Vitamin D in geriatric patients

Abstract

VitaminD deficiency is widespread in geriatric patients. While vitaminD deficiency is prevalent in about 50% of healthy older adults, the prevalence in geriatric patients with hip fracture increases to over 80%. This is partly due to the fact that sunlight is unreliable as the main source of vitaminD. In addition to insufficient sun intensity from November to April, skin aging plays an important role; it causes a4-fold reduction in the skin's own vitaminD production during sunshine exposure in older adults compared with younger people. Immobility and institutionalization are additional risk factors for vitaminD deficiency in geriatric patients. At the same time, vitaminD deficiency (< 20 ng/ml) increases parathyroid hormone levels and thus promotes bone loss and the risk of fracture. Severe vitaminD deficiency (< 10 ng/ml) may also lead to reversible muscle weakness resulting in an increased risk of falling. Since falls affect at least every second geriatric patient and hip fractures increase exponentially after the age of 75, the correction of vitaminD deficiency is an important medical and public health effort in these patients. Several randomized intervention trials, comparing 800-1000 IU vitaminD/day versus placebo or calcium, showed asignificant reduction in falls and hip fractures in adults ≥65years of age who had an increased risk of vitaminD deficiency and of falls or fractures. In geriatric patients, implementing vitaminD supplementation at this dosage is currently preferred. Abolus dose of over 24,000 IU/month should be avoided due to the increased risk of falls and fractures. These recommendations remain relevant after acritical review of the four most recent meta-analyses.