Association Between Hypovitaminosis D in Elderly Women and Long‐ and Short‐Term Mortality—Results from the Osteoporotic Prospective Risk Assessment Cohort

Buchebner, David; McGuigan, Fiona; Gerdhem, Paul; Ridderstråle, Martin; Åkesson, Kristina

doi:10.1111/jgs.14087

Cited by 11 publications

(10 citation statements)

References 44 publications

(52 reference statements)

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“…Mortality was followed up for the entire study duration (10 years) and the date of death recorded through the Swedish National Population Register [23]. Information on the cause of death was not available.…”

Section: Mortalitymentioning

confidence: 99%

Longitudinal Changes in Kidney Function Estimated from Cystatin C and Its Association with Mortality in Elderly Women

Malmgren

McGuigan

Christensson

et al. 2020

Nephron

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Background/Aims: Prospective data on age-related changes in kidney function are required, especially since the current Kidney Disease Improving Global Outcomes (KDIGO) definition has been suggested to classify a large number of elderly people with CKD. Objective: This study, a complement to our previous Cr-based study in the same cohort, is aimed at evaluating cystatin C (cysC)-based changes in kidney function during aging in older women and analyzing the association between CKD and mortality through 10 years of follow-up. Methods: cysC was available in 981 women from the Osteoporosis Prospective Risk Assessment (OPRA) cohort, all aged 75 years on entry. Reinvestigations were made after 5 (n = 685) and 10 years (n = 365). Kidney function was estimated (estimated glomerular filtration rate [eGFR]) using Chronic Kidney Disease Epidemiology Collaboration cysC and Caucasian, Asian, Pediatric, and Adult cysC equations and the change in function calculated. Women were staged equivalent to CKD stage 1, 2, 3a, or 3b-5 according to the KDIGO classification. Mortality risk was estimated for 5-year or 10-year follow-up time using Cox proportional hazard analyses (reference category, CKD stages 1 and 2). Results: Mortality risk for women with the worst kidney function (CKD stages 3b-5) increased during both 5-year follow-up times compared to that for women in stages 1 and 2 (age 75-80 years: adjusted Hazard Ratio [HR adj ] 3.9, 95% confidence interval [CI] 2.3-6.5; age 80-85 years: HR adj 1.7, 95% CI 1.0-2.7). In contrast, women in stage 3a had increased risk only in the first 5-year follow-up (HR adj 1.7, 95% CI 1.0-3.0, age 75-80 years). Change in kidney function amounted to a loss of 1.9 (±1.4) mL/min/1.73 m 2 per year during the 10-year follow-up, and at age 85 years, 4 of every 5 women had an eGFR equivalent to CKD. Conclusion: In the future, an ageadapted definition of CKD, lowering the threshold for CKD in the elderly, may be beneficial to avoid overdiagnosis of CKD.

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Section: Mortalitymentioning

confidence: 99%

Longitudinal Changes in Kidney Function Estimated from Cystatin C and Its Association with Mortality in Elderly Women

Malmgren

McGuigan

Christensson

et al. 2020

Nephron

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“…Administration of vitamin D is recommended as a first-line strategy reducing the incidence of osteoporotic fractures [51]. Indeed, low 25(OH)D levels in women could be viewed as a general marker of impaired health as the Malmö study has documented correlating with increased overall mortality [52].…”

Section: Effects Of Vitamin D In Calcium Absorption and Bone Physiologymentioning

confidence: 99%

Vitamin D and Physical Activity

Koundourakis¹,

Margioris²

2017

A Critical Evaluation of Vitamin D - Basic Overview

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Vitamin D is synthesized in the skin following exposure to ultraviolet radiation, producing cholecalciferol, while only a small percentage of the circulating vitamin D is of exogenous origin deriving from food. Following two sequential hydroxylations, in the liver and in the kidneys, vitamin D is fully activated. Although its role in bone physiology and calcium homeostasis is well documented, there is emerging evidence that vitamin D exerts a plethora of additional effects on most tissues regulating the musculoskeletal, cardiovascular, and immune systems as well as energy homeostasis. Its deficiency/insufficiency poses a major public health problem observed in all age groups and regardless of latitude and insolation. In muscles, vitamin D deficiency is associated with a decline in neuromuscular function including muscular strength, walking speed, balance, jumping and sprinting performance, and aerobic capacity, although the evidence is still weak regarding its effects in the young and the athletes. Supplementation counteracts the negative effects of vitamin D deficiency on performance although in individuals with adequate levels of vitamin D, additional supplementation does not appear to enhance further physical capabilities. The aim of this chapter is to review our current understanding of diverse effects of vitamin D in physical performance in athletic and nonathletic populations.

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“…Notably, the OPRA participants generally had few comorbidities, unlike the severely frail hospitalized individuals with a presumed high disease burden in other studies. More importantly, in the interplay between PTH–kidney function–vitamin D status, PTH itself makes a minor contributor to mortality [ 6 , 7 ], and this study emphasizes the importance of kidney function on mortality risk in older women, seconded by vitamin D status. Subsequently, regarding the clinical implication of elevated PTH in older and very old women, we suggest that the interpretation of PTH should be done in the context of the individuals’ health status, including assessment of kidney function and vitamin D status.…”

Section: Discussionmentioning

confidence: 95%

“…Collection of blood and serum, anthropometrics, and administration of a detailed lifestyle questionnaire were performed at all visits. Information on comorbidities was only available at 5-year follow up [ 7 ]. Date of death (but not cause) was available through the Swedish National Population Register (to a maximum of 91.5 years; October 2012).…”

Section: Methodsmentioning

confidence: 99%

“…PTH increases as kidney function declines, whereas vitamin D decreases [ 2 , 3 ]. Given this relationship, chronic kidney disease (CKD) and vitamin D insufficiency [ 4 , 5 ] are common with increasing age, and both are associated with increased mortality in older women [ 6 , 7 ]. Studies also suggest that PTH itself is associated with cardiovascular disease risk [ 8 , 9 ] and mortality [ 10 ].…”

mentioning

confidence: 99%

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Longitudinal Assessment of PTH in Community-Dwelling Older Women—Elevations Are Not Associated With Mortality

Buchebner

Malmgren

Christensson

et al. 2017

Journal of the Endocrine Society

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Context:In older women, the magnitude of elevated parathyroid hormone (PTH) and its consequence is unclear.Objective:To describe normal PTH profiles over time and the association with mortality.Design and Participants:There were 1044 community-dwelling women in the Malmö Osteoporosis Prospective Risk Assessment cohort (OPRA) who attended baseline (age 75 years). Follow-ups were attended by 715 (age 80 years) and 382 (age 85 years).Main Outcome Measures:PTH, estimated glomerular filtration rate (eGFR), 25-hydroxyvitamin D (25OHD) and mortality.Results:At age 75 years, PTH levels for most (n = 877, 88%) were within the normal reference range (NRR) (i.e., <6.9 pmol/L). Longitudinally, between ages 75 and 80 years, PTH increased in 60% of all women (n = 390) but increases of up to 50% above baseline values (64%; n=250) still resulted in PTH levels within the NRR. These women had lower 25OHD levels (74 vs 83 nmol/L, P = 0.001). Only when increases were >50% was PTH elevated beyond the NRR (mean 7.1 ± 3.3). Here, a pronounced decline in eGFR (56 vs 61 mL/min/1.73 m2, P = 0.002) was found, despite no further changes in 25OHD. Extending the observational period until age 85 years gave similar results. Baseline PTH levels above NRR were associated with mortality (hazard ratio, 1.4; 95% confidence interval (CI), 1.1-1.8; P = 0.007), although not after adjustment for covariates (P = 0.082).Conclusions:Most women remained within normal PTH ranges despite large increases of up to 50%. PTH elevated above normal is not independently associated with mortality; impaired kidney function and low 25OHD status may be more prognostic in the very old.

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Association Between Hypovitaminosis D in Elderly Women and Long‐ and Short‐Term Mortality—Results from the Osteoporotic Prospective Risk Assessment Cohort

Cited by 11 publications

References 44 publications

Longitudinal Changes in Kidney Function Estimated from Cystatin C and Its Association with Mortality in Elderly Women

Longitudinal Changes in Kidney Function Estimated from Cystatin C and Its Association with Mortality in Elderly Women

Vitamin D and Physical Activity

Longitudinal Assessment of PTH in Community-Dwelling Older Women—Elevations Are Not Associated With Mortality

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