Abstract
Objectives:
A significant proportion of the older population may exhibit vitamin D insufficiency. We sought to establish the proportion of 25-hydroxyvitamin D (25OHD) insufficient individuals in an older female cohort presenting for acute medical admission and how they responded to supplementation.
Design:
A prospective cohort study.
Setting:
Hospital admissions followed up as a population-based study.
Subjects:
A total of 114 consecutive female acute medical admissions aged over 65 years from November 2003 to January 2004 were enrolled. All admissions with hypercalcaemia, metabolic bone disease (other than osteoporosis/osteomalacia) and creatinine >150 μmol/l were excluded.
Interventions:
iPTH, calcium and 25OHD levels were measured in each patient. Of the total, 22 were already receiving calcium and vitamin D supplementation at enrolment. The remaining 92 were commenced on 800 IU of vitamin D and 1 g calcium, and levels were reassessed after supplementation for 3 months.
Results:
25-Hydroxyvitamin D insufficiency, as defined by a 25OHD concentration of <50 nmol/l, was present in 86 (75.4%) patients at initial assessment (mean 35.8 nmol/l, s.d. 23.3). Secondary hyperparathyroidism was present in only 36.7% of those with 25OHD deficiency at baseline. Of the total, 51 (44.7%) patients presented for follow-up. 25-Hydroxyvitamin D concentration increased in this group from 42.1 nmol/l (s.d. 26.6) to 59.5 nmol/l (s.d. 27.4) after supplementation, P<0.001, but 18(35.3%) still remained deficient. There was no significant change in iPTH or calcium following supplementation. Assessment of compliance revealed 6 (11.7%) admitted to partial or non-compliance.
Conclusions:
Insufficiency of 25OHD was very common in this cohort. Despite calcium and vitamin D supplementation, 25OHD concentrations failed to reach normality in a significant proportion. Maintaining vitamin D and calcium intake at the level of current recommended doses may not be sufficient to ensure adequate 25OHD stores.
This is a preview of subscription content, access via your institution
Access options
Subscribe to this journal
Receive 12 print issues and online access
$259.00 per year
only $21.58 per issue
Rent or buy this article
Prices vary by article type
from$1.95
to$39.95
Prices may be subject to local taxes which are calculated during checkout
References
Aguado P, del Campo MT, Garces MV, Gonzales-Casaus ML, Bernad M, Gijon-Banos J et al. (2000). Low vitamin D levels in outpatient postmenopausal women from a rheumatology clinic in Madrid, Spain: their relationship with bone mineral density. Osteoporosis Int 11, 739–744.
Armas LA, Hollis BW, Heaney RP (2004). Vitamin D2 is much less effective than vitamin D3 in humans. J Clin Endocrinol Metab 89, 5387–5391.
Bettica P, Bevilacqua M, Vago T, Norbiato P (1999). High prevalence of hypovitaminosis D among free-living postmenopausal women referred to an osteoporosis outpatient clinic in Northern Italy for initial screening. Osteoporosis Int 9, 226–229.
Boland R (1986). Role of vitamin D in skeletal muscle function. Endocr Rev 7, 434–438.
Carter G, Carter R, Jones J, Berry J (2004). How accurate are assays for 25-hydroxyvitamin D? Data from the international vitamin D external quality assessment scheme. Clin Chem 50, 2195–2197.
Chapuy MC, Arlot ME, DuBoeuf F, Brun J, Crouzet B, Arnaud S et al. (1992). Vitamin D3 and calcium to prevent hip fractures in elderly women. N Engl J Med 237, 1637–1642.
Chapuy MC, Pamphile R, Paris E, Kempf C, Schlichting M, Arnaud S et al. (2002). Combined calcium and vitamin D3 supplementation in elderly women: confirmation of reversal of secondary hyperparathyroidism and hip fracture risk: the Decalyos II study. Osteoporosis Int 13, 257–264.
Chapuy MC, Preziosi P, Maamer M, Arnaud S, Galan P, Hercberg S et al. (1997a). Prevalence of vitamin D insufficiency in an adult normal population 1997. Osteoporosis Int 7, 439–443.
Chapuy MC, Preziosi P, Maamer M, Arnaud S, Galan P, Hercberg S et al. (1997b). Prevalence of vitamin D insufficiency in an adult normal population. Osteoporosis Int 7, 439–443.
Chapuy MC, Schott AM, Garnero P, Hans D, Delmas PD, Meunier PJ (1996). Healthy elderly French women living at home have secondary hyperparathyroidism and high bone turnover in winter. J Clin Endocrinol Metab 81, 1129–1133.
Dawson-Hughes B, Heaney R, Lips P, Meunier P, Vieth R (2004). Vitamin D Round table. In: Dawson-Hughes B, Heaney R, Burckhardt P (eds). Nutritional Aspects of Osteoporosis. Academic Press: New York.
Food and Nutrition Board Institute of Medicine (1997). Dietary Reference Inputs for Calcium, Magnesium, Phosphorus, Vitamin D, and Fluoride. National Academy Press: Washington, DC.
Freaney R, McBrinn Y, McKenna MJ (1993). Secondary hyperparathyroidism in elderly people: combined effect of renal insufficiency and vitamin D deficiency. Am J Clin Nutr 58, 187–191.
Glerup H, Mikkelsen K, Poulsen L, Hass E, Overbeck S, Thomsen J et al. (2000). Commonly recommended daily input of vitamin D is not sufficient if sunlight exposure is limited. J Int Med 247, 260–268.
Gloth FM (1995). Vitamin D deficiency in home-bound elderly persons. J Am Med Assoc 274, 1683–1686.
Gloth FM (1999). Vitamin D deficiency in older people. J Am Geriatr Soc 43, 822–828.
Grant AM, Avenell A, Campbell MK, McDonald AM, MacLennan GS, McPherson GC et al. (2005). Oral vitamin D3 and calcium for secondary prevention of low-trauma fractures in elderly people (Randomised Evaluation of Calcium or Vitamin D, RECORD): a randomised placebo-controlled trial. Lancet 365, 1599–1600.
Hannan FM, Fairney A, Johnston DG (2004). Vitamin D deficiency masking primary hyperparathyroidism. Ann Clin Biochem 41, 405–407.
Heaney R, Davies M, Chen T, Holick M, Barger-Lux M (2003). Human serum 25-hydroxycholecalciferol response to extended oral dosing with cholecalciferol. Am J Clin Nutr 77, 204–210.
Heaney RP (1999). Lessons for nutritional science from vitamin D. Am J Clin Nutr 69, 825–826.
Holick MF (1990). The use and interpretation of assays for vitamin D and its metabolites. J Nutr 120 (Suppl 11), 1464–1469.
Inderjeeth CA, Niklason F, Al-Lahham Y, Greenaway T, Jones G, Parameswaran V et al. (2000). Vitamin D deficiency and secondary hyperparathyroidism: clinical and biochemical associations in older non-institutionalised southern Tasmanians. Aust NZ J Med 30, 209–214.
Jacques PF, Felson DT, Tucker KL, Mahnken B, Wilson PWF, Rosenberg IH (1997). Plasma 25-hydroxyvitamin D and its determinants in an elderly population sample. Am J Clin Nutr 66, 929–936.
Lips P, van Ginkel FC, Jongen MJM, Rubertus A, van der Vijgh WJF, Netelenbos JC (1987). Determinants of vitamin D status in patients with hip fracture and elderly control subjects. Am J Clin Nutr 46, 1005–1010.
Lips P, Wiersinga A, Van Ginkel FC, Jongen MJM, Netelenbos JC, Hackeng WHL et al. (1988). The effect of vitamin D supplementation on vitamin D status and parathyroid function in elderly subjects. J Clin Endocrinol Metab 67, 644–650.
Loh CY, Chao SS, Chan YH, Wang DY (2004). A clinical survey on compliance in the treatment of rhinitis using nasal steroids. Allergy 59, 1168–1172.
Oliveri B, Plantalech L, Bagur A, Wittich AC, Rovai G, Pusiol E et al. (2004). High prevalence of vitamin D insufficiency in healthy elderly people living at home in Argentina. Eur J Clin Nutr 58, 337–342.
Porthouse J, Cockayne S, King C, Saxon L, Steele E, Aspray T et al. (2005). Randomised controlled trial of calcium and supplementation with cholecalciferol (vitamin D3) for prevention of fractures in primary care. BMJ 330, 1003.
Sahota O, Gaynor K, Harwood RH, Hosking DJ (2002). Hypovitaminosis D and ‘functional hypoparathyroidism’ – the NoNoF (Nottingham Neck of Femur Study). Age Ageing 31, 486.
Sahota O, Mundey MK, San P, Godber IM, Lawson N, Hosking DJ (2004). The relationship between vitamin D and parathyroid hormone: calcium homeostasis, bone turnover, and bone mineral density in postmenopausal women with established osteoporosis. Bone 35, 312–319.
Schmidt-Gayk H, Bouillon R, Roth HJ (1997). Measurement of vitamin D and its metabolites (calcidiol and calcitriol) and their clinical significance. Scand J Clin Lab Invest 57, 35–45.
Smith H, Anderson F, Raphael H, Crozier S, Cooper C (2004). Effect of annual intramuscular vitamin D supplementation on fracture risk: population based, randomised, double-blind, placebo-controlled trial. Osteoporosis Int 15, S8.
Stein MS, Wark JD, Scherer SC, Walton SL, Chick P, Di Carlantonio M et al. (1999). Falls relate to vitamin D and parathyroid hormone in an Australian nursing home and hostel. J Am Geriatr Soc 47, 1195–1201.
Taylor AV, Wise PH (1997). Treatment of vitamin D deficient osteomalacia may unmask autonomous hyperparathyroidism. Postgrad Med J 73, 813–815.
Theiler R, Stahelin HB, Tyndall A, Binder K, Somorjai G, Bischoff HA (1999). Calcidiol, calcitriol and parathyroid hormone serum concentrations in institutionalized and ambulatory elderly in Switzerland. Int J Vitam Nutr Res 69, 96–105.
Thomas M, Lloyd-Jones D, Thadhani R, Shaw A, Deraska D, Kitch B et al. (1998). Hypovitaminosis D in medical inpatients. N Engl J Med 338, 777–783.
Torgerson D, Donaldson C, Reid D (1996). Using economics to prioritise research: a case study of random trials for the prevention of hip fractures due to osteoporosis. J Health Serv Res Policy 1, 141–146.
Vieth R, Chan PCR, MacFarlane GD (2001). Efficacy and safety of vitamin D3 input exceeding the lowest observed adverse effect concentration. Am J Clin Nutr 73, 288–294.
Vieth R, Cole DE, Hawker GA, Trang HM, Rubin LA (2001). Wintertime vitamin D insufficiency is common in young Canadian women, and their vitamin D input does not prevent it. Eur J Clin Nutr 55, 1091–1097.
Vieth R, Kimball S, Hu A, Walfish PG (2004). Randomized comparison of the effects of the vitamin D3 adequate intake versus 100 mcg (4000 IU) per day on biochemical responses and the wellbeing of patients. Nutr J 3, 8.
Author information
Authors and Affiliations
Corresponding author
Additional information
Guarantor: E DeLappe.
Contributors: EM, CM, NniC and HG conceived and designed the study. CM, EM and ED conducted the study. NniC and HG carried out laboratory analysis. ED analysed and interpreted the data and wrote the article. TOB, HG and EM carried out critical revision of the article.
Rights and permissions
About this article
Cite this article
DeLappe, E., McGreevy, C., ni Chadhain, N. et al. Vitamin D insufficiency in older female community-dwelling acute hospital admissions and the response to supplementation. Eur J Clin Nutr 60, 1009–1015 (2006). https://doi.org/10.1038/sj.ejcn.1602412
Received:
Revised:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1038/sj.ejcn.1602412
Keywords
This article is cited by
-
Vitamin D deficiency and insufficiency prevalence in the west of Ireland-A retrospective study
The Journal of nutrition, health and aging (2017)
-
Vitamin D supplementation versus combined calcium and vitamin D in older female patients — An observational study
The Journal of nutrition, health and aging (2011)
-
Vitamin D insufficiency: a common and treatable problem in the Irish population
Irish Journal of Medical Science (2011)
-
Hypovitaminosis D in a healthy female population, aged from 40 to 85 years, in the west of Ireland
Irish Journal of Medical Science (2011)
-
Impact of oral vitamin D supplementation on serum 25-hydroxyvitamin D levels in oncology
Nutrition Journal (2010)