Muscle strength in the elderly: Its relation to vitamin d metabolites

Bischoff, H.; Stähelin, H B; Urscheler, Niklaus; Ehrsam, Rolf; Vonthein, Reinhard; Perrig-Chiello, Pasqualina; Tyndall, Alan; Theiler, Robert

doi:10.1016/s0003-9993(99)90307-6

Cited by 277 publications

(174 citation statements)

References 41 publications

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“…Renal failure results in abnormalities in vitamin D metabolism due to the decline in proximal tubular production of 1α-hydroxylase. This results in marked declines in circulating levels of 1,25(OH) 2 D. Studies in humans show that vitamin D deficiency is associated with muscle weakness and atrophy [16,28,29]. At the cellular level, vitamin D deficiency impairs intracellular calcium kinetics and muscle cell contractility [8,9], mitochondrial metabolism [10,11] and protein synthesis [12,13].…”

Section: Discussionmentioning

confidence: 99%

“…Treatment with vitamin D corrects these impairments [14,30] as well as restoring strength and improving balance in vitamin D deficient humans [16,29,31]. Despite the fact that vitamin D deficiency is associated with muscle loss [12,13] and weakness [16,28,29], which may contribute to the significant muscle atrophy, weakness, and widespread disability experienced by patients with ESRD, the current focus of vitamin D treatment for the control of SHPT, as outlined in the current K/DOQI guidelines [5], is on measuring its effects on bone metabolism and tissue calcification.…”

Section: Discussionmentioning

confidence: 99%

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Relationship Between Vitamin D and Muscle Size and Strength in Patients on Hemodialysis

Gordon

Sakkas

Doyle

et al. 2007

Journal of Renal Nutrition

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OBJECTIVE-Vitamin D has various actions in skeletal muscle. The purpose of this study was to compare lower limb muscle size and strength in hemodialysis (HD) patients being treated with 1,25-dihydroxyvitamin D (calcitriol) or a 1,25-dihydroxyvitamin D analog (paricalcitol) to HD patients who were receiving none.DESIGN-This was a retrospective cross-sectional study. SETTING-Outpatient hemodialysis centers.PATIENTS-HD patients receiving calcitriol or paricalcitol (active vitamin D) for control of secondary hyperparathyroidism (VitD, n = 49) were compared to HD patients who were not (n = 30).MAIN OUTCOME MEASURES-Cross-sectional areas (CSA) of thigh and tibialis anterior muscles by magnetic resonance imaging (MRI), and three measures of strength; three-repetition maximum (3RM) for knee extension (isotonic), peak torque of knee extensors (isokinetic), and maximal voluntary contraction (MVC) of the ankle dorsiflexor muscles (isometric).RESULTS-There were no differences in age, weight, dialysis vintage, or intact parathyroid hormone levels between the groups, although serum albumin was higher in the VitD group (p <0.05). Patients in the VitD group had larger thigh muscle CSA (p < 0.05) and were stronger across all strength measures (p< 0.05) after controlling for age and gender (ANCOVA). When all analyses were subsequently adjusted for serum albumin concentration, only the difference in 3RM knee extension strength lost significance. There were no significant differences in any measurements between patients who received calcitriol or paricalcitol.CONCLUSION-Treatment with active vitamin D was associated with greater muscle size and strength in this cohort of HD patients.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Relationship Between Vitamin D and Muscle Size and Strength in Patients on Hemodialysis

Gordon

Sakkas

Doyle

et al. 2007

Journal of Renal Nutrition

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“…D-hormone has a scientifically established effect on muscle strength, balance and functional mobility [3,4,5,6,7,8,9], and the effect of D-hormone treatment (alfacalcidol or calcitriol) on risk of falls has been proven in several studies [1,2]. The low D-hormone serum levels observed with a creatinine clearance of <65 ml/min may also be one reason for the increased osteopenia and osteoporosis observed with low creatinine clearance by other authors [15,16].…”

Section: Discussionmentioning

confidence: 99%

“…This positive effect of calcitriol or alfacalcidol on risk of falls or number of fallers is most probably due to an increase in muscle strength [3,4,5] and neuromuscular coordination [6], improved balance [4,5,7] and increased functional mobility [5,8] observed with increasing D-hormone serum levels or under treatment with calcitriol or alfacalcidol [7,9].…”

Section: Introductionmentioning

confidence: 99%

Treatment with alfacalcidol in elderly people significantly decreases the high risk of falls associated with a low creatinine clearance of <65�ml/min

et al. 2004

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We previously observed that a creatinine clearance (CrCl) of <65 ml/min is a significant and independent risk factor for the number of fallers and falls in a community-dwelling elderly population and postulated that this increased risk is due to the associated significant lower D-hormone serum levels. To test our hypothesis, we investigated in a post hoc analysis of a double-blind randomized study whether treatment with alfacalcidol, a synthetic prodrug of the D-hormone, can reduce the high incidence of fallers and the high risk of falls associated with low CrCl. Of 378 Swiss community-dwelling women (n=191) and men (n=187), aged 70 years and older, 191 received randomly 1 lg capsules of alfacalcidol (AlphaD3: Teva), and 187 received one capsule of placebo daily. With the help of questionnaires we regularly assessed the incidence and frequency of falls. The risk of becoming a faller and the risk of falling were assessed in multivariate-controlled logistic regression models according to treatment groups and according to a CrCl cut-off of 65 ml/min. The presented results are from ITT analyses. In participants with a CrCl of <65 ml/min, the 36 weeks of treatment with alfacalcidol was, compared with placebo, associated with a significant reduction in the number of fallers (14/72 versus 25/70; OR 0.26, 95% CI 0.08-0.80, P=0.019), and a significant reduction of the number of falls (16/72 versus 28/70; OR 0.29, 95% CI 0.09-0.88, P=0.028). No such association was observed in participants with a CrCl of ‡65 ml/min (for fallers 26/120 versus 21/116; OR 0.92 95% CI 0.34-2.52, P=0.875; for falls 32/120 versus 23/116; OR 0.93 95% CI 0.34-2.54, P=0.885). In the placebo group frequency of falls was dependent on CrCl (P=0.006), whereas in the alfacalcidol treatment group frequency of falls was independent of CrCl (P=0.494). No cases of clinically relevant hypercalcemia were observed. In a community-dwelling population of elderly men and women with a CrCl of <65 ml/min, treatment with alfacalcidol can significantly and safely reduce the low CrCl associated increased number of fallers and the high risk of falls.

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“…Oestrogen therapy might affect growth hormone concentrations 30 , IGF-1 levels 31 , and vitamin D values 32 . The association between muscle strength and GH 33 , IGF-1 34 and vitamin D 35,36 has been demonstrated before. Finally, muscle strength might increase because of an effect of oestrogen on muscular blood supply 37 or an effect on neuromuscular function 38 .…”

Section: Rank Summentioning

confidence: 60%

Muscle strength and tibolone: a randomised, double-blind, placebo-controlled trial

Meeuwsen¹

2002

BJOG: An International Journal of Obstetrics and Gynaecology

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Muscle strength in the elderly: Its relation to vitamin d metabolites

Cited by 277 publications

References 41 publications

Relationship Between Vitamin D and Muscle Size and Strength in Patients on Hemodialysis

Relationship Between Vitamin D and Muscle Size and Strength in Patients on Hemodialysis

Treatment with alfacalcidol in elderly people significantly decreases the high risk of falls associated with a low creatinine clearance of <65�ml/min

Muscle strength and tibolone: a randomised, double-blind, placebo-controlled trial

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