Het grote belang van
extra vitamine D geldt voor bijna iedereen*
Uit een viertal studies gepresenteerd tijdens de jaarlijkse bijeenkomst van Amerikaanse klinische endocrinologen (AACE) blijkt weer eens het grote belang van voldoende
vitamine D. De ene studie laat zien dat veel mensen (gemiddelde leeftijd 60 jaar) met
osteoporose duidelijk lage bloedwaarden vitamine D hebben en het belangrijk kan zijn deze mensen een flinke vitamine D therapie te laten volgen. Een andere studie laat zien dat 90% van de mensen ( gemiddelde leeftijd 80 jaar) met een
heupfracturen duidelijk tekort heeft aan bloedwaarden vitamine D. Uit de studie onder Amerikanen (gemiddeld 60 jaar) in het zuiden van de Verenigde Staten
(landen met ca. 70% meer zonuren dan hier in België en Nederland) blijkt dat slechts 11% van de deelnemers goede bloedwaarden vitamine D te hebben. 6% had ernstige tekorten, 32% gematigde tekorten, 35% matige tekorten en 16% had wat verlaagde waarden. Uit de laatste studie lijkt het dat 7-9 weken lang wekelijks 1.250 mcg vitamine D zonder enige bijwerking de bloedwaarden weer op peil kan brengen. (De precieze lengte afhankelijk van gemeten bloedwaarden zal nog nader bestudeerd moeten worden.) Nadien is dan dagelijks minstens 20 mcg per dag nodig om de bloedwaarden vitamine D op peil te houden.
New data indicates an aggressive Vitamin D treatment plan should be considered when caring for all Osteoporosis patients. Doing so may help decrease their likelihood of developing Vitamin D deficiency. These findings will be presented at the American Association of Clinical Endocrinologists (AACE) 17th Annual Meeting & Clinical by Harinder Singh, MD on Friday, May 16th at the Walt Disney World Dolphin Resort in Orlando.
"Our research suggests that Vitamin D deficiency is quite prevalent in patients with Osteoporosis," Dr. Singh said. "Much more so than was originally believed."
Singh will present how his research showed an alarming rate of Vitamin D deficiency amongst patients being treated for Osteoporosis and furthermore, how it should be met with an "aggressive" treatment
regimen.
Research on the topics of Vitamin D and Osteoporosis will be a major highlight at this year's meeting. Two major sessions include "Osteoporosis: What's New and What's Next," where AACE Member Nelson Watts MD, FACP, MACE will discuss a possible once-a-year treatment for Osteoporosis. The other session, "Vitamin D Deficiency: A Near Universal Health Problem," will focus on how adequate vitamin D intake may help reduce the severity of chronic endocrine-related
diseases.
Abstract #520
VITAMIN D DEFICIENCY IN PATIENTS
WITH OSTEOPOROSIS
Harinder Singh, MD, Satish Karmegan,
Aswatharayan Manandhi, Jyothi Ratti, Kenneth Grant, Swamy Venkatesh, and Ambika Rao
Objective: Vitamin D facilitates intestinal absorption of Calcium, Phosphate, and maintains normal serum calcium and mineralization of bone. Vitamin D deficiency is not uncommon and may contribute to the development of osteomalacia and fractures. Purpose of this study was to find the prevalence of Vitamin D deficiency in osteoporotic patients who were already on the recommended dose of Vitamin D and calcium. Our observations suggest that Vitamin D deficiency in patients diagnosed with osteoporosis by DEXA scanning is underdiagnosed. We suggest Vitamin D levels as part of initial evaluation of patients with osteoporosis.
Methods: This retrospective chart review study was conducted at the outpatient endocrinology clinic in Las Vegas. Study inclusion criteria were as follows; any patient with osteoporosis diagnosed on DEXA scan who had documented vitamin D levels, irrespective of race, gender, and age or other underlying diagnoses. 328 charts with diagnosis of osteoporosis were reviewed, of which 71 had documented 25-hydroxyvitamin D levels and were included in the study. Patients were on Vitamin D 800 IU and calcium 1200 milligrams daily. 25-hydroxyvitamin D level was checked while patients were assumed to be taking Vitamin D 800 IU. We also reviewed other risk factors including family history of osteoporosis, tobacco use, steroid use and other major pre-existing medical diagnoses.
Results: The average age was 62.2 years and 89% were females. 60 (84.5%) were Caucasians and 11 (15.5 %) were smokers. Five (7%) had family history of osteoporosis and 2 (2.81%) had osteoporotic fractures in the past. Thirteen (18.3%) were taking steroids for various medical reasons. Thirteen (18.3%) subjects were found to be Vitamin D deficient (<20ng/ml) and 16 (22.5%) were Vitamin D insufficient (20-30 ng/ml). Seven (9.86%) patients were hypocalcemic (<9 mg/dL).
Conclusion: Our study demonstrates that many patients with osteoporosis who were on Vitamin D and calcium had low vitamin D levels, which in turn contributes to increased risk of fractures. Therefore, all patients with osteoporosis should have vitamin D levels measured, and replaced
adequately.
Abstract #500
PREVALENCE OF VITAMIN D DEFICIENCY AMONG ACUTE HIP FRACTURE PATIENTS IN A NEW ENGLAND HOSPITAL
Akta Patel Mukherjee, MD, and Suzanne Rieke, MD
Objective: To determine the prevalence of vitamin D deficiency in patients presenting with acute hip fracture in a New England Hospital.
Methods: This study was a retrospective analysis of 117 patients who presented with acute hip fracture from November 2004 to January 2006 to Lahey Clinic in Burlington, Massachusetts. An endocrinology consultation assessed risk factors for osteoporosis including a 25hydroxyvitamin D (25OHD) for all of these patients.
Results: Ninety patients (76.9%) with acute hip fracture were women, and mean age was 80.3 years. With a 25OHD of <30ng/ml, 109 patients (90.6%) presenting with acute hip fracture were vitamin D insufficient. Seventy-three patients (62.4%) were vitamin D deficient, with a 25OHD <20ng/ml. Mean serum calcium was 8.5mg/dl among all patients. The mean parathyroid hormone level in the 15 patients assessed was 57.8pg/ml. Fifty patients (42.7%) reported a history of osteopenia or osteoporosis, and 63 subjects (53.8%) had a history of previous fracture. Twenty-four patients (48%) with osteoporosis prior to admission were vitamin D deficient compared to 49 patients (73.1%) without osteoporosis. However, of the 63 patients with a history of fracture, 43 subjects (68.3%) were vitamin D deficient compared to 30 of 54 patients (55.6%) without a fracture history.
Discussion: The health consequences of vitamin D deficiency have been increasingly recognized, including the greater risk of fractures. Our study demonstrates the continued high prevalence of vitamin D deficiency among patients presenting with a hip fracture. The majority of patients presenting to our hospital with hip fracture, even with history of a previous fracture, were vitamin D deficient. Patients with osteoporosis or osteopenia were less likely to be vitamin D deficient, because they are often advised to start calcium and vitamin D. However, history of fracture is not identified as an osteoporosis risk equivalent that is aggressively treated with vitamin D. The new emphasis on fracture risk assessment will help address this issue and identify patients at high risk of complications from vitamin D deficiency.
Conclusion: This study reinforces the high prevalence of vitamin D deficiency in patients presenting with hip fractures. History of a previous fracture as a risk factor for future fractures is still under-recognized in the medical community. Increased awareness can lead to efforts to modify risk factors including vitamin D deficiency. Identifying and treating these patients with vitamin D may help prevent future fractures and the significant morbidity associated with
them.
Abstract #505
VITAMIN D DEFICIENCY: EFFECTIVENESS OF WEEKLY ADMINISTRATION OF ORAL 50,000 IU ERGOCALCIFEROL
Donald Bodenner, MD, PhD, and Carolyn Redman
Objective: The aim of the present study was to evaluate the response of vitamin D (vit D) deficient patients (<30 ng/ml) to treatment with weekly doses of 50,000 IU of vit D2.
Methods: The records of patients with complete data available who had been treated weekly with 50,000 IU of vit D for variable amounts of time were retrospectively reviewed. Clinical variables abstracted from each patient’s record included: race, sex, age, diagnosis of malabsorption, vit D levels, and number of vit D treatments.
Results: 48 patients were treated with 50,000 IU vit D2. The mean age was 70.8 (+/-10.1) years, 45 were female, and there were 6 African Americans. All patients were taking greater than 1,000 mg of calcium. In 11 patients (23 %), the treatment course failed to raise the vit D level more than 6 ng/ml. None of the patients carried the diagnosis of malabsorption, so these treatment failures were considered to be secondary to noncompliance. Of the 37 patients that appeared to take the vit D as prescribed, one treatment course normalized vit D levels (>30 ng/ml) in 29 patients (78% success rate) and two courses were required in 4 patients for an overall success rate of 89%. True treatment failures where the vit D level increased by more than 6 ng/ml but did not normalize occurred 6 times, however only in patients severely deficient (2 of 6, 8.0 avg doses of 50,000 IU) or moderately deficient (4 of 6, 8.0 avg doses). Of the 31 patients successfully treated, the average number of weekly 50,000 IU doses prescribed for the severely deficient (1-10 ng/dl), deficient (11-20 ng/dl) and insufficient
(21-30 ng/dl) patients were 9.3 (+/- 1.6), 9.3 ( +/- 3.5), and 7.2 (+/- 2.7). Vit D levels were elevated outside the normal range (20 to 57 ng/ml) in two patients (91 ng/ml and 61 ng/ml) who remained normocalcemic and asymptomatic.
Discussion: Although vit D deficiency is extremely common, there are few guidelines for replenishment. This retrospective review demonstrated that a weekly dosage regimen with 50,000 IU of vit D successfully treated the vast majority of compliant patients without toxicity. We recommend 50,000 IU vit D2 for 9 weeks in patients with vit D levels less than 21 ng/ml, and 7 weeks for patients with levels from 21 to 30 ng/ml. This should be followed by a repeat vit D level and maintenance with at least 800 IU D3 daily.
Conclusion: Weekly 50,000 IU doses of vit D were safe and effective in treating vit D deficiency, but non-compliance was a major problem. A prospective study will be required to determine the specific duration required to adequately treat all
patients.
Abstract #506
VITAMIN D DEFICIENCY IN AN ENDOCRINOLOGY-LIPID PRACTICE IN
THE SUNBELT
Syeda Sadia Zaidi, MD, and Thomas A. Hughes, MD
Objective: In order to assess the frequency of vitamin D deficiency, we reviewed the charts of all patients seen in the previous 6 years in the University of Tennessee, Endo-Lipid private practice office of one of the co-authors in Germantown, TN (a relatively affluent population). Patients with primary or tertiary hyperparathyroidism (Ca >11.0 mg/dl), a serum creatinine >2.0 mg/dl, and those on high-dose vitamin D supplementation (>5000 U/day) were excluded. A total of 262 patients were included in this analysis.
Demographics: Average age: 59.9+12.8 (+SD) years (range: 21-88); 89% Caucasian, 7% African-American; 46% male; serum Ca 9.6+0.5 mg/dl (range 7.8-11.0); serum creatinine 1.0+0.3 mg/dl (range 0.5-2.0). Twenty-five percent of patients are known to have osteopenia or osteoporosis. The most common diagnoses were: Type 2 Diabetes (60%), hyperlipidemia (92%), and thyroid disease (28%).
Results & Discussion: Six percent of these 262 patients had severe 25-hydroxy vitamin D (25VitD) deficiency (<10 ng/ml), 32% moderate (10-20 ng/ml), and 35% mild (20-32 ng/ml) deficiency, while 16% were in the low-normal range (32-40 ng/ml). Only 11% of these patients had satisfactory 25VitD levels (>40 ng/ml) and these patients were typically younger and/or on low-dose vitamin D supplements. Many of the patients with vitamin D deficiency were also on low-dose supplements. Only 1 of 18 AA’s had a 25VitD >32 ng/ml. Vitamin D deficiency and secondary hyperparathyroidism are associated with metabolic bone disease, myopathy, cardiomyopathy, vasculopathy, and carcinogenesis. Therefore, this high incidence of deficit could have wide-spread clinical consequences.
Conclusions: These data indicate that vitamin D deficiency is extremely common in older, relatively healthy, affluent patients being seen in a sunbelt location for generally unrelated
problems. (Mei
2008)
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