VITAMIN D SUPPLEMENTATION IN ELDERLY PEOPLE WITH OSTEOPOROSIS, OSTEOPENIA AND OSTEOSARCOPENIA
VITAMIN D SUPPLEMENTATION IN ELDERLY PEOPLE WITH OSTEOPOROSIS, OSTEOPENIA AND OSTEOSARCOPENIA

Author(s): Tatjana Bačun, Ivan Lekić, Barbara Bačun
Subject(s): Health and medicine and law, Gerontology
Published by: Sveučilište Josipa Jurja Strossmayera u Osijeku, Ekonomski fakultet u Osijeku
Keywords: Vitamin D; hyperparathyroidism; osteoporosis; bone diseases; metabolic;
Summary/Abstract: Vitamin D plays a crucial role in calcium metabolism and bone health. Vitamin D deficiency can lead to impaired calcium absorption, increased parathyroid hormone (PTH) levels, and secondary hyperparathyroidism, resulting in excessive bone breakdown and increased risk of fractures. Optimal vitamin D levels can increase bone mineral density and improve response to bisphosphonate therapy. Vitamin D is primarily synthesized in the skin by exposure to sunlight and can also be obtained from dietary sources. It is hydroxylated in the liver to form 25-hydroxyvitamin D (25(OH)D), the primary form used to assess vitamin D status. Further hydroxylation in the kidney produces the active form, 1.25-dihydroxyvitamin D (1.25(OH)2D), which regulates calcium and phosphorus metabolism and promotes bone health. Secondary hyperparathyroidism is a condition in which the parathyroid glands overproduce PTH in response to low serum calcium levels, which may be caused by vitamin D deficiency. This overproduction of PTH leads to increased bone resorption, resulting in decreased bone density and increased fracture risk. Vitamin D significantly impacts bone density and fractures. Adequate vitamin D levels help maintain proper calcium and phosphorus metabolism and promote the formation and maintenance of strong, healthy bones. Individuals with low vitamin D levels are at higher risk of bone fractures. Serum 25(OH)D concentration is used to assess vitamin D status, with 100 IU of vitamin D increasing serum 25-(OH)D by about 1 ng/mL. A daily calcium intake of 1000-1200 mg and a vitamin D level greater than 20 ng/mL but not greater than 50 ng/ mL are recommended to prevent osteosarcopenia, a condition characterized by low bone mineral density, muscle strength, and mass. Both daily and pulse dosing of vitamin D have been studied with varying results. Daily dosing, which mimics the natural production of vitamin D in the skin, has been shown to maintain more stable and consistent 25(OH)D serum levels. On the other hand, pulse dosing, where a large dose of vitamin D is taken once or a few times a week, has been shown to effectively increase 25(OH)D levels, but also results in higher variability and fluctuations in serum levels. Daily dosing may provide more consistent and stable serum levels and may better maintain bone health markers. For individuals who have difficulty maintaining adequate daily vitamin D intake, pulsed dosing may still be an effective option. In terms of vitamin D supplementation, through either daily or pulse dosing, the American Association of Clinical Endocrinologists (AACE) and the Endocrine Society (EC) recommend a target level of 50 ng/dl or higher and safe levels between 30-50 ng/dl. A daily dose of 1000 IU for adults over 50 years of age and up to 4000 IU/day for adults is recommended, along with dietary or supplemetal calcium intake of 800-1200 mg. Obesity and malabsorption may affect vitamin D status and require higher doses.

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