Medical Centre for Postgraduate Education, 01-813 Warsaw, Poland.
Department of Biochemistry, Radioimmunology and Experimental Medicine, The Children's Memorial Health Institute, 04-730 Warsaw, Poland.
Nutrients. 2021 Apr 10;13(4):1247. doi: 10.3390/nu13041247.
Vitamin D deficiency frequently occurs in older people, especially in individuals with comorbidity and polypharmacotherapy. In this group, low vitamin D plasma concentration is related to osteoporosis, osteomalacia, sarcopenia and myalgia. Vitamin D levels in humans is an effect of the joint interaction of all vitamin D metabolic pathways. Therefore, all factors interfering with individual metabolic stages may affect 25-hydroxyvitamin D plasma concentration. The known factors affecting vitamin D metabolism interfere with cytochrome CYP3A4 activity. There is another group of factors that impairs intestinal vitamin D absorption. The phenomenon of drugs and vitamin D interactions is observed first and foremost in patients with comorbidity. This is a typical situation, where the absence of "hard evidence" is not synonymous with the possible lack of adverse effects. Osteoporosis and sarcopenia (generalized and progressive decrease of skeletal muscle mass and strength) are some of the musculoskeletal consequences of hypovitaminosis D. These consequences are related to an increased risk of adverse outcomes, including bone fractures, physical disabilities, and a lower quality of life. This can lead not only to an increased risk of falls and fractures but is also one of the main causes of frailty syndrome in the aging population. Generally, Vitamin D plasma concentration is significantly lower in subjects with osteoporosis and muscle deterioration. In some observational and uncontrolled treatment studies, vitamin D supplementation resulted in a reduction of proximal myopathy and muscle pain. The most conclusive results were found in subjects with severe vitamin D deficiency and in patients avoiding large doses of vitamin D. However, the role of vitamin D in muscle pathologies is not clear and research has provided conflicting results. This is plausibly due to the heterogeneity of the subjects, vitamin D doses and environmental factors. This report presents data on some problems with vitamin D deficiency in the elderly population and the management of vitamin D deficiency D in successful or unsuccessful aging.
维生素 D 缺乏症在老年人中很常见，尤其是在合并症和多药物治疗的个体中。在这一群体中，低维生素 D 血浆浓度与骨质疏松症、骨软化症、肌肉减少症和肌痛有关。人体中的维生素 D 水平是所有维生素 D 代谢途径共同作用的结果。因此，干扰个体代谢阶段的所有因素都可能影响 25-羟维生素 D 血浆浓度。已知影响维生素 D 代谢的因素会干扰细胞色素 CYP3A4 的活性。还有另一组因素会损害肠道维生素 D 吸收。药物和维生素 D 相互作用的现象首先在合并症患者中观察到。这是一种典型的情况，缺乏“确凿证据”并不等同于可能缺乏不良反应。骨质疏松症和肌肉减少症（骨骼肌肉量和力量的普遍和进行性下降）是维生素 D 缺乏症的一些骨骼肌肉后果。这些后果与不良后果风险增加有关，包括骨折、身体残疾和生活质量下降。这不仅会导致跌倒和骨折的风险增加，而且是衰老人群中衰弱综合征的主要原因之一。一般来说，骨质疏松症和肌肉恶化患者的维生素 D 血浆浓度明显较低。在一些观察性和非对照治疗研究中，维生素 D 补充可减少近端肌病和肌肉疼痛。在严重维生素 D 缺乏症和避免大剂量维生素 D 的患者中发现了最明确的结果。然而，维生素 D 在肌肉病理中的作用尚不清楚，研究结果相互矛盾。这可能是由于研究对象、维生素 D 剂量和环境因素的异质性。本报告介绍了一些老年人维生素 D 缺乏症的问题以及成功或不成功老化过程中维生素 D 缺乏症的管理数据。
