VITAMIN D IS ESSENTIAL for maintaining calcium
|
|
- Alexander Wade
- 8 years ago
- Views:
Transcription
1 904 ORIGINAL ARTICLE Vitamin D Deficiency and Osteoporosis in Rehabilitation Inpatients Leonid M. Shinchuk, MD, Leslie Morse, DO, Nadia Huancahuari, Seth Arum, MD, Tai C. Chen, PhD, Michael F. Holick, MD, PhD ABSTRACT. Shinchuk LM, Morse L, Huancahuari N, Arum S, Chen TC, Holick MF. Vitamin D deficiency and osteoporosis in rehabilitation inpatients. Arch Phys Med Rehabil 2006;87: Objective: To determine vitamin D status and bone mineral density (BMD) in patients admitted to a subacute rehabilitation facility. Design: Cross-sectional cohort study. Setting: Subacute rehabilitation facility. Participants: Fifty-three community-dwelling patients admitted from June through February Interventions: Not applicable. Main Outcome Measures: BMD, 25-hydroxyvitamin D (25[OH]D), C-telopeptide (CTX), osteocalcin, and dietary milk intake. Results: Prevalence of vitamin D deficiency (25[OH]D 20ng/mL) was 49.1%, while a total of 83% of patients were either vitamin D deficient or insufficient (25[OH]D 30ng/ ml). The prevalence of osteopenia (T score, 1) was 52.8%; osteoporosis (T score, 2.5) was 17.0%. CTX (bone resorption marker) was elevated in 60.4% of patients. Osteocalcin (bone formation marker) was elevated in 13.2% of patients. Measurements of bone resorption and formation positively correlated (R 2.22) indicating increased bone remodeling. Conclusions: Vitamin D deficiency and osteopenia and osteoporosis were highly prevalent in patients admitted for rehabilitation. Elevated bone resorption and remodeling were evident. This could be due to vitamin D deficiency that should be corrected before antiresorptive therapy is considered. The study emphasizes the need for vigilance for vitamin D status and BMD testing in patients admitted to rehabilitation facilities. Key Words: Bone density; Osteoporosis; Rehabilitation; Vitamin D deficiency by the American Congress of Rehabilitation Medicine and the American Academy of Physical Medicine and Rehabilitation From the Departments of Physical Medicine and Rehabilitation (Shinchuk, Morse) and Medicine (Huancahuari, Arum, Chen, Holick), Boston University Medical Center, Boston, MA. Presented to the American Academy of Physical Medicine and Rehabilitation, October 28, 2005, Philadelphia, PA. Supported by the National Institutes of Health (grant no. M01RR 00533). No commercial party having a direct financial interest in the results of the research supporting this article has or will confer a benefit upon the authors or upon any organization with which the authors are associated. Correspondence to Michael F. Holick, MD, PhD, Boston University School of Medicine, 715 Albany St, #M1013, Boston, MA 02118, MFHolick@BU.edu. Reprints are not available from the author /06/ $32.00/0 doi: /j.apmr VITAMIN D IS ESSENTIAL for maintaining calcium and phosphorus homeostasis, and optimizing bone health. The active form of vitamin D, 1,25-dihydroxyvitamin D (1,25[OH] 2 D), acts on specific nuclear receptors to increase calcium absorption from the small intestine and to regulate bone turnover. 1 Vitamin D deficiency leads to secondary hyperparathyroidism and, if not treated, to development of osteoporosis with subsequent increase in fracture risk. 2-4 Additionally, 1,25(OH) 2 D binds to receptors on skeletal muscles. 5-8 Recent studies 9-11 showed strong association between higher serum vitamin D concentrations and muscle strength, physical activity, and reduced falls in elderly. Vitamin D can be obtained from diet or synthesized in the skin under appropriate intensity and duration of ultraviolet radiation. 12,13 Vitamin D is biologically inert and must undergo 2 successive hydroxylations in the liver and kidney to become the biologically active 1,25(OH) 2 D. 1 Factors that interfere with vitamin D intake, absorption, synthesis, or metabolism result in vitamin D deficiency. Advanced age, nonwhite ethnicity, poor dietary intake, increased body mass index (BMI), inadequate sun exposure, northern latitude, and medications that impair vitamin D activation or accelerate clearance are known risk factors for vitamin D deficiency. 14 However, standard clinical risk factors are poor predictors of vitamin D status. 15 The prevalence of vitamin D deficiency in communitydwelling elderly is estimated to be between 25% and 54%. 16 The prevalence of vitamin D deficiency in medical inpatients was reported around 57%. 15 Untreated, vitamin D deficiency will lead to development of osteopenia and osteoporosis defined by World Health Organization (WHO) as bone mass 1 and 2.5 standard deviations (SDs) below the sex-controlled young adults, respectively. In the United States, 40% of women over the age of 50 have osteopenia and 7% suffer from osteoporosis. 17 Vitamin D deficiency is also highly prevalent in men. In the United States, 3.5 million men over the age of 65 have osteopenia and 1.5 million suffer from osteoporosis. 18 Osteoporosis is a silent disease with the first manifestation being development of pathologic fracture. There are approximately 1.3 million osteoporotic fractures each year in the United States with an estimated cost of $13.8 billion in Patients who require a subacute rehabilitation stay after an acute hospitalization possess multiple risk factors for vitamin D deficiency and are at risk of osteopenia and osteoporosis. Frequently, these patients are older, medically complex, and suffer from reduced mobility and poor nutritional status. The goal of this study was to determine vitamin D status and the prevalence of vitamin D deficiency in this vulnerable group of patients. In addition, we determined the prevalence of osteopenia and osteoporosis, ascertained factors related to vitamin D deficiency and low bone mineral density (BMD), and determined bone resorption and formation activity in these patients.
2 VITAMIN D DEFICIENCY AND OSTEOPOROSIS IN REHABILITATION, Shinchuk 905 METHODS Study Participants From June 2004 to February 2005, we recruited a cohort of inpatients admitted to a subacute rehabilitation facility at Boston Medical Center to participate in the study. Subjects were excluded if they were younger than 21 years old, pregnant, not proficient in English, or were taking vitamin D or calcium supplementation. The study was approved by the institutional review board and signed informed consent was obtained from each subject prior to enrollment. Study Conduct Subjects attended a single study visit at the General Clinical Research Center where demographic information, height, and weight were recorded. A dual x-ray absorptiometry (DXA) scan was performed on a QDR 4500 Hologic bone densitometer. a A single blood sample was collected to assess 25(OH)D, osteocalcin, and C-telopeptide (CTX). A questionnaire was administered to ascertain pertinent medical, dietary, and medication history. Laboratory Studies We determined serum 25(OH)D using a Nichols Advantage Specialty System b with a 6.4% to 14.5% interassay coefficient of variation (CV). The normative range for adults is 20 to 100ng/mL. We measured CTX utilizing the Serum CrossLaps ELISA c kit. The detection limit was.01ng/ml. The intra- and interassay CV ranges from 5.0% and 8.0%, respectively. Mean observed reference values for premenopausal women, postmenopausal women, and men are , , and ng/mL, respectively. We measured osteocalcin with a Nichols Advantage system. The assay has sensitivity of 0.1ng/mL, and the intra- and interassay CV ranges from 4.6% to 5.3% and 7.3% to 9.5%, respectively. The reference values of osteocalcin for premenopausal women and men range from 0.5 to 7.0ng/mL and 1.1 to 7.2ng/mL, respectively. Outcome Measures The major outcome measures include vitamin D inadequacy, bone resorption and formation activity, prevalence of osteopenia and osteoporosis, and milk consumption data. Various cut-points of serum 25(OH)D were used to define vitamin D inadequacy ( 9, 15, 20, 25, 30ng/mL). An increase in bone resorption activity was defined as CTX levels above the normative range provided by the manufacturer for premenopausal women, postmenopausal women, and men. An increase in bone formation was defined as osteocalcin levels above the normative range provided by the manufacturer for premenopausal women and men. The normative range for osteocalcin for postmenopausal women is unknown, so the value for premenopausal women was used instead, which may have led to underestimation of the results. Osteopenia and osteoporosis were defined based on the WHO classification. Inadequate milk consumption was defined as self-reported intake of less than 1 glass of milk a day prior to hospitalization. Statistical Analysis We calculated the distribution of serum 25(OH)D and the percentage of patients below 9, 15, 20, 25, and 30ng/mL and associated 95% confidence intervals (CIs). Prevalence of vitamin D deficiency and associated CIs by sex and race were ascertained. The Pearson correlation coefficient was calculated to assess the relation between serum 25(OH)D, age, and BMI. We calculated the prevalence of osteopenia, osteoporosis, increased CTX and osteocalcin, and milk consumption with associated 95% CIs. The Pearson correlation coefficient was calculated to assess the relation between CTX and osteocalcin. We performed group comparisons by sex and race for serum 25(OH)D less than 20ng/mL and less than 30ng/mL, osteopenia, osteoporosis, and inadequate milk consumption based on chi-square or Fisher exact tests as appropriate. A P value of.05 or less was considered statistically significant. All analyses were performed using SAS statistical software. d RESULTS Participants Sixty-one patients met inclusion criteria. Eight (13.1%) patients were excluded from the study (3 patients withdrew consent, 4 patients did not provide sufficient material for serum measurements, 1 patient was discharged prior to completion of the study). Fifty-three (86.9%) patients provided a blood sample for determination of serum 25(OH)D, osteocalcin, and CTX, underwent DXA scan, and completed the questionnaire. Subjects mean age was years and included 30 (56.6%) men, 23 (43.4%) women, 29 (54.7%) whites, 20 (37.7%) African Americans, 2 (5.7%) Hispanics, and 1 (1.9%) Asian. Forty-nine (92.5%) patients were ambulatory prior to admission, 3 (5.7%) patients were housebound, and 1 (1.9%) patient was homeless. None of the patients was a nursing home resident. Patients demographics are summarized in table 1. The length of acute hospitalization prior to transfer to the transitional care unit was days. Forty-three (81.1%) patients were transferred from a surgical service (23 [43.4%] patients after joint replacement, 8 [15.1%] patients after other orthopedic procedure, 12 [22.6%] patients after surgical nonorthopedic procedure). Ten (18.9%) patients were transferred from a medical service. Three (5.7%) patients were receiving therapy with glucocorticoids, 3 (5.7%) were taking anticonvulsant agents (phenytoin, phenobarbital, or carbamazepine), 1 (1.9%) patient was receiving both glucocorticoid and anticonvulsant agents, and none of the patients were taking rifampin. Table 1: Demographics Characteristic Total (N 53) Age (y) Sex Male 30 (56.6) Female 23 (43.4) Ethnicity White 29 (54.7) Black 20 (37.7) Hispanic 3 (5.7) Asian 1 (1.9) Other 0 (0.0) Residential and functional status Ambulatory 49 (92.5) Housebound 3 (5.7) Nursing home resident 0 (0.0) Homeless 1 (1.9) BMI (kg/m 2 ) NOTE. Values are mean SD or n (%).
3 906 VITAMIN D DEFICIENCY AND OSTEOPOROSIS IN REHABILITATION, Shinchuk Prevalence ± 95% Confidence Interval 100% 80% 60% 40% 20% 0% All Subjects White Non-white <9ng/mL <15ng/mL <20ng/mL <25ng/mL <30ng/mL Cutoff Points for Serum-25(OH)D Fig 1. Prevalence of vitamin D inadequacy in all subjects, white and nonwhite patients. The percentage of subjects with serum 25(OH)D concentrations below predefined cutoffs of <9, <15, <20, <25, and <30ng/mL. Prevalence of Low Serum 25(OH)D Several cutpoints were used to describe the prevalence of vitamin D inadequacy in the study population (fig 1). We found that 83.0% (95% CI, 72.9% 93.1%) of subjects had a serum 25(OH)D less than 30ng/mL and 49.1% (95% CI, 35.6% 62.6%) had values less than 20ng/mL. Vitamin D deficiency ( 20ng/mL) was equally present in men (46.7%) and women (52.2%). The prevalence of vitamin D deficiency was 41.4% in white patients and 58.3% in nonwhite patients (see fig 1). There was no difference in the prevalence of vitamin D deficiency during seasonal peak (June September) and the other months (October February), 51.7% and 45.8%, respectively. Age and BMI did not correlate with 25(OH)D (r and r 2.097, respectively). Prevalence of Osteopenia and Osteoporosis Exactly 53.3% (95% CI, 35.4% 71.2%) of men and 52.2% (95% CI, 31.8% 72.6%) of women had osteopenia (T score of 1.0) and 20% (95% CI, 5.7%.34.3%) of men and 13% (95% CI, 0% 26.7%) of women had osteoporosis (T score 2.5) (fig 2). Prevalence of osteopenia in white and nonwhite patients was 51.7% and 54.2%, respectively, while prevalence of osteoporosis was 6.9% and 29.2%, respectively (see fig 2). Markers of Bone Resorption and Formation In this patient population, 60.4% (95% CI, 47.2% 73.6%) of patients had an increase in bone resorption (CTX.52ng/mL in men,.48ng/ml in premenopausal women,.77ng/ml in postmenopausal women), and 13.2% (95% CI, 4.1% 22.3%) of patients had an increase in bone formation (osteocalcin 7.0ng/mL in women; 7.2ng/mL in men). Bone formation and resorption activity correlated weakly (r 2.22), indicating an increase in bone remodeling. Milk Intake Forty-nine percent (95% CI, 35.5% 62.5%) of patients reported consuming less than 1 glass of milk a day prior to hospitalization (53.3% men, 47.8% women) while 13.2% (95% CI, 4.1% 22.3%) consumed more than 2 glasses a day (10.0% men, 17.4% women). Inadequate milk consumption was more prevalent in African Americans (66.7%) than in whites (38.0%) (P.027). DISCUSSION In this study of 53 patients admitted to a rehabilitation facility after an acute hospitalization, we found a high prevalence of vitamin D deficiency in both male and female inpatients. There was no statistical difference in vitamin D deficiency between white and nonwhite patients; even so, there was a tendency for a higher prevalence of vitamin D deficiency in the nonwhite cohort. Given a relatively short duration of preceding acute hospitalization for the majority of patients, the observed prevalence of vitamin D deficiency is likely a premorbid characteristic of the group because the serum half-life for 25(OH)D is approximately 2 weeks. 14 Interestingly, neither age nor BMI correlated with 25(OH)D level (r and r 2.097, respectively). One explanation might be that the younger or more overweight patients who require rehabilitation stay prior to returning home are more medically affected and therefore more likely to develop vitamin D deficiency. Although previous studies described vitamin D deficiency in the general population and in medical inpatients, this study was aimed at evaluating a population of patients who require a subacute level rehabilitation stay after an acute hospitalization. This group of patients is at a higher risk to develop vitamin D deficiency given the reduced mobility and medical complexity that necessitated the rehabilitation stay. Clearly, little has been done to address vitamin D deficiency in these patients. As we reported previously, the prescription rate of vitamin D and/or calcium supplementation on admission to subacute rehabilitation was only about 12% indicating that this group remains an underdiagnosed and undertreated high-risk population for vitamin D deficiency. 20 Osteopenia and osteoporosis were highly prevalent on the subacute rehabilitation unit. Patients of both sexes and all races were equally affected. The combined prevalence of osteopenia and osteoporosis was 69.8%. It was previously reported that 25(OH)D levels correlate positively with BMD in young and older adults. 21 Additionally, vitamin D plays an important role in the maintenance of proximal muscle strength and reduction of falls Long-term vitamin D and calcium supplementation was shown to reduce the risk of nonvertebral fractures by 32% to 58%. 26,27 Bischoff et al 28 demonstrated in a randomized controlled trial that daily vitamin D and calcium supple- Prevalence of Osteopenia/Osteoporosis 100% 80% 60% 40% 20% 0% Male Female White Non-white T score < -1 Osteopenia T score as Defined by WHO T score < -2.5 Osteoporosis Fig 2. Prevalence of osteopenia and osteoporosis in male and female, white and nonwhite patients. T scores as defined by WHO (osteopenia T score < 1 SD; osteoporosis T score < 2.5 SD sexand race-controlled young adults).
4 VITAMIN D DEFICIENCY AND OSTEOPOROSIS IN REHABILITATION, Shinchuk 907 mentation improve musculoskeletal function (knee flexor and extensor strength, grip strength, and Timed Up & Go test) and reduces the risk of falls by 49% in long-term care facility patients. In a recently published meta-analysis, 29 the risk of falls among ambulatory or institutionalized older subjects with stable health was reduced by more than 20% compared with placebo. Thus, the combination of established osteopenia and osteoporosis and vitamin D deficiency puts the subacute rehabilitation inpatients in an especially high risk group of acquiring an osteoporotic fracture. Treatment with vitamin D and calcium supplementations will likely benefit the patients by improving their BMD and musculoskeletal function. We evaluated bone turnover activity by measurement of CTX and osteocalcin. There was significant bone resorption activity as evident by an increased CTX in 60.4% of the patients. At least 13.2% of patients had an increase in bone formation as evidenced by an increased osteocalcin. Overall, bone formation and bone resorption markers positively correlated (r 2.22), indicating an increase in bone remodeling. Exactly 58.5% of patients underwent an orthopedic intervention during the acute hospitalization. Similar results for markers of bone resorption (CTX) and formation (osteocalcin) were obtained evaluating subgroups with and without recent orthopedic procedures. Markers of bone resorption and formation were elevated in 54.8% and 9.7% of patients after an orthopedic procedure, respectively, and in 68.2% and 18.2% of patients, respectively, who did not have an orthopedic intervention. Bone turnover markers are much more sensitive to metabolic changes in bone than BMD. 30 It is unclear if substantially increased bone resorption activity in rehabilitation inpatients is due to a preceding period of relative inactivity during an acute hospitalization or to their baseline medical status and vitamin D deficiency. Caution must be taken when interpreting these results. Nevertheless, the changes in bone turnover markers are strong predictors of reduced fracture risk. 31 Casual exposure to sunlight provides most of the vitamin D requirement. 1 However, elderly people have decreased ability to synthesize vitamin D. Compared with young adults, a person older than 70 years of age produces less than 30% of the amount of vitamin D 3 when exposed to the same amount of sunlight. 32 Cutaneous synthesis of vitamin D also depends on the exposure to appropriate ultraviolet radiation, which depends on time of the day, season, and latitude. In Boston, MA (latitude 42 N), sunlight is incapable of producing vitamin D 3 in the skin between the months of November and February. 33 Thus, patients with limited mobility and the elderly who live in the northern latitudes must rely extensively on oral intake to cover the daily vitamin D requirement. The recommended daily oral vitamin D intake in the United States is 200IU for adults up to 50 years old, 400IU for adults 51 to 70, and 600IU for men and women over Milk is fortified with vitamin D. One glass provides approximately 100IU or from 17% to 50% of daily requirement depending on age. 35 Most dairy products, such as cheese and most yogurts, are not fortified with vitamin D. Thus, milk itself remains the main source of vitamin D. In our patient population, 49.1% of patients consumed less than 1 glass of milk a day. Dietary preferences or the higher prevalence of lactose intolerance with age, especially in the African-American populations, might explain these findings. However, it is clear that patients need to rely on other sources, either dietary or pharmacologic, to obtain adequate amounts of vitamin D. Although the relatively small sample size and the use of a single subacute site in Boston, MA, as a referral base limit the generalization of results, the high prevalence of vitamin D deficiency that we observed should alert physicians about hypovitaminosis D in rehabilitation inpatients at other medical centers. The study excluded patients who were taking vitamin D or calcium supplementations. These patients were representing less than 12% of all patients admitted, so excluding them did not significantly bias the reported prevalence of hypovitaminosis D. However, care must be taken to insure adequate vitamin D supplementation in that group as recent studies demonstrated high prevalence of vitamin D deficiency even in patients on pharmacologic therapy to treat osteoporosis and taking a multivitamin that contained vitamin D. 36 CONCLUSIONS Vitamin D deficiency and osteopenia and osteoporosis are highly prevalent in both men and women admitted for subacute rehabilitation after an acute hospitalization. Bone remodeling activity was elevated with a disproportional increase in bone resorption. This could be due to vitamin D deficiency that should be corrected before antiresorptive therapy is considered. This study emphasizes the need for vigilance for vitamin D status and BMD testing in patients admitted to rehabilitation facilities. References 1. Holick MF. Vitamin D: photobiology, metabolism, mechanism of action, and clinical applications. In: Favus MJ, editor. Primer on the metabolic bone diseases and disorders of mineral metabolism. 5th ed. Philadelphia: Lippincott; p Kinyamu HK, Gallagher JC, Balhorn KE, Petranick KM, Rafferty KA. Serum vitamin D metabolites and calcium absorption in normal young and elderly free-living women and in women living in nursing homes. Am J Clin Nutr 1997;65: Aaron JE, Gallagher JC, Anderson J, et al. Frequency of osteomalacia and osteoporosis in fracture of the proximal femur. Lancet 1974;1: Holick MF. Vitamin D: a millenium perspective. J Cell Biochem 2003;1;88: Simpson RU, Thomas GA, Arnold AJ. Identification of 1,25- dihydroxyvitamin D 3 receptors and activities in muscle. J Biol Chem 1985;260: Costa EM, Blau HM, Feldman D. 1,25-dihydroxyvitamin D 3 receptors and hormonal responses in cloned human skeletal muscle cells. Endocrinology 1986;119: Haddad JG, Walgate J, Min C, Hahn TJ. Vitamin D metabolitebinding proteins in human tissue. Biochim Biophys Acta 1976; 22;444: Bischoff HA, Borchers M, Gudat F, et al. In situ detection of 1,25-dihydroxyvitamin D 3 receptor in human skeletal muscle tissue. Histochem J 2001;33: Mowe M, Haug E, Bohmer T. Low serum calcidiol concentration in older adults with reduced muscular function. J Am Geriatr Soc 1999;47: Dhesi JK, Bearne LM, Moniz C, et al. Neuromuscular and psychomotor function in elderly subjects who fall and the relationship with vitamin D status. J Bone Miner Res 2002;17: Venning G. Recent developments in vitamin D deficiency and muscle weakness among elderly people. BMJ 2005;330: Holick MF, MacLaughlin JA, Clark MB, et al. Photosynthesis of previtamin D 3 in human skin and the physiologic consequences. Science 1980;210: MacLaughlin JA, Anderson RR, Holick MF. Spectral character of sunlight modulates photosynthesis of previtamin D 3 and its photoisomers in human skin. Science 1982;216: Holick MF. Sunlight and vitamin D for bone health and prevention of autoimmune disease, cancers, and cardiovascular disease. Am J Clin Nutr 2004;80(6 Suppl):1678S-88S.
5 908 VITAMIN D DEFICIENCY AND OSTEOPOROSIS IN REHABILITATION, Shinchuk 15. Thomas MK, Lloyd-Jones DM, Thadhani RI, et al. Hypovitaminosis D in medical inpatients. N Engl J Med 1998;338: Gloth FM 3rd, Tobin JD. Vitamin D deficiency in older people. J Am Geriatr Soc 1995;43: Siris ES, Miller PD, Barrett-Connor E, et al. Identification and fracture outcomes of undiagnosed low bone mineral density in postmenopausal women: results from the National Osteoporosis Risk Assessment. JAMA 2001;286: Siddiqui NA, Shetty KR, Duthie EH Jr. Osteoporosis in older men: discovering when and how to treat it. Geriatrics 1999;54(9): 20-2, 27-8, Ray NF, Chan JK, Thamer M, Melton LJ 3rd. Medical expenditures for the treatment of osteoporotic fractures in the United States in 1995: report from the National Osteoporosis Foundation. J Bone Miner Res 1997;12: Shinchuk LM, Huancahuari N, Ingersoll D, Holick MF. Vitamin D deficiency and osteoporosis: highly prevalent in men and women admitted to subacute rehabilitation facility in Boston, Massachusetts during summer [abstract]. Am J Phys Med Rehabil 2005;84: Bischoff-Ferrari HA, Dietrich T, Orav EJ, Dawson-Hughes B. Positive association between 25-hydroxy vitamin D levels and bone mineral density: a population-based study of younger and older adults. Am J Med 2004;116: Janssen HC, Samson MM, Verhaar HJ. Vitamin D deficiency, muscle function, and falls in elderly people. Am J Clin Nutr 2002;75: Pfeifer M, Begerow B, Minne HW, et al. Vitamin D status, trunk muscle strength, body sway, falls, and fractures among 237 postmenopausal women with osteoporosis. Exp Clin Endocrinol Diabetes 2001;109: Sato Y, Inose M, Higuchi I, Higuchi F, Kondo I. Changes in the supporting muscles of the fractured hip in elderly women. Bone 2002;30: Dhesi JK, Bearne LM, Moniz C, et al. Neuromuscular and psychomotor function in elderly subjects who fall and the relationship with vitamin D status. J Bone Miner Res 2002;17: Chapuy MC, Arlot ME, Delmas PD, Meunier PJ. Effect of calcium and cholecalciferol treatment for three years on hip fractures in elderly women. BMJ 1994;308: Dawson-Hughes B, Harris SS, Krall EA, Dallal GE. Effect of calcium and vitamin D supplementation on bone density in men and women 65 years of age or older. N Engl J Med 1997;337: Bischoff HA, Stahelin HB, Dick W, et al. Effects of vitamin D and calcium supplementation on falls: a randomized controlled trial. J Bone Miner Res 2003;18: Bischoff-Ferrari HA, Dawson-Hughes B, Willett WC, et al. Effect of vitamin D on falls: a meta-analysis. JAMA 2004;291: Greenspan SL, Resnick NM, Parker RA. Early changes in biochemical markers of bone turnover are associated with long-term changes in bone mineral density in elderly women on alendronate, hormone replacement therapy, or combination therapy: a threeyear, double-blind, placebo-controlled, randomized clinical trial. J Clin Endocrinol Metab 2005;90: Eastell R, Barton I, Hannon RA, Chines A, Garnero P, Delmas PD. Relationship of early changes in bone resorption to the reduction in fracture risk with risedronate. J Bone Miner Res 2003;18: Holick MF, Matsuoka LY, Wortsman J. Age, vitamin D, and solar ultraviolet. Lancet 1989;2: Holick MF. McCollum Award Lecture, 1994: vitamin D new horizons for the 21st century. Am J Clin Nutr 1994;60: Institute of Medicine, Food and Nutrition Board. Dietary reference intakes: calcium, phosphorus, magnesium, vitamin D and fluoride. Washington (DC): Natl Acad Pr; Dietary reference intakes: applications in dietary assessment. A Report of the Subcommittees on Interpretation and Uses of Dietary Reference Intakes and Upper Reference Levels of Nutrients, and the Standing Committee on the Scientific Evaluation of Dietary Reference Intakes, Food and Nutrition Board. Washington (DC): Natl Acad Pr; p Holick MF, Siris ES, Binkley N, et al. Prevalence of vitamin D inadequacy among postmenopausal North American women receiving osteoporosis therapy. J Clin Endocrinol Metab 2005;90: Suppliers a. Hologic Inc, 35 Crosby Dr, Bedford, MA b. Nichols Advantage, 1311 Calle Batido, San Clemente, CA c. Nordic Bioscience Diagnostics A/S, Herlev Hovedgade 207, 2730 Herlev, Denmark. d. SAS Institute Inc, 100 SAS Campus Dr, Cary, NC
NATIONAL OSTEOPOROSIS FOUNDATION OSTEOPOROSIS CLINICAL UPDATES Vitamin D and Bone Health CE APPLICATION FORM
NATIONAL OSTEOPOROSIS FOUNDATION OSTEOPOROSIS CLINICAL UPDATES Vitamin D and Bone Health CE APPLICATION FORM First Name: Last Name: Mailing Address: City: State: Zip/Postal Code: Country: Phone Number:
More informationElderly nursing home residents have a high risk of falls 1
BRIEF REPORTS A Higher Dose of Vitamin D Reduces the Risk of Falls in Nursing Home Residents: A Randomized, Multiple-Dose Study Kerry E. Broe, MPH, Tai C. Chen, PhD, w Janice Weinberg, ScD, z Heike A.
More informationVitamin D Deficiency in Older Patients
Fourth Year Medical Students Required Written Patient Care Assignments Reflecting Awareness of Use of Vitamin D in Older Patients at Risk for Falling John Agens, M.D. Associate Professor in Geriatrics
More informationKey words: Vitamin D Production, Vitamin D Deficiency, and Vitamin D Treatment
Title: Vitamin D Author: Kerry Lynn Kuffenkam Date: 4-29-09 Key words: Vitamin D Production, Vitamin D Deficiency, and Vitamin D Treatment Abstract: Since the term Vitamin D contains the word vitamin most
More information25-hydroxyvitamin D: from bone and mineral to general health marker
DIABETES 25 OH Vitamin D TOTAL Assay 25-hydroxyvitamin D: from bone and mineral to general health marker FOR OUTSIDE THE US AND CANADA ONLY Vitamin D Receptors Brain Heart Breast Colon Pancreas Prostate
More informationCorporate Medical Policy
Corporate Medical Policy File Name: Origination: Last CAP Review: Next CAP Review: Last Review: testing_serum_vitamin_d_levels 9/2015 2/2016 2/2017 2/2016 Description of Procedure or Service Vitamin D,
More informationVitamin D Deficiency and Thyroid Disease. Theodore C. Friedman, M.D., Ph.D.
Vitamin D Deficiency and Thyroid Disease Theodore C. Friedman, M.D., Ph.D. Vitamin D deficiency and thyroid diseases Vitamin D is an important vitamin that not only regulates calcium, but also has many
More informationVitamin D Status: United States, 2001 2006
Vitamin D Status: United States, 2001 2006 Anne C. Looker, Ph.D.; Clifford L. Johnson, M.P.H.; David A. Lacher, M.D.; Christine M. Pfeiffer, Ph.D.; Rosemary L. Schleicher, Ph.D.; and Christopher T. Sempos,
More informationVitamin D. Sources of vitamin D
1 has been in the news frequently this past year, including an article in The New York Times on November 16, 2009. So what is this vitamin? Why is it important? Most people have heard that vitamin D is
More informationD. Vitamin D. 1. Two main forms; vitamin D2 and D3
D. Vitamin D. Two main forms; vitamin D2 and D3 H H D3 - Cholecalciferol D2 - Ergocalciferol Technically, vitamin D is not a vitamin. It is the name given to a group of fat-soluble prohormones (substances
More informationThe Association of Vitamin D Dietary Intake and Type 2 Diabetes Among African Americans in Central Ohio
The Association of Vitamin D Dietary Intake and Type 2 Diabetes Among African Americans in Central Ohio Presenter: Sin Nee Ng Advisors: Dr. Julie Kennel, Dr. Tonya Orchard Copyright 2014 Sin Nee Ng. All
More informationBULLETIN. Slovak Republic Ministry of Health
BULLETIN Slovak Republic Ministry of Health Part 51-53 November 13, 2009 No. 57 CONTENTS: 52. Slovak Republic Ministry of Health Guidelines for the Diagnosis of Glucocorticoidinduced Osteoporosis 52. Slovak
More informationOsteoporosis/Bone Health in Adults as a National Public Health Priority
Position Statement Osteoporosis/Bone Health in Adults as a National Public Health Priority This Position Statement was developed as an educational tool based on the opinion of the authors. It is not a
More informationOrthopaedic Issues in Adults with CP: If I Knew Then, What I Know Now
Orthopaedic Issues in Adults with CP: If I Knew Then, What I Know Now Laura L. Tosi, MD Director, Bone Health Program Children s National Medical Center Washington, DC Epidemiology 87-93% of children born
More informationHealthy Aging Lab: Current Research Abstracts
Healthy Aging Lab: Current Research Abstracts Arsenic Exposure and Women s Health Environmental exposure to inorganic arsenic is an indisputable source of increased risk of several human cancers and chronic
More informationVitamin D and MS: Implications for Clinical Practice
733 Third Avenue New York, NY 10017-3288 Clinical Bulletin Information for Health Professionals Vitamin D and MS: Implications for Clinical Practice Allen C. Bowling, MD, PhD Introduction Recent studies
More informationNATIONAL OSTEOPOROSIS FOUNDATION OSTEOPOROSIS CLINICAL UPDATES Bariatric Surgery And Skeletal Health CE APPLICATION FORM
NATIONAL OSTEOPOROSIS FOUNDATION OSTEOPOROSIS CLINICAL UPDATES Bariatric Surgery And Skeletal Health CE APPLICATION FORM First Name: Last Name: Mailing Address: City: State: Zip/Postal Code: Country: Phone
More informationA study to Evaluate PPI s effect on vitamin D levels. Rani Hanna M.D., M.S. PGY-3 Joseph Grisanti, MD
A study to Evaluate PPI s effect on vitamin D levels Rani Hanna M.D., M.S. PGY-3 Joseph Grisanti, MD The sunshine vitamin Existed over 500 million years. Prehormone, not only a vitamin. Two major sources:
More informationVitamin D und seine Bedeutung im Immunsystem und bei der Infektabwehr
Vitamin D und seine Bedeutung im Immunsystem und bei der Infektabwehr Stefan Pilz Department of Internal Medicine, Division of Endocrinology and Metabolism, Medical University of Graz, Austria Department
More informationFast Facts on Osteoporosis
Fast Facts on Osteoporosis Definition Prevalence Osteoporosis, or porous bone, is a disease characterized by low bone mass and structural deterioration of bone tissue, leading to bone fragility and an
More informationPress Information. Vitamin D deficiency
DSM, Corporate Communications P.O. Box 6500, 6401 HJ Heerlen The Netherlands phone +31 (0) 45 578 2421 www.dsm.com Vitamin D is one of the essential nutrients for human health. Unlike other types of vitamins
More informationWho should receive calcium and vitamin D supplementation?
Age and Ageing 2012; 41: 576 580 doi: 10.1093/ageing/afs094 Published electronically 8 August 2012 The Author 2012. Published by Oxford University Press on behalf of the British Geriatrics Society. All
More informationOsteoporosis has been identified by the US Surgeon General
New Guidelines for the Prevention and Treatment of Osteoporosis E. Michael Lewiecki, MD, and Nelson B. Watts, MD Abstract: The World Health Organization Fracture Risk Assessment Tool (FRAX ) and the National
More informationDERBYSHIRE JOINT AREA PRESCRIBING COMMITTEE (JAPC) OSTEOPOROSIS GUIDELINE
DERBYSHIRE JOINT AREA PRESCRIBING COMMITTEE (JAPC) OSTEOPOROSIS GUIDELINE This is an updated guideline It incorporates the latest NICE guidance There are strong recommendations for calcium + vitamin D
More informationConsiderations With Calcium And Vitamin D Supplementation
Considerations With Calcium And Vitamin D Supplementation Activity Preview Calcium is an electrolyte involved in many systems in the body including bone health, nerve signaling pathways, muscle contractions,
More informationFOR HEALTH. Huldschinsky 1919. Rickets THE D-LIGHTFUL VITAMIN. Solar UV Radiation. Treated VITAMIN D TOXIC OH FROM SUN EXPOSURE. with Mercury Arc Lamp
THE D-LIGHTFUL VITAMIN W DO YOU MAKE VITAMIN D???? FOR HEALTH Michael F. Holick Boston University Medical Center Solar UV Radiation 7-DHC UV PreD 3 UV UV Tachysterol 3 7-DHC CH2 Vitamin D 3 ΔH PreD 3 Vitamin
More informationVitamin D status: effects on parathyroid hormone and 1,25-dihydroxyvitamin D in postmenopausal women 1,2
Vitamin D status: effects on parathyroid hormone and 1,25-dihydroxyvitamin D in postmenopausal women 1,2 Allan G Need, Michael Horowitz, Howard A Morris, and BE Christopher Nordin ABSTRACT Background:
More informationVitamin D Deficiency and Thyroid Disease. Theodore C. Friedman, M.D., Ph.D.
Vitamin D Deficiency and Thyroid Disease Theodore C. Friedman, M.D., Ph.D. Vitamin D deficiency and thyroid diseases Vitamin D is an important vitamin that not only regulates calcium, but also has many
More informationEarth at Night View from the Space Shuttle. Vitamin D: All You Need to Know
Earth at Night View from the Space Shuttle Vitamin D: All You Need to Know Sunil Wimalawansa, MD, PhD, MBA 11/12/2011 Vitamin D: All You Need to Know Sunil J. Wimalawansa, MD, PhD, MBA, FACE, FACP Professor
More informationNutrition for Family Living
Susan Nitzke, Nutrition Specialist; susan.nitzke@ces.uwex.edu Sherry Tanumihardjo, Nutrition Specialist; sherry.tan@ces.uwex.edu Amy Rettammel, Outreach Specialist; arettamm@facstaff.wisc.edu Betsy Kelley,
More informationCystic fibrosis and bone health
Cystic fibrosis and bone health Factsheet March 2013 Cystic fibrosis and bone health Introduction As we get older our bones become thinner and weaker, and may become more susceptible to fracture. However
More informationModule 5 - Speaking of Bones Osteoporosis For Health Professionals: Fracture Risk Assessment. William D. Leslie, MD MSc FRCPC
Module 5 - Speaking of Bones Osteoporosis For Health Professionals: Fracture Risk Assessment William D. Leslie, MD MSc FRCPC Case #1 Age 53: 3 years post-menopause Has always enjoyed excellent health with
More informationVitamin D (serum, plasma)
Vitamin D (serum, plasma) 1 Name and description of analyte 1.1 Name of analyte Vitamin D 1.2 Alternative names The term vitamin D covers a group of closely related naturally occurring lipid soluble compounds
More informationThe evidencebehindthe increased NordicNutritionRecommendations for vitamind. Christel Lamberg-Allardt University of Helsinki
The evidencebehindthe increased NordicNutritionRecommendations for vitamind Christel Lamberg-Allardt University of Helsinki Aimsfor NutritionRecommendations Aimsfor vitamind The overall aim was to review
More informationShining a light on the Sunshine Vitamin Lin A. Brown,MD Dartmouth and DHMC
Shining a light on the Sunshine Vitamin Lin A. Brown,MD Dartmouth and DHMC Vitamin D What do surfers have in abundance and maybe most of the rest of us lack? Vit D - a vitamin primarily obtained by man
More informationOSTEOPOROSIS REHABILITATION PROGRAM
OSTEOPOROSIS REHABILITATION PROGRAM Tricia Orme, R.N. BSc(N) Mary Pack Arthritis Program Victoria i Arthritis i Centre Objectives Participants will gain an understanding of what Osteoporosis is and how
More informationYOUR TRUSTED SOURCE - FOR ALL YOUR VITAMIN D 3 NEEDS
Vitamin D YOUR TRUSTED SOURCE - FOR ALL YOUR VITAMIN D 3 NEEDS ü Natural form of vitamin D 3, cholecalciferol (from lanolin) ü Strengths from 400 iu to 10,000 iu ü Capsule and liquid forms available ü
More informationVitamin D in Infancy, Childhood and Adolescence
Vitamin D in Infancy, Childhood and Adolescence Christopher Kovacs, MD, FRCPC, FACP Professor of Medicine (Endocrinology) Memorial University of Newfoundland ckovacs@mun.ca Disclosure I am currently serving
More informationVitamin D Status and Its Seasonal Variations and Association With Parathyroid Hormone Concentration in Healthy Women in Riga
:329-34 329 Vitamin D Status and Its Seasonal Variations and Association With Parathyroid Hormone Concentration in Healthy Women in Riga Aivars Lejnieks 1, Anda Slaidina 2, Agnis Zvaigzne 3, Una Soboleva
More informationSelected Questions and Answers on Vitamin D
Selected Questions and Answers on Vitamin D Joint FAQs to the BfR, German Nutrition Society (DGE) und Max Rubner-Institute (MRI) of 03 December 2014 1 Vitamin D promotes the intake of calcium from the
More informationEasy-to-Read Information for Patients and Families. U.S. Department of Health and Human Services National Institutes of Health
BONE HEALTH FOR LIFE Easy-to-Read Information for Patients and Families U.S. Department of Health and Human Services National Institutes of Health National Institute of Arthritis and Musculoskeletal and
More informationOsteoporosis International. Original Article. Calcium Supplement and Bone Medication Use in a US Medicare Health Maintenance Organization
Osteoporos Int (2002) 13:657 662 ß 2002 International Osteoporosis Foundation and National Osteoporosis Foundation Osteoporosis International Original Article Calcium Supplement and Bone Medication Use
More informationVitamin D deficiency: the cause of everything?
Health problems linked to vitamin D deficiency: Vitamin D deficiency: the cause of everything? Louise Gagné M.D. Family Physician Saskatoon Community Clinic Clinical Assistant Professor Department of Community
More informationKDIGO. Active and Native Vitamin D
Active and Native Vitamin D KDIGO Grahame Elder Department of Renal Medicine, Westmead Hospital Osteoporosis & Bone Biology Division, Garvan Institute of Medical Research, Sydney Disclosures Member of
More informationThe National Center for Health Statistics' Linked Data Files: Resources for Research and Policy. Eric A. Miller National Center for Health Statistics
The National Center for Health Statistics' Linked Data Files: Resources for Research and Policy Eric A. Miller National Center for Health Statistics NCHS Record Linkage Program Links survey data with data
More information16. ARTHRITIS, OSTEOPOROSIS, AND CHRONIC BACK CONDITIONS
16. ARTHRITIS, OSTEOPOROSIS, AND CHRONIC BACK CONDITIONS Goal Reduce the impact of several major musculoskeletal conditions by reducing the occurrence, impairment, functional limitations, and limitation
More informationIn the 19th century, vitamin D deficiency
Recognition and Management of Vitamin D Deficiency PAULA BORDELON, DO; MARIA V. GHETU, MD; and ROBERT LANGAN, MD St. Luke s Family Medicine Residency Program, Bethlehem, Pennsylvania Vitamin D deficiency
More informationMonoclonal Antibodies to 25OH Vitamin D
Monoclonal Antibodies to 25OH Vitamin D Contents Monoclonal Antibodies to 25OH Vitamin D 1. Introduction. 3 2. Product Data Sheet..... 5 3. Product Performances...... 6 4. Product Analysis....... 9 5.
More informationEffect of immobilization on vitamin D status and bone mass in chronically hospitalized disabled stroke patients
Age and Ageing 1999; 28: 265 269 Effect of immobilization on vitamin D status and bone mass in chronically hospitalized disabled stroke patients YOSHIHIRO SATO,HARUKO KUNO, TAKESHI ASOH, YOSHIAKI HONDA,
More informationOsteoporosis Treatment Guide
Osteoporosis Treatment Guide An estimated 10 million Americans have osteoporosis. Another 34 million have low bone mass. If left untreated, osteoporosis can be both debilitating and painful. Fortunately,
More informationSymposium: Vitamin D Insufficiency: A Significant Risk Factor in Chronic Diseases and Potential Disease-Specific Biomarkers of Vitamin D Sufficiency
Symposium: Vitamin D Insufficiency: A Significant Risk Factor in Chronic Diseases and Potential Disease-Specific Biomarkers of Vitamin D Sufficiency Dietary Recommendations for Vitamin D: a Critical Need
More informationBone Markers in Osteoporosis: Prediction of Fractures & Treatment Monitoring
Bone Markers in Osteoporosis: Prediction of Fractures & Treatment Monitoring Richard Eastell, MD FRCP FRCPath FMedSci, Professor of Bone Metabolism, University of Sheffield, Sheffield, UK Usefulness of
More informationWhat You Need to Know for Better Bone Health
What You Need to Know for Better Bone Health A quick lesson about bones: Why healthy bones matter The healthier your bones The more active you can be Bone health has a major effect on your quality of life
More information2-1. Osteoporose. Dr. P. Van Wettere Radiologie en medische beeldvorming
2-1 Osteoporose Dr. P. Van Wettere Radiologie en medische beeldvorming 2-2 Osteoporose Definitie Incidentie, mortaliteit, morbiditeit, kost Diagnose Radiologie Botdensitometrie FRAX FractureCascade History
More informationConsumer and Family Sciences
Purdue Extension Consumer and Family Sciences Department of Foods and Nutrition CFS-150-W Osteoporosis: What You Should Know April C. Mason, Ph.D. William D. Evers, Ph.D., RD Erin E. Hanley, RD Osteoporosis,
More informationVitamin D. Frequently Asked Questions
Vitamin D Frequently Asked Questions What is vitamin D? What is a vitamin? Why do we need vitamins? Is there more than one form of vitamin D? Where do I get vitamin D? How long should I be outdoors, and
More informationVitamin D and Fracture Reduction: An Evaluation of the Existing Research Susan E. Brown, PhD, CNS
Reduction: An Evaluation of the Existing Research Susan E. Brown, PhD, CNS Abstract This article re-evaluates the literature on vitamin D and fracture reduction, highlighting the relevance of new understandings
More informationRecent Topics in Treatment of Osteoporosis
Review Article Recent Topics in Treatment of Osteoporosis JMAJ 49(9 10): 309 314, 2006 Satoshi Soen* 1 Abstract It has come to light that osteoporosis-related fractures are more critical than previously
More informationOriginal. Se Hwa Kim 1), Tae Ho Kim 1) and Soo-Kyung Kim 2)
Endocrine Journal 2014 Original Advance Publication doi: 10.1507/endocrj. EJ14-0287 Effect of high parathyroid hormone level on bone mineral density in a vitamin D-sufficient population: Korea National
More informationDEFINITION OF OSTEOPOROSIS
CHAPTER 27 OSTEOPOROSIS AND OSTEOMALACIA DEFINITION OF OSTEOPOROSIS THE EPIDEMIOLOGY AND CONSEQUENCES OF OSTEOPOROSIS REVIEW OF BONE REMODELING BONE LOSS PATHOGENESIS OF OSTEOPOROSIS DIAGNOSIS OF OSTEOPOROSIS
More informationOsteoporosis. Dr Gordon MacDonald BSc MB BChir MRCP Consultant Rheumatologist. Rheumatology and Arthritis Seminar Tuesday 5 th February 2013
Osteoporosis Dr Gordon MacDonald BSc MB BChir MRCP Consultant Rheumatologist Rheumatology and Arthritis Seminar Tuesday 5 th February 2013 Plan What is osteoporosis? Consequences of osteoporosis Risk factors
More informationVitamin D and Cardiometabolic risk
Vitamin D and Cardiometabolic risk 서울의대, 분당서울대병원 내과 최 성 희 2013년 대한당뇨병학회 춘계학술대회 Metabolism Of Vitamin D Risk factors for vitamin D deficiency - Aging decreased concentrations of 7-dehydro-cholesterol in
More informationFacts About Aging and Bone Health
Facts About Aging and Bone Health A Guide to Better Understanding and Well Being with the compliments of Division of Health Services Diocese of Camden Exercise as treatment Along with medication, proper
More informationNutritional problems. Age-related diseases Functional impairments Drug-induced nutritional deficiencies
Nutritional problems Age-related diseases Functional impairments Drug-induced nutritional deficiencies Protein energy Vitamins Fibre Water Malnutrition >Deficiencies Obesity Hypervitaminosis >Excesses
More informationCalcium. 1995-2013, The Patient Education Institute, Inc. www.x-plain.com nuf40101 Last reviewed: 02/19/2013 1
Calcium Introduction Calcium is a mineral found in many foods. The body needs calcium to maintain strong bones and to carry out many important functions. Not having enough calcium can cause many health
More informationNATIONAL OSTEOPOROSIS FOUNDATION OSTEOPOROSIS CLINICAL UPDATES Rehabilitation of Patients With Fragility-Related Fractures CE APPLICATION FORM
NATIONAL OSTEOPOROSIS FOUNDATION OSTEOPOROSIS CLINICAL UPDATES Rehabilitation of Patients With Fragility-Related Fractures CE APPLICATION FORM First Name: Last Name: Mailing Address: City: State: Zip/Postal
More informationDrug treatment pathway for Osteoporosis in Postmenopausal Women
Drug treatment pathway for Osteoporosis in Postmenopausal Women Version 1.0 Ratified by: East Sussex HEMC Date ratified: 26.01.2011 Job title of originator/author Gillian Ells, East Sussex HEMC Pharmacist
More informationCalcium and Vitamin D: Important at Every Age
Calcium and Vitamin D: Important at Every Age National Institutes of Health Osteoporosis and Related Bone Diseases ~ National Resource Center 2 AMS Circle Bethesda, MD 20892-3676 Tel: (800) 624-BONE or
More informationPrevalence of osteoporosis and factors associated with osteoporosis in women above 40 years in the Northern Part of Saudi Arabia
International Journal of Research in Medical Sciences Oommen A et al. Int J Res Med Sci. 2014 Feb;2(1):274-278 www.msjonline.org pissn 2320-6071 eissn 2320-6012 Research Article DOI: 10.5455/2320-6012.ijrms20140252
More informationNutrition and Parkinson s Disease: Can food have an impact? Sarah Zangerle, RD, CD Registered Dietitian Froedtert Memorial Lutheran Hospital
Nutrition and Parkinson s Disease: Can food have an impact? Sarah Zangerle, RD, CD Registered Dietitian Froedtert Memorial Lutheran Hospital Importance of Nutrition & Parkinson s Disease Good nutrition
More informationTitle:Vitamin D deficiency among admitted patients with acute stroke: a cross -sectional study at a national referral hospital in Kampala, Uganda.
Reviewer's report Title:Vitamin D deficiency among admitted patients with acute stroke: a cross -sectional study at a national referral hospital in Kampala, Uganda. Version:2Date:6 May 2015 Reviewer:Andre
More informationQuestion I. A vitamin D deficient mother will give birth. A. True B. False. Answer A
Vitamin D Jatinder Bhatia, MD, FAAP Question I A vitamin D deficient mother will give birth to an infant with Vit D deficiency A. True B. False Answer A Question II Human breast milk has adequate amounts
More informationTraditional View of Diabetes. Are children with type 1 diabetes obese: What can we do? 8/9/2012. Change in Traditional View of Diabetes
Are children with type 1 diabetes obese: What can we do? Traditional View of Diabetes Type 1 Diabetes ( T1DM) Onset Juvenile Lean Type 2 Diabetes ( T2DM) Onset Adult Obese QI Project Indrajit Majumdar
More informationScans and tests and osteoporosis
Scans and tests and osteoporosis What is osteoporosis? Osteoporosis occurs when the struts which make up the mesh-like structure within bones become thin causing them to become fragile and break easily,
More informationMaría del Carmen Navarro*, Pedro Saavedra, Esteban Jódar, Mª Jesús Gómez de Tejada, Ana Mirallave and Manuel Sosa **
Clinical Endocrinology (2013) 78, 681 686 doi: 10.1111/cen.12051 ORIGINAL ARTICLE Osteoporosis and metabolic syndrome according to socioeconomic status, contribution of PTH, vitamin D and body weight:
More informationClinical Practice Guideline for Osteoporosis Screening and Treatment
Clinical Practice Guideline for Osteoporosis Screening and Treatment Osteoporosis is a condition of decreased bone mass, leading to bone fragility and an increased susceptibility to fractures. While osteoporosis
More informationBone Appétit: New Information on Calcium & Vitamin D QUESTION & ANSWER
Bone Appétit: New Information on Calcium & Vitamin D QUESTION & ANSWER Wednesday, November 17, 2010 1:30 p.m. to 3:00 p.m. ET 1. I like to drink warm milk, but I have heard that heating some vitamins can
More informationVitamin D for Prevention of Falls and their Consequences in Older Adults
AMERICAN GERIATRICS SOCIETY CONSENSUS STATEMENT Vitamin D for Prevention of Falls and their Consequences in Older Adults Developed by the Workgroup of the Consensus Conference on Vitamin D for the Prevention
More informationTestosterone; What s all the hype? KRISTEN WYRICK, LTCOL,USAFR, MC USUHS, FAMILY MEDICINE JOINT BASE LANGLEY-EUSTIS
Testosterone; What s all the hype? KRISTEN WYRICK, LTCOL,USAFR, MC USUHS, FAMILY MEDICINE JOINT BASE LANGLEY-EUSTIS The faces of Low Testosterone What your patients are seeing Pharmacy Industry Testosterone
More informationNutrient Reference Values for Australia and New Zealand
Nutrient Reference Values for Australia and New Zealand Questions and Answers 1. What are Nutrient Reference Values? The Nutrient Reference Values outline the levels of intake of essential nutrients considered,
More informationPROTOCOL FOR PATIENTS WITH ABNORMAL LAB AND X-RAY VALUES
PROTOCOL FOR PATIENTS WITH ABNORMAL LAB AND X-RAY VALUES Patients newly diagnosed as osteopenic or osteoporotic on a radiology report or patients receiving abnormal lab values on the following lab tests
More informationHold the Sunscreen: Your Body Needs that Vitamin D
Transcript Details This is a transcript of an educational program accessible on the ReachMD network. Details about the program and additional media formats for the program are accessible by visiting: https://reachmd.com/programs/clinicians-roundtable/hold-the-sunscreen-your-body-needs-that-vitamind/4149/
More informationDoes chronic lymphocytic leukemia increase the risk of osteoporosis?
Does chronic lymphocytic leukemia increase the risk of osteoporosis? Amrita Desai, MD Internal Medicine Residency Program Adam Olszewski, MD Department of Hematology and Oncology Memorial Hospital of Rhode
More informationTreatment of osteoporosis in fragility fractures
Orthogeriatrics Clinical Summary Document Treatment of osteoporosis in fragility fractures Fragility fractures are extremely prevalent in older adults with a staggering cost of treatment. As the population
More informationGene A. Spiller, PhD, Antonella Dewell, MS, RD, Sally Chaves, RN, Zaga Rakidzich
TITLE Effect of daily use natural astaxanthin on C-reactive protein. Conducted by: Health Research & Studies Center, Los Altos, CA Gene A. Spiller, PhD, Antonella Dewell, MS, RD, Sally Chaves, RN, Zaga
More informationVitamin D. Why Vitamin D is important and how to get enough
Vitamin D Why Vitamin D is important and how to get enough Why is vitamin D vital for health? Vitamin D is needed by the body for both physical and mental health, but is best known for making sure bones
More informationBone Basics National Osteoporosis Foundation 2013
When you have osteoporosis, your bones become weak and are more likely to break (fracture). You can have osteoporosis without any symptoms. Because it can be prevented and treated, an early diagnosis is
More informationSYLLABUS FOR DMRSc 1-1 MEDICAL RECORD SCIENCE
SYLLABUS FOR DMRSc 1-1 MEDICAL RECORD SCIENCE Subject description: Information is the life blood of health care delivery system. The medical record, in manual or automated form, houses the medical information
More informationSouthern Derbyshire Shared Care Pathology Guidelines. Vitamin D
Southern Derbyshire Shared Care Pathology Guidelines Vitamin D Purpose of guideline Provide clear advice on when to measure vitamin D and identify patients with insufficiency and deficiency. To provide
More informationVitamin D and Calcium Guideline
Vitamin D and Calcium Guideline Vitamin D Functions of Vitamin D 2 Serum Levels 2 Deficiency 2 Toxicity 2 Dietary Reference Intakes 3 Sources of Vitamin D 3 Therapeutic Options 4 Adults 4 Children (0 18
More informationClinical Practice Guidelines for the Diagnosis and Management of Osteoporosis in Canada: Background and Technical Report
Clinical Practice Guidelines for the Diagnosis and Management of Osteoporosis in Canada: Background and Technical Report Authors: Alexandra Papaioannou MD MSc 1, Suzanne Morin MD MSc 2, Angela M. Cheung
More informationOral Zinc Supplementation as an Adjunct Therapy in the Management of Hepatic Encephalopathy: A Randomized Controlled Trial
Oral Zinc Supplementation as an Adjunct Therapy in the Management of Hepatic Encephalopathy: A Randomized Controlled Trial Marcus R. Pereira A. Study Purpose Hepatic encephalopathy is a common complication
More informationScreening Mammography for Breast Cancer: American College of Preventive Medicine Practice Policy Statement
Screening Mammography for Breast Cancer: American College of Preventive Medicine Practice Policy Statement Rebecca Ferrini, MD, Elizabeth Mannino, MD, Edith Ramsdell, MD and Linda Hill, MD, MPH Burden
More informationOsteoporosis Assessment Using DXA and Instant Vertebral Assessment. Working Together For A Healthier Community
Osteoporosis Assessment Using DXA and Instant Vertebral Assessment Working Together For A Healthier Community Osteoporosis The Silent Thief The Facts About Osteoporosis 1 in 2 women will develop osteoporosis
More informationACTIVE-B12 EIA. the next level of B12 testing
ACTIVE-B12 EIA the next level of B12 testing Vitamin B12 an essential nutrient Vitamin B12 is an essential nutrient (can only be obtained from the diet) and is a vital component in many cellular functions
More informationDAIRY- GOOD OR BAD FOR YOUR BONES?
DAIRY- GOOD OR BAD FOR YOUR BONES? It appears that there is still (and will always be!) confusion about the health benefits of cow s milk and this is being perpetuated by many health advisors who tell
More informationUnintended consequences: Successful social marketing campaign creates health problems
Unintended consequences: Successful social marketing campaign creates health problems Professor Linda Brennan (corresponding author RMIT, Melbourne Australia ) Professor Gillian Sullivan Mort (presenting
More informationBISPHOSPHONATE RELATED OSTEONECROSIS OF THE JAW (BRONJ) BISPHOSPHONATES AND WHAT HAPPENS TO BONE VINCENT E. DIFABIO, DDS, MS MEMBER OF THE COMMITTEE ON HEALTHCARE AND ADVOCACY FROM THE AMERICAN ASSOCIATION
More informationCURRICULUM VITAE DONNA C. HERMEY. Ph.D. (Anatomy and Cell Biology) June 1994 Temple University School of Medicine Philadelphia, PA
CURRICULUM VITAE DONNA C. HERMEY EDUCATION: B.S. (Biology) May 1988 Muhlenberg College Allentown, PA PROFESSIONAL POSITIONS: Ph.D. (Anatomy and Cell Biology) June 1994 Temple University School of Medicine
More informationHow To Choose A Biologic Drug
North Carolina Rheumatology Association Position Statements I. Biologic Agents A. Appropriate delivery, handling, storage and administration of biologic agents B. Indications for biologic agents II. III.
More information