Effect of Supplementation with Vitamin D 3 and Calcium on Quantitative Ultrasound of Bone in Elderly Institutionalized Women: A Longitudinal Study

Abstract

Supplementation of elderly institutionalized women with vitamin D and calcium decreased hip fractures and increased hip bone mineral density. Quantitative ultrasound (QUS) measurements can be performed in nursing homes, and easily repeated for follow-up. However, the effect of the correction of vitamin D deficiency on QUS parameters is not known. Therefore, 248 institutionalized women aged 62-98 years were included in a 2-year open controlled study. They were randomized into a treated group (n = 124), receiving 440 IU of vitamin D3 combined with 500 mg calcium (1250 mg calcium carbonate, Novartis) twice daily, and a control group (n = 124). One hundred and three women (42%), aged 84.5 +/- 7.5 years, completed the study: 50 in the treated group, 53 in the controls. QUS of the calcaneus, which measures BUA (broadband ultrasound attenuation) and SOS (speed of sound), and biochemical analysis were performed before and after 1 and 2 years of treatment. Only the results of the women with a complete follow-up were taken into account. Both groups had low initial mean serum 25-hydroxyvitamin D levels (11.9 +/- 1.2 and 11.7 +/- 1.2 micrograms/l; normal range 6.4-40.2 micrograms/l) and normal mean serum parathyroid hormone (PTH) levels (43.1 +/- 3.2 and 44.6 +/- 3.5 ng/l; normal range 10-70 ng/l, normal mean 31.8 +/- 2.3 ng/l). The treatment led to a correction of the metabolic disturbances, with an increase in 25-hydroxyvitamin D by 123% (p < 0.01) and a decrease in PTH by 18% (p < 0.05) and of alkaline phosphatase by 15% (p < 0.01). In the controls there was a worsening of the hypovitaminosis D, with a decrease of 25-hydroxyvitamin D by 51% (p < 0.01) and an increase in PTH by 51% (p < 0.01), while the serum calcium level decreased by only 2% (p < 0.01). After 2 years of treatment BUA increased significantly by 1.6% in the treated group (p < 0.05), and decreased by 2.3% in the controls (p < 0.01). Therefore, the difference in BUA between the treated subjects and the controls (3.9%) was significant after 2 years (p < 0.01). However, SOS decreased by the same amount in both groups (approximately 0.5%). In conclusion, BUA, but not SOS, reflected the positive effect on bone of supplementation with calcium and vitamin D3 in a population of elderly institutionalized women.

Prevalência da deficiência, insuficiência de vitamina D e hiperparatiroidismo secundário em idosos institucionalizados e moradores na comunidade da cidade de São Paulo, Brasil

“…Os valores de PTH correlacionam-se de maneira inversa às concentrações de vitamina D tanto em idosos quanto na população jovem, e a alta prevalência Sabendo-se que a reposição de cálcio e vitamina D tem efeito protetor sobre a massa óssea (25)(26)(27)(28)(29), torna-se relevante a identificação de pacientes com risco de hipovitaminose D, para que haja uma adequada reposição atuando como mecanismo preventivo sobre o risco de fratura.…”

Multivitamin supplementation improves nutritional status and bone quality in aged care residents

“…In that study, however, serum 25(OH)D levels were initially higher (77 nmol l À1 ) compared with our group (36 nmol l À1 ). Other large dose calcium/ vitamin D supplementation studies in elderly residents have not documented rates of 25(OH)D deficiency (Krieg et al, 1999;Peacock et al, 2000;Grados et al, 2003) nor did they measure serum 25(OH)D at follow-up (Flicker et al, 2005;Law et al, 2006).…”

Seasonal Variance in Serum Levels of Vitamin D Determines a Compensatory Response by Parathyroid Hormone: Study in an Ambulatory Elderly Population in Quebec

“…Although some studies show this change in an inverse correlation with serum levels of vitamin D [13,16,25,27] , the opposite has also been observed [17][18][19] ; nevertheless, the majority of these studies are cross-sectional and involve a short number of patients. Overall, interventional studies with calcium and vitamin D supplementation support the hypothesis of seasonal changes in vitamin D showing and effect of treatment in seasonality, markers of bone turnover and bone mineral density [20,[28][29][30] .…”