The impact of medication on vitamin D status in older individuals

Sohl, E.; Schoor, Natasja M. van; Jongh, Renate T. de; Vries, Oscar J. de; Lips, Paul

doi:10.1530/eje-11-0917

Cited by 30 publications

(61 citation statements)

References 36 publications

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“…In contrast to Sohl et al [15], we were unable to demonstrate significant associations between diuretic use and circulating 25OHD levels. The calciuretic effect of loop diuretics is well known, whereas thiazide diuretics have calcium-sparing effects [24].…”

Section: Discussioncontrasting

confidence: 99%

“…The inverse association between ACE-inhibitor use and circulating 25OHD was much weaker in our study compared with the study by Sohl et al [15]. Our data support several earlier, small, quasi-experimental studies (non-randomized interventions), indicating that ACEinhibitors are not associated with clinically relevant reductions in circulating 25OHD levels [16].…”

Section: Discussionsupporting

confidence: 70%

“…Evidence-based recommendations of CVD therapy include a variety of medications such as diuretics, beta-blockers, antiarrhythmics, calciumchannel blockers, statins and angiotensin-converting enzyme (ACE)-inhibitors or angiotensin receptor (AT) blockers [13,14]. Indeed, data from two cross-sectional analyses of the Dutch older population indicate inverse associations of the use of loop diuretics, calcium-channel blockers and ACE-inhibitors with circulating 25OHD levels [15]. However, a recent review of observational and experimental studies also came to the conclusion that there is still a remarkable lack of valid data on the association between drugs and vitamin D status [16].…”

Section: Introductionmentioning

confidence: 99%

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Association between circulating 25-hydroxyvitamin D levels and medication use in patients scheduled for cardiac surgery

Ernst

Kühn

Becker

et al. 2015

Nutrition, Metabolism and Cardiovascular Diseases

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Section: Discussioncontrasting

confidence: 99%

Section: Discussionsupporting

confidence: 70%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Association between circulating 25-hydroxyvitamin D levels and medication use in patients scheduled for cardiac surgery

Ernst

Kühn

Becker

et al. 2015

Nutrition, Metabolism and Cardiovascular Diseases

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“…On the other hand, having a large number of variables in a fully adjusted model (Model 4) may have contributed to a nonsignificant or biased result, given the fact that we categorized 25(OH) into season-specific quartiles ( n average - mean number per quartile = 194), and therefore may have had limited power for detection of associations. Although we controlled for the number of chronic diseases and for frailty status, increased mortality amongst older women may be mediated by other mechanisms associated with nonoptimal 25(OH)D levels such as polypharmacy [38] or an acute inflammatory response [39,40]. Recent studies have demonstrated a rapid decline in serum 25(OH)D after elective hip or knee surgery or after an acute inflammatory insult, thus 25(OH)D may be an unreliable biomarker of vitamin D status up to 3 months after the event [39,40].…”

Section: Discussionmentioning

confidence: 99%

25‐hydroxyvitamin D and increased all‐cause mortality in very old women: the Newcastle 85+ study

et al. 2014

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ObjectiveTo investigate the associations between low and high concentrations of baseline serum 25-hydroxyvitamin D [25(OH)D] and all-cause mortality in very old (≥85 years) men and women over 6 years.Design, setting and subjectsProspective mortality data from 775 participants in the Newcastle 85+ Study were analysed for survival in relation to 25(OH)D (season-specific quartiles and predefined cut-off values) and sex using Cox proportional hazards models. The models were fitted to the entire and restricted (nonusers of vitamin D-containing supplements and medication) cohorts.ResultsFor the entire cohort, mortality was higher in both the lowest and highest 25(OH)D season-specific quartiles [SQ1: hazard ratio (HR) 1.31, 95% confidence interval (CI) 1.01–1.69, P = 0.04; SQ4: HR 1.44, 95% CI 1.12–1.85, P = 0.004] compared with the combined middle quartiles (SQ2 + SQ3), after adjustment for sociodemographic factors. The increased risk for the highest quartile remained significant after further adjustment for lifestyle variables (SQ4: HR 1.37, 95% CI 1.06–1.77, P = 0.02) and was seen only in women in sex-specific analyses. Similarly, in sensitivity analyses with predefined 25(OH)D cut-off values, the highest 25(OH)D concentration (≥75 nmol L−1) was associated with a 2.4-fold increased risk of mortality in women (restricted cohort) after adjusting for all covariates.ConclusionLow and high season-specific 25(OH)D quartiles were associated with increased risks of mortality over 6 years in the very old; this effect was particularly noticeable in women, including those who reported taking vitamin D-containing supplements/medication.

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“…anticonvulsants, rifampicin, cimetidine, thiazides, corticosteroids (24,25) • Taking drugs that decrease absorption, e.g. mineral oil, laxatives, orlistat, cholestyramine (26) …”

Section: Madammentioning

confidence: 99%

Vitamin D deficiency

Gani¹,

How²

2015

smedj

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Vitamin D deficiency is common among elderly patients in temperate countries, especially in early spring due to reduced cutaneous synthesis during the winter months, (1,2) and in housebound individuals (3) and medical inpatients.The prevalence of vitamin D deficiency is even higher in elderly patients with fragility fractures, ranging from 55%-91.6%. A recent local study in Singapore showed a vitamin D deficiency prevalence of 57.5% and vitamin D insufficiency of 34.5% in elderly patients admitted to hospital with hip fractures. Consequences of vitamin D deficiencyVitamin D deficiency results in abnormalities in calcium, phosphorus and bone metabolism. Specifically, it causes a decrease in the efficiency of intestinal calcium and the phosphorus absorption of dietary calcium and phosphorus, resulting in an increase in parathyroid levels. (9,10) In secondary hyperparathyroidism, serum calcium is maintained at the normal range at the expense of mobilising calcium from the skeleton and increasing phosphorus wasting in the kidneys. This process causes a generalised decrease in bone mineral density, resulting in osteopenia and osteoporosis. The secondary hyperparathyroidism also causes phosphaturia, which results in a low or low-normal serum phosphorus level. This leads to inadequate calciumphosphorus levels and a mineralisation defect in the skeleton. In young children with little mineral in their skeleton, this defect results in rickets. In adults, the result is osteomalacia. Quantified by bone mineral density scores, osteomalacia presents symptomatically with isolated or generalised aches and pains in bones and muscles.(11) In the elderly, vitamin D deficiency causes increasing sway and frequent falls, (12,13) increasing the risk of fracture. In addition to improvements in bone density and the prevention of falls and fracture, vitamin D may have several other putative benefits, including beneficial effects on the immune and cardiovascular systems. (14) Some risk factors Table I shows some common risk factors for vitamin D deficiency in the general population. For the elderly in Singapore, being housebound and of Malay ethnicity is significantly associated with vitamin D deficiency. In a recent study, 90.5% of the Malay patients had a vitamin D level of less than 20 µg/mL compared to 55.0% of the Chinese patients.(8) Those at risk of vitamin D deficiency may be able to overcome it by increasing their exposure to sunlight or dietary intake of vitamin D. In children and adults, exposing the hands, face and arms to the sun for 10-15 minutes per day is usually sufficient. However, the amount of vitamin D that is produced from sunlight depends on the time of day, geographic location and the colour of one's skin. Vitamin D can also be obtained from food and dietary supplements. However, sources in food are limited and include oily fish such as salmon, sardines and mackerel, fortified foods such as margarine, dairy products and cereals, as well as eggs and liver. As vitamin D production in skin and from dietary intake var...

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The impact of medication on vitamin D status in older individuals

Cited by 30 publications

References 36 publications

Association between circulating 25-hydroxyvitamin D levels and medication use in patients scheduled for cardiac surgery

Association between circulating 25-hydroxyvitamin D levels and medication use in patients scheduled for cardiac surgery

25‐hydroxyvitamin D and increased all‐cause mortality in very old women: the Newcastle 85+ study

Vitamin D deficiency

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