Why is vitamin D status important in older adults

Why is vitamin D status important in older adults?

  • Vitamin D supplementation has been found to reduce the incidence of osteoporotic fractures in the elderly. This may occur via increased bone mineralization and/or improved muscle function and reduction in falls.
  • According to the Institute of Medicine, vitamin D deficiency is defined as a serum 25-hydroxyvitamin D (25[OH]D) level < 20 ng/mL (50 nmol/L). National and international groups have suggested that a 25(OH)D level ≥ 30 ng/mL (75 nmol/L) is needed to minimize fracture and fall risk. There are insufficient data to recommend a safe upper limit of 25(OH)D.
  • It has been estimated that > 40% of community-dwelling older women and men in the United States are vitamin D deficient, and the prevalence is even higher in nursing home residents.
  • There are multiple causes of vitamin D deficiency in older adults, including decreased sun exposure; decreased skin synthesis; decreased intake; impaired absorption, transport, or liver hydroxylation of oral vitamin D; medications altering vitamin D metabolism (e.g., drugs that induce p450 enzymatic activity leading to decreased circulating levels of 25[OH]D); chronic illnesses associated with malabsorption; and liver and kidney diseases.
  • Bone mineral density is adversely affected when serum 25(OH)D levels are < 30 ng/mL.
  • Although vitamin D supplementation has been found to raise serum 25(OH)D levels above 30 ng/mL, recent meta-analyses did not find that vitamin D (alone or in combination with calcium) supplementation reduced fracture risk among community-dwelling older adults without known vitamin D deficiency, osteoporosis or prior fracture. There is currently no evidence for antifracture efficacy of vitamin D supplementation.
  • Vitamin D deficiency also causes muscle weakness.
  • Proximal muscle strength is linearly related to serum 25(OH)D when levels are < 30 ng/mL. Vitamin D supplementation has been associated with a 22% reduction in falls. Nursing home residents randomized to receive 800 IU/day of vitamin D plus calcium had a 72% reduction in falls.
  • In addition to its important role in muscle and bone metabolism, vitamin D deficiency is postulated to influence immune function, cancer risk, parathyroid hormone and renin production, and insulin secretion.
  • Epidemiological studies demonstrate higher mortality in patients with insufficient or deficient levels of 25(OH)D.

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