Annals of Long Term Care

Vitamin D deficiency has long been associated with skeletal diseases, but an ever-growing body of research is linking vitamin D deficiency to chronic illnesses such as diabetes, cancer, and multiple sclerosis, and to an increased risk of falls and fractures. Elders are especially susceptible to vitamin D deficiency and its consequences. A new study published by European researchers in the February 2012 issue of the Journal of Clinical Endocrinology and Metabolism shows that the consequence of vitamin D deficiency can be death. In the study, low 25-hydroxyvitamin D (25[OH]D) concentrations were found to serve as an independent risk factor for mortality among female nursing home residents.           

The study included 961 women (age, >70 years) who were recruited from 95 nursing homes throughout Austria. The median 25(OH)D concentration among the participants was 17.5 nmol/L (interquartile range, 13.7-25.5 nmol/L), with 93% having 25(OH)D levels below 50 nmol/L (or approximately <20 ng/mL). After a mean follow-up time of 27 ± 8 months, 284 participants had died. The researchers used Cox proportional hazard ratios (HR) to determine all-cause mortality based on the participants’ 25(OH)D levels. Using these calculations, the investigators found that the age-adjusted HR was 1.49 (95% confidence interval [CI], 1.07-2.10) in individuals with a 25(OH)D <14.0 nmol/L when compared with those who had a 25 (OH)D level >25.5 nmol/L. This association remained statistically significant even after multivariate adjustments (HR, 1.56; 95% CI, 1.01-2.40).

Based on these data, the researchers conclude that their findings “underscore the urgent need for effective strategies for the prevention and treatment of vitamin D deficiency, in particular in the setting of nursing homes.”

In an article on vitamin D published in a previous issue of Annals of Long-Term Care: Clinical Care and Aging^®, Jerome Epplin, MD, AGSF, clinical professor, Family and Community Medicine, Southern Illinois University School of Medicine, Springfield, IL, reviews the prevention and treatment of vitamin D deficiency in the nursing home setting. He notes that most studies show a “maximum benefit from vitamin D replacement is obtained when serum levels are at least 30 ng/mL.” He notes that “For patients with insufficient vitamin D levels (21 ng/mL–29 ng/mL), oral supplementation with vitamin D doses between 1000 IU and 2000 IU is often adequate. For those who are deficient in vitamin D (levels <21 ng/mL), loading doses of 50,000 IU weekly for 8 weeks is often given, followed by 1000 to 2000 IU daily." Dr. Epplin states that "It is imperative that vitamin D levels are rechecked in about 3 months due to the wide variability in response to oral supplementation. If levels remain lower than 30 ng/mL, the daily dose can be increased or the 50,000 IU weekly dose can be given over a longer period of time.”

To read additional articles on the use of vitamin D in nursing home residents and community-dwelling elders, see also “Vitamin D: Beneficial for Pain, Fracture, and Falls in Long-Term Care Residents?” and “Vitamin D and Calcium: Implications for Healthy Aging.”—Christina T. Loguidice