DeLappe E, McGreevy C, ni Chadhain N, Grimes H, O'Brien T, Mulkerrin E
Department of Medicine for the Elderly, University College Hospital, Galway, Ireland.
Eur J Clin Nutr. 2006 Aug;60(8):1009-15. doi: 10.1038/sj.ejcn.1602412. Epub 2006 Mar 15.
A significant proportion of the older population may exhibit vitamin D insufficiency. We sought to establish the proportion of 25-hydroxyvitamin D (25OHD) insufficient individuals in an older female cohort presenting for acute medical admission and how they responded to supplementation.
A prospective cohort study.
Hospital admissions followed up as a population-based study.
A total of 114 consecutive female acute medical admissions aged over 65 years from November 2003 to January 2004 were enrolled. All admissions with hypercalcaemia, metabolic bone disease (other than osteoporosis/osteomalacia) and creatinine > 150 micromol/l were excluded.
iPTH, calcium and 25OHD levels were measured in each patient. Of the total, 22 were already receiving calcium and vitamin D supplementation at enrolment. The remaining 92 were commenced on 800 IU of vitamin D and 1 g calcium, and levels were reassessed after supplementation for 3 months.
25-Hydroxyvitamin D insufficiency, as defined by a 25OHD concentration of < 50 nmol/l, was present in 86 (75.4%) patients at initial assessment (mean 35.8 nmol/l, s.d. 23.3). Secondary hyperparathyroidism was present in only 36.7% of those with 25OHD deficiency at baseline. Of the total, 51 (44.7%) patients presented for follow-up. 25-Hydroxyvitamin D concentration increased in this group from 42.1 nmol/l (s.d. 26.6) to 59.5 nmol/l (s.d. 27.4) after supplementation, P < 0.001, but 18(35.3%) still remained deficient. There was no significant change in iPTH or calcium following supplementation. Assessment of compliance revealed 6 (11.7%) admitted to partial or non-compliance.
Insufficiency of 25OHD was very common in this cohort. Despite calcium and vitamin D supplementation, 25OHD concentrations failed to reach normality in a significant proportion. Maintaining vitamin D and calcium intake at the level of current recommended doses may not be sufficient to ensure adequate 25OHD stores.
相当一部分老年人群可能存在维生素D不足的情况。我们试图确定因急性内科疾病入院的老年女性队列中25-羟维生素D（25OHD）不足个体的比例，以及她们对补充剂的反应。
一项前瞻性队列研究。
以人群为基础的研究对医院入院患者进行随访。
纳入了2003年11月至2004年1月期间连续入院的114名年龄超过65岁的老年女性急性内科患者。排除所有高钙血症、代谢性骨病（骨质疏松症/骨软化症除外）和肌酐>150微摩尔/升的患者。
测量每位患者的甲状旁腺激素（iPTH）、钙和25OHD水平。其中，22名患者在入组时已在接受钙和维生素D补充剂治疗。其余92名患者开始服用800国际单位的维生素D和1克钙，并在补充3个月后重新评估水平。
初次评估时，86名（75.4%）患者存在25-羟维生素D不足，定义为25OHD浓度<50纳摩尔/升（平均35.8纳摩尔/升，标准差23.3）。基线时25OHD缺乏的患者中，仅有36.7%存在继发性甲状旁腺功能亢进。总共51名（44.7%）患者接受了随访。补充后，该组患者的25-羟维生素D浓度从42.1纳摩尔/升（标准差26.6）升至59.5纳摩尔/升（标准差27.4），P<0.001，但仍有18名（35.3%）患者仍存在缺乏。补充后iPTH或钙水平无显著变化。对依从性的评估显示，6名（11.7%）患者承认部分或完全不依从。
25OHD不足在该队列中非常常见。尽管补充了钙和维生素D，但仍有相当一部分患者的25OHD浓度未能恢复正常。将维生素D和钙的摄入量维持在当前推荐剂量水平可能不足以确保充足的25OHD储备。
