Vitamin D and bone health outcomes in older age

Abstract

The aim of this review is to summarise the evidence linking vitamin D to bone health outcomes in older adults. A plethora of scientific evidence globally suggests that large proportions of people have vitamin D deficiency and are not meeting recommended intakes. Older adults are at particular risk of the consequences of vitamin D deficiency owing to a combination of physiological and behavioural factors. Epidemiological studies show that low vitamin D status is associated with a variety of negative skeletal consequences in older adults including osteomalacia, reduced bone mineral density, impaired Ca absorption and secondary hyperparathyroidism. There seems to be inconsistent evidence for a protective role of vitamin D supplementation alone on bone mass. However, it is generally accepted that vitamin D (17 . 5 mg/ d) in combination with Ca (1200 mg/d) reduces bone loss among older white subjects. Evidence for a benefit of vitamin D supplementation alone on reducing fracture risk is varied. According to a recent Agency for Healthcare Research and Quality review in the USA the evidence base shows mixed results for a beneficial effect of vitamin D on decreasing overall fracture risk. Limitations such as poor compliance with treatment, incomplete assessment of vitamin D status and large drop-out rates however, have been highlighted within some studies. In conclusion, it is generally accepted that vitamin D in combination with Ca reduces the risk of non-vertebral fractures particularly those in institutional care. The lack of data on vitamin D and bone health outcomes in certain population groups such as diverse racial groups warrants attention. 25-hydroxyvitamin D: Vitamin D requirements: Older age: Bone mineral density: FracturesOsteoporosis is a condition characterised by a low bone mass and microarchitectural deterioration of bone with a consequent increase in bone fragility and susceptibility to fracture. In the UK, it is estimated that 3 million people are affected with osteoporosis. Furthermore, one in two British women and one in five British men aged > 50 years will experience an osteoporotic fracture in their lifetime with the estimated costs in the UK being about £1 . 7 billion annually. In the European Union, it has been estimated that previous and incident fractures accounted for 1 180 000 quality-adjusted life years lost during 2010 (1) . Furthermore, with an ageing population, the costs associated with treating osteoporosis in the EU are expected to increase by 25% in 2025(1) . Bone is a dynamic tissue that responds to the external and internal environments to which it is exposed during an individual's lifetime. While a considerable proportion (up to 70%) of the inter-individual variation in bone mass is genetically determined, lifestyle factors such as diet and exercise are well established modifiable factors of bone mass. Bone turnover is important for the self-repair of skeletal tissue (2) as well as maintaining mineral homoeostasis (e.g. Ca and P) and the balance between the rate of bone formation ...

Prevalence of Vitamin D deficiency in Pakistan and implications for the future

“…It is believed that vitamin D (25-hydroxyvitamin D) deficiency (affects over one billion people worldwide (1,2). However, VDD appears to be one of the most under-diagnosed and under-treated dietary insufficiencies (3)(4)(5)(6)(7)(8)(9)(10)(11)(12)(13)(14)(15)(16). This includes Pakistan (1,2,(17)(18)(19)(20)(21).…”

“…This includes Pakistan (1,2,(17)(18)(19)(20)(21). Vitamin D deficiency has been linked to the progression of osteoporosis and osteoporotic fractures arising from secondary hyperparathyroidism (1,11,16,19,(22)(23)(24)(25)(26)(27)(28)(29), and can also lead to rickets and osteomalacia (10,12,23,26,30) as well as potentially myopathy, helping explain why patients with nonspecific musculoskeletal pain syndrome can be refractory to standard therapies (31)(32)(33). Recent studies also suggest vitamin D has a potential role as an immune modulator and tumour suppressor (6,16,29,(34)(35)(36)(37)(38)(39), although others are less certain (40).…”

“…Exposure to sunlight is perhaps the most important factor (2, 20). However, sufficient intake of vitamin D and calcium in a person's diet can also play an appreciable role in the prevention and management of the consequences of Vitamin D deficiency including osteoporosis and reducing the subsequent occurrence of fractures (1,10,11,16,23,25). Studies have suggested serum 25(OH)D levels greater than 30 ng/mL (75 nmol/L) may be necessary to maximize intestinal calcium absorption and stop secondary hyperparathyroidism-induced skeletal conditions (1,33,53).…”

Micronutrient status and intake in the UK – where might we be in 10 years' time?

“…Vitamin D deficiency in older adults is associated with reduced bone mineral density and increased risk of osteomalacia (Hill et al . ). All older adults aged 65 years and over are recommended to take a daily vitamin D supplement (DH ).…”

Fracture risk after three bariatric surgery procedures in Swedish obese subjects: up to 26 years follow‐up of a controlled intervention study

“…However, bariatric surgery, especially surgical procedures that affect nutritional absorption such as gastric bypass and biliopancreatic diversion, may also lead to nutritional deficiencies. Such deficiencies result in low levels of minerals and vitamins, including calcium and vitamin D , which are important for bone formation and maintenance of bone mineral density .…”