Now with the aging population more and more, the aging problem is more and more serious, the elderly health medical treatment question also more and more receives everybody’s attention.
Common health problems in the elderly include arthritis, heart disease, Alzheimer’s disease, osteoporosis, and so on.
Osteoporosis is a systemic bone disease characterized by decreased bone mineral density (BMD) and damage to bone microstructure, resulting in decreased bone strength and increased fracture risk.
Osteoporosis occurs in older people because many older people, especially women, lose a lot of bone after menopause, which can lead to osteoporosis. Here are a few common causes of osteoporosis:
- No increase in calcium supplementation and ossification alcohol intake before menopause.
- Lack of proper exercise.
- Lack of sunlight.
- Drink too much coffee, drink too much, smoke too much.
With age, the risk of osteoporotic fracture increases significantly, and at the same time, it is easy to be associated with myopenia, so that the quality of life of patients decreased, and even increased risk of death.
Because vitamin D plays an important role in the regulation of bone and muscle, its role in the occurrence, development, prevention and treatment of osteoporosis can not be ignored.
Important role of vitamin D in osteoporosis.
The occurrence of osteoporosis depends on the peak bone mass obtained in young age and the rate of bone loss in middle and old age.
Studies have shown that D hormone is an important endocrine hormone regulating the growth and development of bone. In adolescence, the synthesis and intake of adequate vitamin D can promote bone construction and mineralization, and help to obtain a higher peak bone mass.
Adequate vitamin D helps maintain the calcium balance, reducing bone turnover imbalances and accelerating bone loss.
Several studies have shown that vitamin D deficiency is associated with increased parathyroid hormone levels, increased bone resorption, bone mass loss, falls, and increased fracture risk in middle-aged and elderly people.
Studies have shown that vitamin D 800 and 1000 IU/d, supplementation can reduce bone turnover levels, reduce bone loss rates, and increase bone mineral density at the lumbar spine and hip.
In addition, fall is the main cause of osteoporosis fracture. The incidence of fall is more than 20% in Chinese people over 70 years old. Vitamin D supplementation of 700-1000 IU daily can significantly reduce the incidence of falls in elderly people.
Meta analysis showed that the combination of vitamin D and calcium can reduce the risk of fracture in the elderly population.
The important role of active vitamin D and its analogues in osteoporosis
Due to the decreased ability of the elderly to synthesize vitamin D in the skin, the ability of the kidney to reduce the 1α hydroxylation of 25OHD is weak, and the active vitamin D is especially suitable for elderly patients or patients with kidney disease.
Studies have shown that calcitriol and alfacalcidol can improve muscle function and balance and reduce the risk of falls in the elderly.
A systematic review of the elderly population showed that calcitriol and alfacalcidol reduced bone resorption biochemical markers and increased bone density.
Chinese studies have also shown that calcitriol combined with calcium carbonate treatment significantly increases the bone density of the lumbar spine and femoral neck.
Studies have also shown that calcitriol and alfacalcidol can reduce the risk of falls and non-vertebral fractures.
How to correctly supplement ordinary vitamin D?
Common vitamin D is often used as a basic nutritional supplement for bone health, but the role of ordinary vitamin D supplementation in increasing bone mineral density and reducing the risk of fractures and falls in different populations remains controversial.
Here are a few recommendations for vitamin D supplementation:
- Exposure to adequate sunlight promotes the formation of endogenous vitamin D in the skin.
- Regular vitamin D supplements of 600-1000 IU per day are available for those with insufficient sunlight. Studies have also shown that taking larger daily doses of vitamin D (& gt;2000 IU/d) can increase bone mineral density in people with vitamin D deficiency.
- Serum 25OHD and parathyroid hormone (PTH) levels were monitored regularly to guide the adjustment of common vitamin D supplementation.
- It is recommended that the serum 25OHD concentration be adjusted to at least 20 μ g / L (50 nmol/L), preferably above 30 μ g / L (75 nmol/L), to prevent secondary hyperparathyroidism and bone mineral density loss due to vitamin D deficiency.
- Some studies have shown that taking 700 to 1, 000 IU of regular vitamin D a day can reduce the risk of falls.
How to use active vitamin D correctly?
Active vitamin D and its analogues are commonly used in clinical applications such as calcitriol and Alfacalcidol. They are recommended for use in patients over 65 years of age or with serum creatinine clearance less than 60 ml/min.
Active vitamin D can increase intestinal calcium absorption, reduce secondary hyperparathyroidism, inhibit bone resorption, slightly increase bone mineral density, reduce the risk of falls, and reduce the risk of vertebral or non-vertebral body fracture. Active vitamin D can be used in combination with other anti-osteoporosis drugs.
The guidelines recommend that:
In patients with osteoporosis, the dosage of calcitriol is usually 0.25 to 0.5 μ g / d, and the dose of Alfacalcidol is 0.25 to 1.0 μ g / d.
For osteoporosis patients with significant vitamin D deficiency, common vitamin D may be given, if necessary, to correct vitamin D deficiency, while active vitamin D may be given to play its role in the treatment of osteoporosis.
It should be noted that patients using active vitamin D can not adjust the dosage of the drug according to the serum 25OHD concentration, but can evaluate the efficacy of the drug according to the serum PTH level and bone turnover biochemical indicators.
It is recommended that patients’ serum calcium and 24 hour urinary calcium concentrations should be monitored regularly and the dosage should be adjusted according to their levels, whether using conventional vitamin D, active vitamin D preparations or a combination of both. In order to avoid drug overdose caused by hypercalcemia or hypercalcemia in urine to ensure the safety of treatment.