VITAMIN D

Primary food sources are meat, fish, and fortified milk (in US)

Many elderly are at risk for deficiency b/c of low exposure to sunlight, decreased synthesis of Vit. D in the skin, and decreased absorption and activation of the vitamin.

USRDA as of 1998:

19-50yo: 200IU/d
51-70yo: 400IU/d
51-70yo: 600IU/d

Vitamin D + Ca for elderly at risk for deficiency (home-bound, poor nutritional status, unsunny climate)

  1. 389 healthy men & women >65yo, residing in non-institutional settings, randomized to Ca 500mg + vit. D3 700IU QD vs. placebo; at 3y f/u, tx group had sig. increases in bone density at femoral neck, spine, and total body; sig. decreased incidence of a first nonvertebral fx (6% vs. 13%) (NEJM 337:670, 1997-JW)
  2. In a trial of 2686 community-dwelling pts 65-85yo randomized to vit. D 100IU PO Q4mos vs. placebo, over 5y f/u, vit. D group had sig. lower incidence of fx (RR 0.78) (BMJ 326:469, 2003--JW)
  3. In a meta-analysis of 5 RCT's of vitamin D vs. placebo in elderly populations (mean age 60y), use of vitamin D was ass'd with OR of 0.78 for falls (sig.) (JAMA 291:1999, 2004--abst)
  4. In a meta-analysis of seven randomized trials of Calcium + Vitamin D in elderly patients (mean age 79y), vitamin D at dose of 400IU was not associated with reduced risk of fracture, but 700-800IU/day was (OR 0.75, NNT = 50) (JAMA 293:2257, 2005--AFP)
  5. In a randomized study in 625 residents in nursing homes and assisted-living facilities randomized to vitamin D 1000IU/d vs. placebo + Ca supplements (600mg elemental ca/day), over 2y f/u, vit. D. recipients had sig. lower incidence of falls (1.37 vs. 1.86/person/yr_ (J. Am. Geriat. Soc. 53:1881, 2005--JW)
  6. In a study in 5,292 pts > 70yo with h/o low-trauma fractures randomized to vitamin D 800IU/d, Ca 1000mg/d, both, or placebo, at 24-62mo f/u, there was no sig. diff. in incidence of fracture, death, or falls between the two groups (Lancet 365:1599, 2005--JW)
  7. In a study in 36,282 postmenopausal women randomized to CaCO3 1g/d + Vit. D 400IU/d vs. placebo, over 7y f/u, there was no sig. diff. in overall incidence of spine, hip, or total fractures, though among the subgroup of women not using supplemental Ca/Vit. D outside the treatment protocol, RR for hip fx was sig. lower in supplemented group (HR 0.7); ctive-tx group had sig. higher incidence of kidney stones (WHI Trial; NEJM 354:669, 2006--JW)
  8. In a study in 3,314 community-dwelling women > 70yo with one of (prior fx, body weight < 58kg, fair or poor self-reported health, cigarette use, or maternal h/o gracture) randomized to calcium 1000 mg/vit. D3 800IU/d vs. printed information only, over 2 mo, there was no sig. diff. in incidence of self-reported fx (BMJ 330:1003, 2005--JW)
  1. CaCO3 500mg = 200mg elemental Ca
  2. CaCitrate 950mg = 200mg elemental Ca