Calcium and Vitamin D: Current Evidence for Benefit and Harm 2014
|
|
- Shannon Howard
- 7 years ago
- Views:
Transcription
1 Calcium and Vitamin D: Current Evidence for Benefit and Harm 2014 David A Hanley, MD, FRCPC Professor, Depts. of Medicine, Community Health Sciences, and Oncology University of Calgary
2 Disclosures (None are relevant to this presentation) Advisory Boards: Novartis Canada, Warner Chilcott, Eli Lilly Canada, Merck Canada, Amgen Canada Clinical Trials: Amgen, Eli Lilly, Merck, Novartis, NPS Pharmaceuticals I have received honoraria for speaking from most of the above companies Grant Support: CIHR, Pure North S Energy Foundation
3 Outline Calcium Supplements controversy Basics of vitamin D Recent media interest papers Evidence from Canadian Multicentre Osteoporosis Study (CaMOS) and Canadian Health Measures Survey Current recommendations for vitamin D and calcium intake and targets
4 Bone is Sacrificed to Correct Calcium Deficiency But How Much Calcium is Needed? Total intake requirements of around 1000 mg/d based on early calcium balance studies that will never be repeated. For many years the standard recommendation was mg/d (as supplement) often prescribed while ignoring dietary intake IOM recommendation mg/d European recommendations lower ( mg/d) Simple dietary history: Diet without dairy ~ 400 mg/d; cup of milk = 300 mg Few patients need more than mg supplement/d
5 Observational Studies Low calcium intake (< mg/d) may contribute to an increased risk of fracture Most studies fail to demonstrate incremental benefit of calcium intake > mg/d in fracture prevention Use of calcium supplements may be associated with increased risk of hip fracture Looker AC, et al. Osteoporosis Int 1993; 3: Warensjo E, et al. BMJ 2011; 342:d1473. Key TJ, et al. Public Health Nutrition 2007; 10: Cumming RG et al. Am J Epidemiol 1997; 145:
6 Calcium and Fractures: Controlled Studies Most studies compared Ca + vitamin D to placebo Conflicting results Chapuy (1992): Ca/D significantly reduced hip # by 43% in institutionalized patients WHI (2006): Ca/D did not significantly reduce # risk, but many patients taking personal supplements Reid (2006): Ca alone increased risk of hip # Chapuy MC, et al. NEJM 1992; 327: Jackson RD, et al. NEJM 2006; 354: Cauley JA, et al. J Womens Health 2013; 22: Reid et al. Am J Med 2006; 119:
7 Are Calcium Supplements Dangerous?
8 Calcium Supplements and Increased Risk of CVD: Auckland Calcium Study Bolland MJ, et al. BMJ 2008; 336:262.
9 Bolland (2011) Calcium and CVD Ca supps with or without vitamin D Bolland MJ, et al. BMJ 2011; 342:d2040.
10 Studies Reporting No CV Risk Iowa Women s Health Study Supplemental Ca ( mg/d) associated with a decreased risk of IHD death RR = 0.50 ( ) Health Professionals Follow-up Study Prospective cohort study of men No significant associations between dietary or supplemental Ca and ischemic heart disease CaMOS: Calcium (any source) protective for women WHI (allowed subjects to take 1000 mg calcium/day, in addition to the trial s treatment package) Bostick RM, et al. Am J Epidemiol 1999;149: Al-Delaimy WK, et al. Am J Clin Nutr 2003; 77: Langsetmo L, et al. JCEM 2013; 98: LaCroix, et al. J Gerentology 2009; 64A:
11 Wang et al: Meta-analysis 4 prospective cohort studies of Ca supplements: no effect on CVD incidence 8 RCTs: CaD or Ca alone: no effect on CVD incidence Wang L et al. Ann Intern Med 2010; 152:
12 Calcium and Cardiovascular DIsease Remains an unanswered question Recommend D. Bauer s recent reviews: Clinical practice. Calcium supplements and fracture prevention. N Engl J Med. 2013;369(16): The calcium supplement controversy: Now what?. J Bone Miner Res 2014; 29:
13 Vitamin D 3 Metabolism Acetate CH 3 COO - Skin Vitamin D 2 (ergocalciferol) follows the same pathway - Potency equivalent to D 3? HO Cholesterol HO CH 3 CH 3 CH 3 CH 3 H CH 3 UV irradiation 7-Dehydrocholesterol HO CH 3 CH 3 CH 2 CH 3 OH OH CH 3 24,25-(OH) 2 D 3 Ingested D3 Cholecalciferol CH 3 CH 3 CH 3 CH 2 H CH 3 Liver 25-Hydroxylase HO HO D 3 25-(OH)D 3 25-Hydroxylase = CYP2R1 24-Hydroxylase = CYP24A1 CH 3 CH 3 CH 3 CH 2 OH CH 3 Kidney 24-Hydroxylase 1-Hydroxylase PTH FGF-23 PO 4 Ca HO CH 3 CH CH 3 3 OH CH 3 1-alpha Hydroxylase = CYP27B1 CH 2 OH 1,25(OH) 2 D 3 1,25-(OH) 2 D 3 Adapted from DeLuca HF. Monographs on Endocrinology 13, Vitamin D: Metabolism and Function
14 Photobiology of Vitamin D Skin HO CH 3 H Lumisterol CH 3 CH 3 Heat CH 2 HO 7-Dehydrocholesterol HO Pre D 3 HO D 3 CH 3 CH 2 In presence of UV B 7-Dehydrocholesterol is converted to Pre-Vitamin D 3, which undergoes heat-dependent isomerization to Vitamin D 3 If UV exposure continues, Pre- D 3 is preferentially converted to lumisterol and tachysterol, which can revert back to Pre- D 3 when it is dark, but then there is not enough heat to convert Pre- D 3 to D 3 HO Adapted from Bikle D 2004: Endotext.com
15 WHAT S AN OPTIMAL VITAMIN D LEVEL?
16 25OHD Levels in Traditionally Living Adults in Equatorial Africa (Hunter-Gatherers) Two groups living in Tanzania, within 3-4 o of the equator: - Nilotic Maasai (semi-nomadic) - Hadzabe (hunter-gatherers) Avoid direct sun mid-day Clothing: upper body, upper legs Outside most of the day 25-OHD measured by LC/MS-MS: Mean = 115 nmol/l, range Maasai: 119 nmol/l +/- 26 (SD) Hadzabe: 109 nmol/l +/- 28 Luxwolda MF et al. Brit J Nutr 2012; 108:
17 Seasonal Change in Vitamin D 30 Male Outdoor Workers Nebraska Median 25(OH)D (inter-quartile range) 25(OH)D (nmol/l) * Late summer Late winter Late summer 122 (95-154) Late winter 74 (60-94) Seasonal difference 49 (29-67) Unanswered Question: Is the seasonal fluctuation in vitamin D adequacy bad for bone or other health outcomes? * Sunscreen user Barger-Lux & Heaney JCEM 2002; 87:
18 If Equatorial Humans and Outdoor Workers Have Average 25OHD Levels of 115 nmol/l What does this mean for us, living in the Frozen North? Probably not much more than an indication that these are safe levels, in that our skin synthesis of vitamin D is regulated Many are of the opinion that this should be a target level for optimal vitamin D effects, but this remains controversial
19 Non-Skeletal Roles for Vitamin D?
20 Note the Crucial Role of 25-OH Vitamin D Substrate for Production of 1,25(OH) 2 Vitamin D Liver Paracrine/Autocrine System D 3 25(OH)D 3 Endocrine System Kidney Many Tissues: Immune System Breast, Colon, Prostate, Parathyroid, etc 1,25(OH) 2 D 3 plasma/circulation Gut Calcium absorption Muscle health Bone health 1,25(OH) 2 D 3 intracellular and local Holick MF. J Cell Biochem 2003; 88:
21 Basic Role for 1,25(OH) 2 -Vitamin D Classical, physiological role of 1,25(OH) 2 D 3 is the regulation of calcium and phosphate homeostasis and bone mineralization Transcriptome-wide analysis indicates that between 200 and 600 genes are primary targets of vitamin D Since most of these genes respond to vitamin D in a cell-specific fashion, the total number of vitamin D targets in the human genome is far higher than 1,000. Carlberg C et al. Primary vitamin D target genes allow a categorization of possible benefits of vitamin D₃ supplementation. PLoS One Jul 29;8(7):e71042.
22 Skeletal and Non-Skeletal Consequences of Vitamin D Deficiency Population studies reasonably consistent: Vitamin D deficiency (25-OHD levels < nmol/l) associated with bad outcomes Any benefit (or harm) in aiming for higher levels? IOM report chose 125 nmol/l as upper level for safety - a level commonly achieved with summer sunlight exposure
23 Adjusted Hazard Ratio for MACS (Mortality and Acute Coronary Syndromes) by Serum Calcidiol Israeli Health Services plan 25OHD in 422,822 subjects (aged>45) 16,213 had MACS events within 54 months died (905 with ACS); 3933 had ACS 125 nmol/l Vitamin D skeptics call this a U-shaped curve ; Enthusiasts call it an L- or J-shaped curve 2013 by Endocrine Society Dror Y et al. JCEM 2013;98:
24 25-OHD and Mortality Risk For a 75 Year Old Man Median Johansseon H, et al. Low serum vitamin D is associated with increased mortality in elderly men: MrOS Sweden. Osteoporos Int 2012; 23: epub 19 October 2011
25 Recent Controversies/Papers
26 Clinical Trial Calcium 1200 mg daily vs 4000 IU vit D vs Both vs Placebo: PTH and Bone Turnover Markers Aloia JF et al. Calcium and Vitamin D Supplementation in Postmenopausal Women. JCEM 2013; 98: E
27 Clinical Trial: 1200 mg Calcium vs 4000 IU Vit D vs Both vs Placebo Effect on PTH and Bone Turnover Markers Baseline 15 weeks 28 weeks Vitamin D alone: No effect on bone turnover markers Calcium loading suppressed PTH and bone turnover markers Aloia JF et al. Calcium and Vitamin D Supplementation in Postmenopausal Women. JCEM 2013; 98: E
28 Aloia Study: Conclusions in Lay Press Vitamin D has no effect on bone. Before taking vitamin D, you should consult with your doctor - more than 800 IU/day is dangerous (Mansbridge on The National ) Problems with Aloia study: Vitamin D suppresses PTH gene expression, effect on PTH levels occurs gradually If vitamin D has any direct effects on bone, they are complex, and mediated through the osteoblast, probably not via PTH suppression and reduced bone turnover
29 Reid Meta-analysis Vitamin D and BMD Large number of studies and subjects, wide range of ages, doses, calcium use and other variables No clear benefit of vitamin D on BMD Explanation: Vit D does not have a direct effect on bone bone density benefit (if present at all) is probably through effect on calcium absorption and provision of adequate mineral to bone matrix Authors Conclusion: Vitamin D supplement recommendations for general population to enhance BMD not warranted Vitamin D recommendations for bone health should be targeted to high risk populations Reid IR, Bolland MJ, Grey A. Effects of vitamin D supplements on bone mineral density: a systematic review and meta-analysis. Lancet Diabetes Endocrinol 2014; Published Online January 24.
30 Bolland: Trial Sequential Meta-analysis: Vit D Effect on Skeletal and Non-Skeletal Events Research Question: Can previous clinical trials predict whether future RCTs will be able to show an effect of vitamin D? Only Hip Fracture trials exceeded 15% futility boundary (only in trials with institutionalized individuals) Vitamin D supplementation with or without calcium does not reduce skeletal or non-skeletal outcomes in unselected community-dwelling individuals by more than 15%. Uncertain whether vitamin D reduces risk of death Basic Conclusion: Future trials with similar designs unlikely to alter these conclusions advised funding agencies to consider the low likelihood of value in funding studies of vitamin D. Bolland MJ, Grey A, Gamble GD, Reid IR. The effect of vitamin D supplementation on skeletal, vascular, or cancer outcomes: a trial sequential meta-analysis. Lancet. 2014; 383:
31 Vitamin D and Cancer, CV Disease: The VITAL Trial 5-year randomized placebo-control trial Omega-3 FAs and Vit D in healthy men 60, women 65 yrs Has recruited >20,000 subjects Treatment Groups: Vitamin D 2000 IU + Fish Oil: 840 mg Omega-3 [465 EPA & 375 DHA] Vit D + Placebo Fish Oil Placebo Vit D + Fish Oil Placebo Vit D + Placebo Fish Oil Potential Problem: All subjects will be allowed to take up to 800 IU Vitamin D supplement/day
32 Recent Umbrella Systematic Review of Meta-analyses and Systematic Reviews Conclusion: Despite a few hundred systematic reviews and meta-analyses, highly convincing evidence of a clear role of vitamin D does not exist for any outcome, but associations with a selection of outcomes are probable. Theodoratou E, et al. BMJ 2014;348:g2035
33 Time for a Moratorium on Vitamin D Meta-Analyses MJ Bolland, A Grey, IR Reid Letter to editor, BMJ 2009; 339: b4394 Response to a Meta-analysis by Bischoff-Ferrari et al, finding vitamin D prevents falls in the elderly The ratio of the number of RCTs to meta-analyses for vitamin D and falls is 17:9 The RCT to meta-analyses ratio for vitamin D and fractures is 22:14 We suggest that no further meta-analyses are conducted on vitamin D and falls or fractures until more adequately powered RCTs are performed. With due respect to the New Zealand group, I think they should have taken their own advice
34 Problems with Clinical Studies of Vitamin D Supplementation Opinion: Main Problem: RCTs poorly designed: optimal dose not identified, wide variability in vitamin D status at entry Evidence Based Medicine has failed vitamin D inadequate data meta-analyzed to death almost as many meta-analyses as RCTs garbage in garbage out readers of the meta-analyses often conclude that absence of evidence = evidence of absence, thereby discouraging proper studies It s easier to fund Cochrane reviews than proper RCTs
35 Vitamin D and Bone Clinical Trials and Meta-Analyses Problem: For bone studies, should we separate vitamin D and calcium effects? Beneficial effect of D must be related to mineral absorption early RCTs combine Ca and D: fracture prevention Modest BMD benefit Later trials suffer from poor design, poor adherence Meta-analyses even less convincing To paraphrase the great 20 th Century Philosopher, Tom Lehrer s comment on life: Meta-analysis is like a sewer. What you get out of it depends on what you put into it
36 Key Points in Assessing Clinical Studies of Vitamin D Supplementation Opinion: Vitamin D is a facilitator in many biological systems an essential component at a threshold level, but pushing levels higher may not have any effect we haven t defined optimal level adequately Vitamin D RCTs not the same as a clinical trial of a drug: e.g. we re not correcting a bisphosphonate deficiency in osteoporosis therapy clinical trials Demonstrating positive effect in a clinical trial requires a D-deficient subject population (e.g Chapuy study) But RCTs have not specifically recruited a vitamin D-deficient population Remember: RCTs of OP drugs use Ca + D as a placebo comparator we shouldn t expect huge benefits, except in D-deficiency So maybe Bolland is right re. more clinical trials
37 Vitamin D and Osteoporosis Vitamin D Insufficiency Hypothesis: Vit D Insufficiency causes increased risk of osteoporotic fractures due to: malabsorption of calcium and phosphate and relative deficiency of mineral for bone maintenance secondary hyperparathyroidism increases bone turnover resulting in net bone loss Vitamin D insufficiency? Defined by serum 25-OH vitamin D and relationship to PTH Weak, mainly observational evidence supporting its role in predicting osteoporotic fracture risk
38 Vitamin D from Diet and Supplements 2011 Institute of Medicine Report Recommended Dietary Allowance (RDA) Vitamin D 2011 US and Canada: IOM Report 1 : 600 IU/d for adults up to age IU/d for adults over age 70 No change in requirements for Pregnancy and Lactation Tolerable Upper Intake Level (TUL) = 4000 IU/d RDA = 2 standard deviations above Estimated Average Requirement (EAR) EAR = Average daily intake that meets the nutrient needs of half of the healthy individuals in the age or gender group in question TUL = maximum chronic daily intake judged likely to pose no risk of adverse health effects to the most sensitive members of the healthy population 1. Institute of Medicine Dietary Reference Intakes for Calcium and Vitamin D. Washington DC, National Academies Press.
39 Scientific Advisory Council 2010 Guidelines Osteoporosis Canada Adults under age 50 years: IU/day (10-25µg) Adults 50 years: IU/day (20-50 µg) Hanley DA, Cranney A, Jones G, Whiting S, Leslie WD, Cole DEC, Atkinson SA, Josse RG, Feldman S, Kline GA, Rosen C, for the Guidelines Committee of the Scientific Advisory Council of Osteoporosis Canada. Vitamin D in Adult Health and Disease: A Review and Guideline Statement from Osteoporosis Canada. CMAJ. 2010; 182: E (Epub 2010 July 12). s
40 Vitamin D Guidelines: Adequate Vitamin D as Reflected by Serum 25OHD Institute of Medicine: RDA (by definition) should be adequate for bone health for 97.5% of healthy Canadians, and this should be achieved at a serum 25OHD of 50 nmol/l. Endocrine Society, Osteoporosis Canada recommend a target of 75 nmol/l, based on some clinical trials showing fracture benefit at levels higher than 50, and the relationship of 25OHD to serum PTH suppression plateaus around nmol/l (higher in CaMOS)
41 Canadian Health Measures Survey (CHMS) Cycle 1: ; Cycle 2: CHMS samples collected representative cross-country sample of Canadians aged 6 to 79 years analysis of 5604 samples mean serum 25OHD 64 nmol/l (combined CHMS) highest levels = children aged 3 to 5 (74.0 nmol/l) next highest = age 60 to 79 (70.0 nmol/l) 25.7% below 50 nmol/l (20% in CaMOS) 5.4% < 30 nmol/l (frank deficiency) Whiting SJ et al. The vitamin D status of Canadians relative to the 2011 Dietary Reference Intakes: an examination in children and adults with and without supplement use. Am J Clin Nutr 2011; 94: Statistics Canada Catalogue no X: Vitamin D Blood Levels of Canadians
42 If 20-25% of Canadians have 25OHD levels below 50 nmol/l, the use of supplements seems justifiable. Unanswered Question: Is the seasonal fluctuation in vitamin D adequacy bad for bone or other health outcomes?
43 Problems with Reliance on 25OHD Levels Access to the assay Issues with available assay systems: role of Vitamin D-Binding Protein do we need to calculate a free 25OHD?? detection of vitamin D2 How good is the assay in your neighbourhood?
44 Variability in Reported 25-OHD Results Binkley N, Wiebe D. Clinical Controversies in Vitamin D: 25(OH)D Measurement J Clin Densitom 2013; 16:
45 Variability in Reported 25-OHD Results Binkley s main point: Because of the variability in 25OHD assays, if you re treating a person and want to assure the patient is above the desired threshold level, you need to aim higher. - No evidence of harm of supplement use to achieve these levels comparable to normal UV light exposure response Binkley N, Wiebe D. Clinical Controversies in Vitamin D: 25(OH)D Measurement J Clin Densitom 2013; 16:
46 Recommendations re. Vitamin D Dosing and Monitoring in Osteoporosis Most Canadian clinical laboratories have set the lower optimal serum 25-OH-vitamin D level at nmol/l IOM 2011 Report supports 50 nmol/l (Healthy Population) To achieve either optimal level, Canadians need to take vitamin D supplements (CaMOS, CHMS) patients over the age of 50 probably need doses closer to 2000 IU/day) for adults under 50: IU/day Only moderate evidence for IU/day for prevention of fractures and falls BUT: No evidence of harm
47 My Opinion: What Is Optimal Vitamin D Intake? Maintain serum 25-OH vitamin D levels at 75 nmol/l (Osteoporosis Canada 2010 Guidelines) Evidence for Benefit*: fair; Evidence for Risk: none; Cost: minimal * Bones and Falls: systematic reviews show clear benefit for institutionalized elderly CaMOS and CHMS indicate 25% of Canadians below 50 nmol/l in winter supplements are necessary to attain optimum levels Dose of vitamin D to consistently achieve this is probably more than 800 IU vitamin D per day IU/d (Osteoporosis Canada) seems reasonable and safe Elderly may need total intake of 3200 IU/day (food, sunlight and supplements) to consistently achieve this (J Am Geriatr Soc 62: , 2014)
48 Fundraising For My Next Project
49 Calcium and Vitamin D: Differences in Regulation of PTH Secretion Calcium High ECF Ca suppresses secretion of intact PTH and increases secretion of inactive PTH fragments Low Ca increases release of intact active PTH and reduces PTH catabolism Long term hypocalcemia: PT hyperplasia, slow increase in PTH Gene expression Long term hypercalcemia: suppression of PTH gene expression,? involution of PT glad tissue Vitamin D (calcitriol) no direct (acute) effect on PTH secretion suppresses PTH gene expression and may increase apoptosis/ autophagy (?involution of PT hyperplasia) Vitamin D deficiency causes hyperplasia (larger adenomata) PT cells express 1-α hydroxylase, 24-hydroxylase and VDR: Can synthesize and degrade calcitriol. Therefore, high doses of vitamin D can gradually suppress PTH synthesis
50 Calcium and Vitamin D: Differences in Skeletal Effect of Deficiency Calcium Deficiency increases PTH secretion, resulting in increased bone turnover increased turnover means increased bone loss in adult humans severe Ca deficiency has been associated with mineralization defect in children high dose calcium can partially heal Type II Vitamin D-Dependent Rickets/ osteomalacia (VDR mutations) Vitamin D Deficiency causes reduced intestinal Ca and PO 4 absorption secondary HPT may be mediated through effects on Ca absorption Decreased Ca and PO 4 means poor bone matrix mineralization (osteomalacia) and inadequate mineralization around growth plate in children means rickets: deformities and short stature role of vitamin D in human bone physiology less clear, but effects not just via Ca and PO 4 absorption. Bone cell regulation D-dependent protein synthesis (e.g. osteocalcin)
D. 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 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 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 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 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 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 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 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 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 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 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 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 informationTurning patients into baywatchers: extra-skeletal effects of vitamin D, from diabetes to ICU R. Rizzoli (CH)
ESPEN Congress Leipzig 2013 From A to Zinc: the evolving concept of micronutrient supplementation Turning patients into baywatchers: extra-skeletal effects of vitamin D, from diabetes to ICU R. Rizzoli
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 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 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 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 informationNATIONAL 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 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 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 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 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 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 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 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 informationCa : methods for determining DRIs. Adults. 4average requirement, meta-analyzed balance studies by FAO/WHO :
Minerals Categories of Ds for Minerals - Ca, P, Na, Cl, K, Mg - Mineral Ca RDA P Ca ; 서울대학교 이연숙 Na P ; 국민대학교 김선희 Na, Cl ; 동의대학교 임화재 K ; 국민대학교 장문정 Mg ; 인하대학교 천종희 Cl K Mg Indicators for Estimating Ds Ca
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 informationVitamin D & Iron Dosing Guidelines
Vitamin D & Iron Dosing Guidelines Ayman Khmour, MD I have no actual or potential conflict of interest in relation to this program. Objectives Review Ca metabolism Review Recent AAP Guidelines Review CMH
More informationSupplements, Vitamin D, Omega-3 Fatty Acids, and Co-Enzyme Q10: What Really Works?
Supplements, Vitamin D, Omega-3 Fatty Acids, and Co-Enzyme Q10: What Really Works? DAVID P. GOWMAN, D.O. S E C T I O N CHIEF, CARDIOLOGY P R O G R A M D I R E C T O R, CARDIOLOGY F E L L O W S H I P B
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 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 informationA product of living cells that circulates in body fluids. Webinar broadcast at live.oregonstate.edu (only on day and time of the event).
Vitamin D: Bone Up For Winter The "Vitamin D Winter" is coming. In this webinar we will learn about this important molecule and how you can get the you need to help maintain more than just healthy bones.
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 informationCALCIUM&Vit D FRIEND OR FOE?
CALCIUM&Vit D FRIEND OR FOE? Raheela Khawaja, M.D. Clinical Associate Professor of Medicine Division Of Endocrinology Department of Internal Medicine Ohio State University, Columbus OH Is Calcium & Vit
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 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 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 informationNHS GGC Vitamin D Supplementation Frequently asked Questions
Pharmacy & Prescribing Support Unit NHS GGC Vitamin D Supplementation Frequently asked Questions In February 2012 the Scottish Government issued advice on supplements for groups at risk of vitamin D deficiency.
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 informationCalcium and Vitamin D Supplementation: Who Needs It?
Detail-Document #270102 This Detail-Document accompanies the related article published in PHARMACIST S LETTER / PRESCRIBER S LETTER January 2011 ~ Volume 27 ~ Number 270102 Calcium and Vitamin D Supplementation:
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 informationPart 1: Essential Nutrients for Bone Health
Stephanie A. Atkinson, PhD, FCAHS Professor & Associate Chair Dept. of Pediatrics, McMaster University Beyond the Break Module 3: Osteoporosis & Nutrition Part 1: Essential Nutrients for Bone Health Outline
More informationMANAGEMENT OF LIPID DISORDERS: IMPLICATIONS OF THE NEW GUIDELINES
MANAGEMENT OF LIPID DISORDERS: IMPLICATIONS OF THE NEW GUIDELINES Robert B. Baron MD MS Professor and Associate Dean UCSF School of Medicine Declaration of full disclosure: No conflict of interest EXPLAINING
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 informationAppendix: Description of the DIETRON model
Appendix: Description of the DIETRON model Much of the description of the DIETRON model that appears in this appendix is taken from an earlier publication outlining the development of the model (Scarborough
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 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 informationVitamin D and Calcium: A Systematic Review of Health Outcomes (Update) Executive Summary
Evidence Report/Technology Assessment Number 217 Vitamin D and Calcium: A Systematic Review of Health Outcomes (Update) Executive Summary Background In 2009, the Tufts Evidence-based Practice Center (EPC)
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 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 informationSteven K. Clinton, MD, PhD Professor Department t of Internal Medicine Division of Medical Oncology The Ohio State University Wexner Medical Center
Vitamin D: The 2011 Dietary Reference Intakes fo Vitamin D and Calcium Steven K. Clinton, MD, PhD Professor Department t of Internal Medicine i Division of Medical Oncology The Ohio State University Wexner
More informationEvaluation, Treatment, and Prevention of Vitamin D Deficiency: an Endocrine Society Clinical Practice Guideline
SPECIAL FEATURE Clinical Practice Guideline Evaluation, Treatment, and Prevention of Vitamin D Deficiency: an Endocrine Society Clinical Practice Guideline Michael F. Holick, Neil C. Binkley, Heike A.
More informationVITAMIN D DEFICIENCY IN THE ELDERLY
1 VITAMIN D DEFICIENCY IN THE ELDERLY Naushira Pandya M.D., CMD, FACP Professor and Chair Department of Geriatrics Nova Southeastern University College of Osteopathic Medicine FT. Lauderdale, FL FGS 2015
More informationTowards an adequate intake of vitamin D
Towards an adequate intake of vitamin D Gezondheidsraad Health Council of the Netherlands To the Minister of Health, Welfare and Sport Subject : Presentation of advisory report Towards an adequate intake
More informationNutrition Requirements
Who is responsible for setting nutrition requirements in the UK? In the UK we have a set of Dietary Reference Values (DRVs). DRVs are a series of estimates of the energy and nutritional requirements of
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 informationEvaluation, Treatment, and Prevention of Vitamin D Deficiency:
CLINICAL GUIDELINES Evaluation, Treatment, and Prevention of Vitamin D Deficiency: An Endocrine Society Clinical Practice Guideline Authors: Michael F. Holick, Neil C. Binkley, Heike A. Bischoff-Ferrari,
More informationOverview. Nutritional Aspects of Primary Biliary Cirrhosis. How does the liver affect nutritional status?
Overview Nutritional Aspects of Primary Biliary Cirrhosis Tracy Burch, RD, CNSD Kovler Organ Transplant Center Northwestern Memorial Hospital Importance of nutrition therapy in PBC Incidence and pertinence
More informationGUIDE FOR VITAMIN D IN CHILDHOOD
GUIDE FOR VITAMIN D IN CHILDHOOD October 2013 Introduction There are many different recommendations for the prevention, detection and treatment of Vitamin D deficiency in the UK. The following is a practical
More informationTesting Serum Vitamin D Level
MEDICAL POLICY 2.04.135 Testing Serum Vitamin D Level Effective Date: August 1, 2016 Last Revised: July 12, 2016 Replaces: N/A RELATED MEDICAL POLICIES: None Introduction Vitamin D is an important nutrient
More informationThe VITamin D and OmegA-3 TriaL (VITAL)
The VITamin D and OmegA-3 TriaL (VITAL) JoAnn E. Manson, MD, DrPH Principal Investigator, VITAL Brigham and Women's Hospital Professor of Medicine and the Michael and Lee Bell Professor of Women s Health
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 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 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 informationNew Cholesterol Guidelines: Carte Blanche for Statin Overuse Rita F. Redberg, MD, MSc Professor of Medicine
New Cholesterol Guidelines: Carte Blanche for Statin Overuse Rita F. Redberg, MD, MSc Professor of Medicine Disclosures & Relevant Relationships I have nothing to disclose No financial conflicts Editor,
More informationImportance of zinc in human body. Overview of terminology. Rationale for upper intake level for zinc as recommended by the US Institute of
Sonja Y. Hess, PhD University of California, Davis Importance of zinc in human body Overview of terminology Rationale for upper intake level for zinc as recommended by the US Institute of Medicine (2001)
More informationMediterranean diet: A heart-healthy eating plan Source: mayoclinic.org/mediterranean-diet
Mediterranean diet: A heart-healthy eating plan Source: mayoclinic.org/mediterranean-diet The heart-healthy Mediterranean is a healthy eating plan based on typical foods and recipes of Mediterranean-style
More informationOmega-3 fatty acids improve the diagnosis-related clinical outcome. Critical Care Medicine April 2006;34(4):972-9
Omega-3 fatty acids improve the diagnosis-related clinical outcome 1 Critical Care Medicine April 2006;34(4):972-9 Volume 34(4), April 2006, pp 972-979 Heller, Axel R. MD, PhD; Rössler, Susann; Litz, Rainer
More informationTHE ROLE OF VITAMIN D IN BONE METABOLISM AND BEYOND
THE ROLE OF VITAMIN D IN BONE METABOLISM AND BEYOND PRINT THIS ARTICLE Martha Spencer, MD, Department of Medicine, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia Roger
More informationESCMID Online Lecture Library. by author
Do statins improve outcomes of patients with sepsis and pneumonia? Jordi Carratalà Department of Infectious Diseases Statins for sepsis & community-acquired pneumonia Sepsis and CAP are major healthcare
More informationClinical Significance And Assessment of 25 OH Vitamin D
Clinical Significance And Assessment of 25 OH Vitamin D by Bruce Hollis, PhD; Gordon MacFarlane, PhD; and André Valcour, PhD Presented by qwertyui Clinical Significance And Assessment of 25 OH Vitamin
More informationSINPE trial, Ann Surg 2009. Overall morbidity. Minor Major. Infectious Non infectious. Post-hoc analysis WL < %5 (n=379) WL between 5-10% (n=49)
Chinese International Symposium on Nutritional Oncology Changchun, June 20-21 2014 IMMUNONUTRITION IN CANCER PATIENTS IMMUNONUTRITION IN SURGERY OBJECTIVE To get the patient undergoing major surgery for
More informationAnalysis by Pamela Mason
Analysis by Pamela Mason Contents Executive Summary 1 Overview 2 Introduction 3 Fruit and Vegetable Intake 4 Wholegrain Consumption 5 Oily Fish Consumption 5 Vitamin and Mineral Intakes 6 The NDNS in Adults
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 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 informationInstitute of Medicine Food Forum September 15, 2011 Informing Health & Food Policy through Systematic, Evidence-Based Reviews
Institute of Medicine Food Forum September 15, 2011 Informing Health & Food Policy through Systematic, Evidence-Based Reviews Nutrition and Problems of Proof Jeffrey Blumberg, PhD, FACN, FASN, CNS Friedman
More informationPERINATAL NUTRITION. Nutrition during pregnancy and lactation. Nutrition during infancy.
PERINATAL NUTRITION Nutrition during pregnancy and lactation Nutrition during infancy. Rama Bhat, MD. Department of Pediatrics, University of Illinois Hospital Chicago, Illinois. Nutrition During Pregnancy
More informationProlia 2 shots a year proven to help strengthen bones.
Ask your doctor if Prolia (denosumab) is right for you and visit us at www.prolia.com For women with postmenopausal osteoporosis at high risk for fracture: there s Prolia. Prolia 2 shots a year proven
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 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 informationVienna the captial city of Vienna, Austria
20 20 Vienna the captial city of Vienna, Austria Vienna, downtown Vienna, Hofburg Vienna, St. Peter Old building, a sign of history University of Vienna The University of Vienna (Universität Wien) is the
More informationHormone Replacement Therapy : The New Debate. Susan T. Hingle, M.D.
Hormone Replacement Therapy : The New Debate Susan T. Hingle, M.D. Background Hormone replacement therapy (HRT) is extensively used in the United States, especially for: *treatment of menopausal symptoms
More informationDVITA PLUS Vitamin D 1000 IU Tablet INDICATED CLAIMS:
DVITA PLUS Vitamin D 1000 IU Tablet INDICATED CLAIMS: Vitamin D is the principal regulator of calcium homeostasis in the body Vitamin D is particularly important in skeletal development and bone mineralization.
More informationDuring the past decade, important advances in the study. High Prevalence of Vitamin D Inadequacy and Implications for Health
VITAMIN D INADEQUACY AND IMPLICATIONS REVIEW FOR HEALTH High Prevalence of Vitamin D Inadequacy and Implications for Health MICHAEL F. HOLICK, PHD, MD During the past decade, major advances have been made
More informationCOULD IT BE LOW TESTOSTERONE?
COULD IT BE LOW TESTOSTERONE? By Dr. Lauren M. Bramley For thousands of years women have been recognized for their sensitivity to hormones. PMS, post partum depression, menopause have long been plights
More informationJournal Club: Niacin in Patients with Low HDL Cholesterol Levels Receiving Intensive Statin Therapy by the AIM-HIGH Investigators
Journal Club: Niacin in Patients with Low HDL Cholesterol Levels Receiving Intensive Statin Therapy by the AIM-HIGH Investigators Shaikha Al Naimi Doctor of Pharmacy Student College of Pharmacy Qatar University
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 informationVitamin D. Your guide to understanding vitamin D. Title of page 1. Created by
Vitamin D Your guide to understanding vitamin D Created by Title of page 1 Vitamin D Your guide to understanding vitamin D Created by A public health nonprofit Vitamin D Council 1241 Johnson Ave #134
More informationAllen Dobson, PhD Health Economist. Co-Founder & President Dobson DaVanzo & Associates, LLC
Allen Dobson, PhD Health Economist Co-Founder & President Dobson DaVanzo & Associates, LLC Dobson DaVanzo & Associates, LLC Vienna, VA 703.260.1760 www.dobsondavanzo.com Discussion of Methods Used to Study
More informationPrevalence of Vitamin D Deficiency In Secure Mental Health Setting: is routine screening required?
Prevalence of Vitamin D Deficiency In Secure Mental Health Setting: is routine screening required? Dr Neel Halder, Consultant Psychiatrist and Senior Honorary Lecturer, Manchester University Dhana Govindaraj,
More informationEpidemic Vitamin D Deficiency Among Patients in an Elderly Care Rehabilitation Facility Stefan Schilling
ORIGINAL ARTICLE Epidemic Vitamin D Deficiency Among Patients in an Elderly Care Rehabilitation Facility Stefan Schilling SUMMARY Background: Many benefits are ascribed to vitamin D beyond its well-known
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 informationParathyroid hormone (serum, plasma)
Parathyroid hormone (serum, plasma) 1 Name and description of analyte 1.1 Name of analyte Parathyroid hormone (PTH) 1.2 Alternative names Parathormone 1.3 NMLC code 1.4 Description of analyte PTH is an
More informationTestosterone Treatment in Older Men
Testosterone Treatment in Older Men J. Bruce Redmon, M.D. Professor Division of Endocrinology Departments of Medicine and Urologic Surgery Disclosure Information I have no financial relationships to disclose.
More informationCardiovascular Effects of Drugs to Treat Diabetes
Cardiovascular Effects of Drugs to Treat Diabetes Steven E. Nissen MD Chairman, Department of Cardiovascular Medicine Cleveland Clinic Disclosure Consulting: Many pharmaceutical companies Clinical Trials:
More informationFact Sheet on Vitamin D
Fact Sheet on Vitamin D DISCLAIMER: This Fact Sheet Does Not Constitute Medical Advice. This sheet is a compilation of recommendations by top researchers. These recommendations may or may not apply to
More informationEndocrine Responses to Resistance Exercise
chapter 3 Endocrine Responses to Resistance Exercise Chapter Objectives Understand basic concepts of endocrinology. Explain the physiological roles of anabolic hormones. Describe hormonal responses to
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 information.org. Metastatic Bone Disease. Description
Metastatic Bone Disease Page ( 1 ) Cancer that begins in an organ, such as the lungs, breast, or prostate, and then spreads to bone is called metastatic bone disease (MBD). More than 1.2 million new cancer
More informationPresentation Prepared By: Jessica Rivers, BASc., PTS
Presentation Prepared By: Jessica Rivers, BASc., PTS Presentation Outline Why should we care about our eating habits? Why is nutrition so important as we age? How do we know if we are eating healthy? What
More information