Highest prevalence of vitamin D inadequacy in institutionalized women compared with noninstitutionalized women: a case-control study.
Bruyère, Olivier ; ; et al
in Women's Health (2009), 5(1), 49-54
The reduced capacity of older skin to synthesize vitamin D(3) under the influence of ultraviolet light makes older persons at risk of vitamin D deficiency. The risk could even be increased in ... [more ▼]
The reduced capacity of older skin to synthesize vitamin D(3) under the influence of ultraviolet light makes older persons at risk of vitamin D deficiency. The risk could even be increased in institutionalized persons owing to their lower sunshine exposure. It has been reported that an inadequate vitamin D level is associated with secondary hyperparathyroidism, increased bone turnover, and bone loss, which increase fracture risk. The objective of this study was to assess the prevalence of inadequate serum vitamin D levels in institutionalized, postmenopausal, osteoporotic women. Assessment of 25-hydroxyvitamin D [25(OH)D] was performed in 445 institutionalized, osteoporotic women from nine countries (Australia, Belgium, France, Germany, Hungary, Italy, Poland, Spain and UK). For each institutionalized woman, three age-matched, noninstitutionalized, osteoporotic controls were also included. Four cutoffs of 25(OH)D inadequacy were fixed: less than 80, less than 75, less than 50 and less than 30 nmol/l. Mean age was 79.7 years (standard deviation [SD] = 5.8) for the institutionalized women and 79.5 years (SD = 5.5) for the noninstitutionalized women (p = 0.45). Significantly fewer institutionalized women received vitamin D supplements (13.2 vs 24.0%; p < 0.0001). In women without vitamin D supplements, the level of 25(OH)D was significantly lower in institutionalized women (56.9 [SD = 23.9] nmol/l) compared with noninstitutionalized women (63.2 [SD = 22.0] nmol/l; p < 0.0001). In institutionalized women (without vitamin D supplements), the prevalence of 25(OH)D inadequacy was 10.4, 41.2, 80.3 and 84.2% when considering cutoffs of 80, 75, 50 and 30 nmol/l, respectively. In the control group, the prevalence was 2.7, 22.9, 74.4 and 81.7%, respectively. The prevalence of vitamin D inadequacy was significantly higher in institutionalized women when considering the 75, 50 and 30 nmol/l cutoffs but not when considering the 80 nmol/l cutoff. This study highlights a high prevalence of vitamin D inadequacy in institutionalized, osteoporotic women. Compared with age-matched osteoporotic controls, the prevalence of severe vitamin D inadequacy was substantially more important in institutionalized women. We believe that a greater awareness of the importance of vitamin D inadequacy is needed in order to address this public health problem. [less ▲]Detailed reference viewed: 54 (11 ULg)
Vitamin D status and response to antiosteoporotic therapy.
Bruyère, Olivier ; Reginster, Jean-Yves
in Women's Health (2008), 4(5), 445-7
Evaluation of: Adami S, Giannini S, Bianchi G et al.: Vitamin D status and response to treatment in post-menopausal osteoporosis. Osteoporos. Int. (2008) (Epub ahead of print). All recent osteoporosis ... [more ▼]
Evaluation of: Adami S, Giannini S, Bianchi G et al.: Vitamin D status and response to treatment in post-menopausal osteoporosis. Osteoporos. Int. (2008) (Epub ahead of print). All recent osteoporosis guidelines recommend that patients taking treatments for osteoporosis (i.e., bisphosphonates) should be supplemented with vitamin D and calcium. However, the bone response (i.e., bone mineral density change and fractures incidence) to bisphosphonates therapy in relation to vitamin D intake in clinical practice is unknown. In a recent retrospective study, 1515 women with postmenopausal osteoporosis under antiresorptive treatment were classified as vitamin D deficient or vitamin D repleted, according to risk factors or the level of 25 hydroxy vitamin D above or below 50 nmol/l. The change in bone mineral density remained significantly higher in vitamin D-repleted compared with vitamin D-deficient women. Moreover, the adjusted odds ratio for incident fractures in vitamin D-deficient as compared with vitamin D-repleted women was 1.77 (95% CI: 1.20-2.59; p = 0.004). [less ▲]Detailed reference viewed: 35 (4 ULg)
Injectable bisphosphonates for the treatment of osteoporosis.
Reginster, Jean-Yves ; ; et al
in Women's Health (2007), 3(6), 719-23
Bisphosphonates are the current mainstay of the management of osteoporosis worldwide. Oral daily and weekly formulations have been linked to poor adherence, yielding a decrease in antifracture efficacy ... [more ▼]
Bisphosphonates are the current mainstay of the management of osteoporosis worldwide. Oral daily and weekly formulations have been linked to poor adherence, yielding a decrease in antifracture efficacy, in real-life settings. Development of new bisphosphonates, with increased antiosteoclastic potency and affinity for bone matrix allowed intravenous administration and intervals between dosings to be higher than weekly. Ibandronate and zoledronic acid have been investigated in established osteoporosis. Quarterly injections of ibandronate (3 mg) have been shown to be at least as effective in increasing bone mineral density and reducing bone turnover markers as the oral ibandronate regimen, which has proven antifracture efficacy. A once-yearly infusion of zoledronic acid (5 mg) during a 3-year period significantly reduced the risk of vertebral, hip and other fractures. Intravenous administration of bisphosphonates can now be considered as an important component of the management of postmenopausal osteoporosis. [less ▲]Detailed reference viewed: 22 (16 ULg)