Mild Vitamin D Deficiency and Secondary Hyperparathyroidism in Nursing Home Patients Receiving Adequate Dietary Vitamin D

McMurtry, Cynthia T.; Young, Shari E.; Downs, Robert W.; Adler, Robert A.

doi:10.1111/j.1532-5415.1992.tb02132.x

Cited by 54 publications

(34 citation statements)

References 26 publications

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“…Since elderly people are much more prone to fracture, it is possible that the AI for vitamin D in the elderly in Japan would be higher. Institutionalized elderly have been our special concern, since they are at even higher risk of fracture ( 7 -9 ) and have been reported to have a high prevalence of vitamin D deficiency or insufficiency (10)(11)(12)(13)(14).…”

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confidence: 99%

Improvement of Vitamin D Status in Japanese Institutionalized Elderly by Supplementation with 800 IU of Vitamin D3

Kuwabara¹,

Tsugawa²,

Tanaka³

et al. 2009

J Nutr Sci Vitaminol

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SummaryTo study the adequate intake (AI) for vitamin D in the elderly, we have performed an intervention study with 800 IU/d of vitamin D 3 in the institutionalized elderly. Sixty-two institutionalized elderly were randomly assigned to two groups; receiving either supplements of 200 mg calcium plus 800 IU vitamin .3 ng/mL in the Ca ϩ VD group and to 11.1 ng/mL in the Ca group. Post intervention serum 25OH-D level was significantly higher in the Ca ϩ VD group than in the Ca group ( p Ͻ 0.001). In 53 subjects (85.5%) who took more than 80% of their supplements for 30 d, serum PTH level in the Ca ϩ VD group was significantly lower than in the Ca groups ( p ϭ 0.05). Bone turnover markers were not significantly changed after intervention in either group. Daily supplementation of 800 IU vitamin D 3 was considered effective in the institutionalized elderly with minimal chance of sun exposure, but further studies with longer duration are necessary.

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confidence: 99%

Improvement of Vitamin D Status in Japanese Institutionalized Elderly by Supplementation with 800 IU of Vitamin D3

Kuwabara¹,

Tsugawa²,

Tanaka³

et al. 2009

J Nutr Sci Vitaminol

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“…Certain risk factors for vitamin D deficiency have been identified such as low sunshine exposure, advanced age, obesity, skin pigmentation, and malabsorption [14,15]. For decades we have recognized a very high rate of vitamin D deficiency among nursing home residents in the U.S [4,12]. In recent years, the nursing home environment has become more regulated and there has been increasing pressure to individualize care plans for residents.…”

Section: Introductionmentioning

confidence: 99%

“…Vitamin D deficiency has long been recognized asan undertreated, but important factor in the health and well-being of older adults, especially in a skilled nursing facility [1][2][3][4][5][6][7][8][9]. It can cause osteomalacia, exacerbate osteoporosis, secondary hypo-parathyroidism, and has been linked to falls and fractures in the nursing home [4,[10][11][12].…”

Section: Introductionmentioning

confidence: 99%

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A Model for Implementing a Vitamin D3 Regimen in a Skilled Nursing Facility

F¹

2014

J Gerontol Geriatric Res

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Purpose: To describe a process for implementing widespread Vitamin D 3 supplementation in a skilled nursing home setting that didn't require laboratory assessment and was acceptable in a state regulatory environment. Methods:After a discussion with state officials, a chart review of all long-term care residents in a nursing home (The Chateau at Moorings Park) was conducted to identify risk factors noted in a review of medical literature for vitamin D deficiency. Data were also collected on whether or not the patient had been given a Vitamin D deficiency diagnosis, treated with Vitamin D and what dosage, and if there were 25-OH Vitamin D serum level evaluations.Results: Seventy resident charts were reviewed. Thirty-two men and 38 women comprised the cohort evaluated. Hours of sunlight per day (60%), menopause (54%), and muscle weakness (69%) were found to be the most common risk factors present in this population and every patient met at least one risk factor. Also, four patients had a Vitamin D deficiency diagnosis and twenty patients were taking Vitamin D. Conclusion:A screening process without facility-wide laboratory testing for Vitamin D status was acceptable to state regulators. All nursing home patients in this cohort were at risk for Vitamin D deficiency even though they may have had access to the sunshine outdoors. A process for facility-wide Vitamin D supplementation was successfully developed that was acceptable to state officials without requiring laboratory assessment of vitamin D status from every resident. Even so, the process was inconvenient and time-consuming. If these findings are replicated in other facilities, it may be reasonable recognize a sufficiently high risk of vitamin D deficiency in nursing homes and accept facility-wide vitamin D supplementation. Our report supports such a practice while not compromising the principles of individualized medical care in the nursing home environment.

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“…McMurtry and colleagues found that most veterans living in nursing homes have vitamin D insufficiency (3). We sought to determine the prevalence of vitamin D insufficiency in ambulatory US war veterans seen at the Atlanta VA Medical Center.…”

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Vitamin D Statusin UnitedStatesWar Veterans

Judd¹,

Tangpricha²

2008

Endocrine Practice

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To the Editor:Vitamin D insufficiency has become recognized as a common phenomenon among ambulatory and hospitalized adults (1). Vitamin D is associated with increased risk of many chronic illnesses including cancer, hypertension, diabetes, and osteoporosis (2). The best marker of vitamin D status is the serum 25-hydroxyvitamin D concentration (1). Many factors influence circulating 25-hydroxyvitamin D levels including race, season, body mass index, and age (1).The prevalence of vitamin D insufficiency has not been well characterized in US war veterans. McMurtry and colleagues found that most veterans living in nursing homes have vitamin D insufficiency (3). We sought to determine the prevalence of vitamin D insufficiency in ambulatory US war veterans seen at the Atlanta VA Medical Center. We were also interested in which physicians were screening for vitamin D insufficiency and how vitamin D insufficiency was being treated.The study was approved by the Emory University Institutional Review Board and the Atlanta VA Medical Center Research and Development Committee. Using the VA computerized patient record system, we collected all 25-hydroxyvitamin D levels that were measured in the fall month of September 2006 and the spring month of March 2007. We collected demographic information including age, sex, body mass index, race, and the specialty of the physician ordering the test. We determined the number of individuals who were vitamin D insufficient defined as a 25-hydroxyvitamin D concentration less than 30 ng/mL. We reviewed pharmacy records to determine if and how the vitamin D insufficiency was treated.We found that 25-hydroxyvitamin D was measured 136 and 226 times in the months of September and March, respectively. There were no differences in age, sex, and body mass index in the fall and spring groups ( Table 1). As expected, mean 25-hydroxyvitamin D levels were statistically lower in the spring compared with the fall, and there was a higher prevalence of vitamin D insufficiency in the spring (Table 1) NIH-PA Author ManuscriptNIH-PA Author Manuscript NIH-PA Author Manuscript subjects had a higher prevalence of vitamin D insufficiency in the spring compared to the fall in contrast to black subjects who did not have statistically significant seasonal variation in the prevalence of vitamin D insufficiency. There were differences in the specialty of the physician ordering the 25-hydroxyvitamin D level with nephrologists being the most common physician group testing for vitamin D status. Only about 30% of participants who were deemed to have vitamin D insufficiency were prescribed more than 1000 IU of vitamin D. Almost half of the participants did not receive any treatment for vitamin D insufficiency.In conclusion, we found that vitamin D insufficiency was highly prevalent in veterans and that many veterans either did not receive treatment for vitamin D insufficiency or received inadequate amounts of vitamin D replacement to restore vitamin D status to normal. These findings further underscore the urgent need t...

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Mild Vitamin D Deficiency and Secondary Hyperparathyroidism in Nursing Home Patients Receiving Adequate Dietary Vitamin D

Abstract: Despite apparently adequate calories, calcium, and vitamin D intake, hypovitaminosis D with compensatory PTH elevations occurs, regardless of season, in the nursing home population.

Cited by 54 publications

References 26 publications

Improvement of Vitamin D Status in Japanese Institutionalized Elderly by Supplementation with 800 IU of Vitamin D3

Improvement of Vitamin D Status in Japanese Institutionalized Elderly by Supplementation with 800 IU of Vitamin D3

A Model for Implementing a Vitamin D3 Regimen in a Skilled Nursing Facility

Vitamin D Statusin UnitedStatesWar Veterans

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