How to select the doses of vitamin D in the management of osteoporosis

The dose of vitamin D in the management of osteoporosis should be no less than 700-800IU per day. An optimal dose of vitamin D should raise serum concentrations of 25(OH)D to the desirable range of at least 75nmol/l. Higher intermittent oral doses of vitamin D may overcome low adherence. Vitamin D supplementation in the management of osteoporosis holds a significant public health potential because of its low cost, excellent tolerability, and combined musculo-skeletal benefits. Fall and fracture prevention with vitamin D is especially appealing in the treatment of older individuals at risk for fall-related fractures. However, bone density, strength, and function benefits with vitamin D include active and inactive subgroups of community-dwelling older men and women. Based on a recent expert panel and supportive evidence presented in this review, serum concentrations of at least 75nmol/l 25(OH)D will be referred to as desirable. Today, desirable serum 25(OH)D levels of at least 75nmol/l may only be reached in about one third of US older individuals and even fewer European older individuals. Two main factors discussed in this review may help public health efforts to ensure desirable vitamin D levels for fall and fracture prevention, including (1) a sufficient dose of vitamin D and (2) improved adherence to supplementatio

Validated treatments and therapeutic perspectives regarding nutritherapy

Nutritherapy seeks to prevent or correct disease by the use of nutritional supplements including vitamins, trace elements, or macronutrients. This chapter of the "Les Entretiens du Carla” reviews the potential of nutritherapy for the prevention or improvement of sarcopenia, which is the progressive reduction in muscle mass and muscle strength prevalent in late-life. It is critical that we review nutrients and their potential to maintain muscle mass and strength which ultimately will help minimize falls and fractures among the older population. Evidence from randomized-controlled trials will be reviewed for muscle mass as well as important sarcopenia-related endpoints including lower extremity strength and function, as well as falls and fallrelated fractures. This chapter will focus on vitamin D as a compelling strategy with evidence for strength gain, fall and fracture prevention from double-blind randomized controlled trials. The other strategy discussed is increased protein intake although longer-term trials and evidence for clinically important endpoints are limited. Today, there is no consistent data on other micronutrients or macronutrients with an established potential to combat sarcopeni

Relevance of vitamin D in muscle health

This review will summarize the impact of vitamin D deficiency on muscle health. Mechanistic evidence regarding the presence of the specific vitamin D receptor in muscle tissue and muscle biopsy abnormalities observed with deficiency will be reviewed, as well as molecular and non-molecular effects of vitamin D in muscle tissue. At the clinical level, the evidence from randomized controlled trials of vitamin D supplementation on functional improvement and fall reduction will be summarized. Further, the manuscript will discuss whether vitamin D effects on fall prevention modulate in part its benefit on fracture prevention and why fall prevention is essential in fracture prevention at higher age. Finally, trial and epidemiological data will be reviewed to assess desirable serum 25-hydroxyvitamin D levels for optimal muscle healt

Additive benefit of higher testosterone levels and vitamin D plus calcium supplementation in regard to fall risk reduction among older men and women

Summary: Higher physiologic testosterone levels among community dwelling older men and women may protect against falls, and this benefit may be further increased among those taking additional vitamin D plus calcium. Introduction: The aim of this study is to investigate sex hormone levels and fall risk in older men and women. Methods: One hundred and ninety-nine men and 246 women age 65+ living at home were followed for 3years after baseline assessment of sex hormones. Analyses controlled for several covariates, including baseline 25-hydroxyvitamin D, sex hormone binding globulin, and vitamin D plus calcium treatment (vitD+cal). Results: Compared to the lowest quartile, men and women in the highest quartile of total testosterone had a decreased odds of falling (men: OR = 0.22; 95% CI [0.07,0.72]/ women: OR = 0.34; 95% CI [0.14,0.83]); if those individuals also took vitD+cal, the fall reduction was enhanced (men: OR = 0.16; 95% CI [0.03,0.90] / women: OR = 0.15; 95% CI [0.04,0.57]). Similarly, women in the top quartile of dihydroepiandrosterone sulfate (DHEA-S) had a lower risk of falling (OR = 0.39; 95% CI [0.16,0.93]). Other sex hormones and SHBG did not predict falling in men or women. Conclusions: Higher testosterone levels in both genders and higher DHEA-S levels in women predicted a more than 60% lower risk of falling. With vitD+cal, the anti-fall benefit of higher physiologic testosterone levels is enhanced from 78% to 84% among men and from 66% to 85% among wome

Effect of seasonality and weather on fracture risk in individuals 65years and older

Summary: In this large population-based study, fracture rates for hips, distal forearms, proximal humeri, and ankles were higher in winter than in other seasons, although the winter peak was small for hip fractures (p < 0.05 at all sites). Younger age between 65 and 80, living in warmer states and male gender were associated with increased winter morbidity due to fractures. Introduction: The objective was to investigate seasonal variation in the incidence of four common fractures, and explore the association of weather with risk. Methods: Population-based analysis of individuals age 65 and older, including fractures of the hip, the distal forearm, the proximal humerus and the ankle. Weather information was obtained from the US National Oceanic and Atmospheric Administration website. Results: For all fractures, rates were highest in winter and lowest in summer (p < 0.05 at all sites). Winter peaks were more pronounced in warm climate states, in men, and in those younger than 80years old. In winter, total snowfall was associated with a reduced risk of hip fracture (−5% per 20inches) but an increased risk of non-hip fractures (6-12%; p < 0.05 at all sites). In summer, hip fracture risk tended to be lower during sunny weather (− 3% per 2weeks of sunny days; p = 0.13), while other fractures were increased (15%-20%; p < 0.05) in sunny weather. Conclusion: Fractures contribute considerably to winter morbidity in older individuals. Younger age between 65 and 80, living in warmer states and male gender are risk factors for increased winter morbidity due to fractures. Weather affects hip fracture risk differently than the other fractures studie

Can we translate vitamin D immunomodulating effect on innate and adaptive immunity to vaccine response?

Vitamin D (VitD), which is well known for its classic role in the maintenance of bone mineral density, has now become increasingly studied for its extra-skeletal roles. It has an important influence on the body's immune system and modulates both innate and adaptive immunity and regulates the inflammatory cascade. In this review our aim was to describe how VitD might influence immune responsiveness and its potential modulating role in vaccine immunogenicity. In the first instance, we consider the literature that may provide molecular and genetic support to the idea that VitD status may be related to innate and/or adaptive immune response with a particular focus on vaccine immunogenicity and then discuss observational studies and controlled trials of VitD supplementation conducted in humans. Finally, we conclude with some knowledge gaps surrounding VitD and vaccine response, and that it is still premature to recommend "booster" of VitD at vaccination time to enhance vaccine response