its actions on bone enhance mineralisation.
Herbal and Supplement Use in Pain Management
Sahar Swidan, Matthew Bennett in Advanced Therapeutics in Pain Medicine, 2020
Dose:Fibromyalgia: preliminary clinical research suggests that taking cholecalciferol reduces the pain that fibromyalgia patients experience.121 The greatest effects were in patients who also had low serum levels of vitamin D compared with that of placebo. Quality of life was not affected.121 The dose depended on the patient’s plasma vitamin D status, with patients taking 2400 IU daily if calcifediol levels were <60 nmol/L or 1200 IU daily if serum calcifediol were 60–80 nmol/L at baseline. Supplementation was conducted to achieve and maintain blood levels between 32 and 48 ng/mL for 20 weeks.121
Fat-Soluble Vitamins
Luke R. Bucci in Nutrition Applied to Injury Rehabilitation and Sports Medicine, 2020
Vitamin D therapy is in use for osteomalacia and rickets. Large doses of 10,000 to 300,000 IU daily of cholecalciferol have been used.497 However, increasing use is being made of 1,25OHD at small oral doses with equivalent results. Prevention of steroid-induced osteopenia may be prevented by large doses of vitamin D2, but results have not been replicated.502 A link between vitamin D metabolism and osteoporosis is still being explored. This has ramifications for amenorrheic female athletes with bone loss. At this time, it is unknown if vitamin D supplements would aid in repletion of bone mass in amenorrheic athletes. Likewise, the effects of vitamin D supplements on fracture healing in humans are not fully known. Topical application of 5 ng per wound per day of 1,25OHD to skin punch biopsies in rats led to significant acceleration of wound closure, accomplished in the first 2 d postwounding.504
Vitamin D in the development and progression of alzheimer’s disease: implications for clinical management
Published in Expert Review of Neurotherapeutics, 2021
Francesco Panza, Maddalena La Montagna, Luisa Lampignano, Roberta Zupo, Ilaria Bortone, Fabio Castellana, Rodolfo Sardone, Luisa Borraccino, Vittorio Dibello, Emanuela Resta, Mario Altamura, Antonio Daniele, Madia Lozupone
Vitamin D3, also known as cholecalciferol, is one of the five forms of vitamin D produced by the skin when exposed to sunlight [ultraviolet B (UVB) light]; it is also found in some foods and can be taken as a dietary supplement. Vitamin D3 is converted in the liver to 25-hydroxyvitamin D [25(OH)D or calcifediol], a form of vitamin D3 whose values are measured in the blood and which is then converted in the kidney to the active form 1◽,25-dihydroxyvitamin D3 [1,25(OH)2D3 or calcitriol]. Low serum 25(OH)D concentrations have been associated with cognitive disorders among older adults [9–12]. The detection of hydroxylases for vitamin D activation and vitamin D receptors in neurons and glia suggested that vitamin D might have a role in cognition [13]. Intriguingly, vitamin D, particularly its active form calcitriol, has recently emerged as a new, promising agent for combating AD [14,15]. The aim of the present article was to provide a comprehensive review of the role of vitamin D in the development and progression of AD, considering its physiological role in the brain, with a focus on existing preclinical and clinical studies, and their possible implications on the clinical management of the disease.
Factors associated with the number of clinical pharmacy recommendations: findings from an observational study in geriatric inpatients
Published in Acta Clinica Belgica, 2021
Lorenz Van Der Linden, Julie Hias, Karolien Walgraeve, Silke Loyens, Johan Flamaing, Isabel Spriet, Jos Tournoy
The profile of our patient population and by extension, that of the subset of patients identified by the count regression analysis, mostly corresponded with that of the geriatric, polymedicated and complex patient profile. Most associative factors have already been described and our study findings seem to confirm previous reports. For example, the total number of drugs (i.e. number of drugs on admission and the number of newly initiated drugs during hospital stay) has been identified as a risk factor for adverse (drug) events during hospital stay and afterwards [22,23]. Presence of an ejection fraction <40% identifies patients who are likely to take multiple drugs, but also who should avoid certain therapies (e.g. verapamil) and in whom drug initiation and up-titration (e.g. of beta-blockers) could still be of clinical benefit, even in high age as time to benefit is short (i.e. months) [24,25]. The number of previous contacts with the geriatric dept. was inversely correlated with the number of CP recommendations, which can be explained by patients having already been reviewed by a multidisciplinary team during previous hospital admissions. Use of colecalciferol could have indirectly identified patients with a higher frailty, or renal impairment, perhaps necessitating the use of dual calcium and vitamin D treatment as well as the correct administration of antiresorptive agents.
A pas de deux of osteoporosis and sarcopenia: osteosarcopenia
Published in Climacteric, 2022
F. Laskou, H. P. Patel, C. Cooper, E. Dennison
An adequate vitamin D status is associated with better BMD, muscle mass and function [82,83] and reduced number of falls in postmenopausal women [84]. The European Society for Clinical and Economic Aspects of Osteoporosis, Osteoarthritis and Musculoskeletal Diseases (ESCEO) recommends a vitamin D intake of 800 IU/daily to maintain 25(OH)D levels >50 nmol/l in postmenopausal women [85]. Conversely, an annual oral administration of high-dose cholecalciferol was associated with an increased risk of falls and fractures [86]. However, to date no interventional and randomized controlled studies have been performed to assess its effect on osteosarcopenic patients [87]. Finally creatine has also been reported to increase muscle mass and strength as well as bone density, but studies are required to show benefit in osteosarcopenic patients [75].
Related Knowledge Centers
- Calcitriol
- Calcium
- Dietary Supplement
- Hypocalcemia
- Vitamin D Deficiency
- Rickets
- Vitamin D
- Calcifediol
- X-Linked Hypophosphatemia
- Hypoparathyroidism