In reply to the letter to the editor regarding “The Relationship Between Serum Vitamin D and Fracture Risk in the Elderly: A Meta-Analysis”

Wang, Ning; Ji, Jindou; Yu, Shengwen; Chang, Jinlei; Chen, Yungang; Yu, Bo

doi:10.1186/s13018-020-01820-5

Cited by 5 publications

(2 citation statements)

References 14 publications

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“…High serum levels were associated with a reduced risk of hip fractures in elderly patients, but not with reduction in total fracture risk. The authors suggested that disparate results seen in earlier studies may have arisen due to selection of fracture sites studied and analysis of both perimenopausal and senile osteoporotic fractures (59).…”

Section: Musculoskeletal Conditionsmentioning

confidence: 97%

New Roles for Vitamin D Superagonists: From COVID to Cancer

2021

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Vitamin D is a potent steroid hormone that induces widespread changes in gene expression and controls key biological pathways. Here we review pathophysiology of vitamin D with particular reference to COVID-19 and pancreatic cancer. Utility as a therapeutic agent is limited by hypercalcemic effects and attempts to circumvent this problem have used vitamin D superagonists, with increased efficacy and reduced calcemic effect. A further caveat is that vitamin D mediates multiple diverse effects. Some of these (anti-fibrosis) are likely beneficial in patients with COVID-19 and pancreatic cancer, whereas others (reduced immunity), may be beneficial through attenuation of the cytokine storm in patients with advanced COVID-19, but detrimental in pancreatic cancer. Vitamin D superagonists represent an untapped resource for development of effective therapeutic agents. However, to be successful this approach will require agonists with high cell-tissue specificity.

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Section: Musculoskeletal Conditionsmentioning

confidence: 97%

New Roles for Vitamin D Superagonists: From COVID to Cancer

2021

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“…VD deficiency is a common condition worldwide, particularly in elderly and osteoporotic individuals [3,4] and the link between VD deficiency and increased risk of fracture in elderly individuals has been extensively documented in trials, observational studies and meta-analyses [5][6][7][8].…”

Section: Introductionmentioning

confidence: 99%

The Potential Impact of Inducing a Restriction in Reimbursement Criteria on Vitamin D Supplementation in Osteoporotic Patients with or without Fractures

Esposti¹,

Perrone²,

Sella

et al. 2022

Nutrients

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In October 2019, the Italian Drug Agency (AIFA) restricted reimbursement criteria for vitamin D (VD) use outside the osteoporosis setting (Note 96). However, whether this restriction could also have involved patients at risk for or with osteoporotic fractures has not yet been investigated. We retrospectively analyzed databases from five Italian Local Health Units. Patients aged ≥50 years with either at least one prescription for osteoporosis treatment or with fragility fractures and evidence of osteoporosis from 2011 to 2020 were included. The proportion of subjects with an interruption in VD treatment before and after the introduction of the new reimbursement criteria and predictors of this interruption were analyzed. A total of 94,505 patients (aged 69.4 years) were included. Following the introduction of Note 96, a 2-fold (OR 1.98, 95% CI: 1.92–2.04) increased risk of VD discontinuation was observed. These findings were independent of seasonal variation, osteoporosis treatment patterns, as well as other confounding variables. However, a higher rate of interruption was observed in patients without vertebral/femur fracture (37.8%) vs. those with fracture (32.9%). Rheumatoid arthritis, dyslipidemia and previous fracture were associated with a lower risk of VD interruption, while stroke increased the risk of VD interruption. Our results highlight that a possible misinterpretation of newly introduced criteria for reimbursement restrictions in VD outside of osteoporosis have resulted in an inadequate level of VD supplementation in patients with osteoporosis. This undertreatment could reduce the effect of osteoporosis therapies leading to increased risk of negative outcome.

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