Abstract
Introduction: In the scenario of vitamin D deficiency, this incident is prevalent and with risks to public health in the world, reaching approximately 90% of individuals. Hypovitaminosis D can cause, mainly in the elderly, lower bone mineral density, fractures, muscle weakness, falls, and acute respiratory infection. Objective: To evaluate the main clinical results on vitamin D levels in the elderly, as well as to analyze which daily or weekly dose of vitamin D is most effective in the elderly in reducing the number of falls and fractures. Methods: The present study developed a systematic review, addressing randomized clinical studies, diverse clinical studies, systematic reviews, meta-analysis, and the latest international consensus, following the rules of PRISMA. Results and Conclusion: A total of 152 articles were found involving the dosage and the impact of vitamin D in the elderly. In total, 72 articles were evaluated in full and 30 were included. According to the main literary findings, vitamin D deficiency implies problems with mineralization and bone mineral density, causing fractures and an increase in the number of elderly falls. In this sense, SBEM recommends maintaining vitamin D concentrations above 30 ng/mL. Also, vitamin D deficiency points to the occurrence of neurological diseases such as cognitive decline, risk of Alzheimer's disease, and depression. In the current scenario of the pandemic, vitamin D points as an important modulator of the immune system, and its deficiency promotes the unregulated release of cytokines, leading to complications in patients with COVID-19.
Metrics
References
- OMS/OPAS. Organização Mundial de Saúde/Organização Pan-Americana da Saúde. Disponível em: https://www.paho.org/bra/index.php?option=com_docman&view=document&layout=default&alias=478-a-eficacia-calcio-e-vitamina-d-na-prevencao-fraturas-osseas-v-2-n-10-2005-8&category_slug=uso-racional-medicamentos 685&Itemid=965. Acessado em: 20 de fevereiro de 2020.
- A. Giustina, R.A. Adler, N. Binkley, J. Bollerslev, R. Bouillon, B. Dawson-Hughes , P.R. Ebeling, D. Feldman, A.M. Formenti, M. Lazaretti-Castro, C. Marcocci, R. Rizzoli, C.T. Sempos, J.P. Bilezikian, Consensus statement from 2nd International Conference on Controversies in Vitamin D, Reviews in Endocrine and Metabolic Disorders, 21 (2020) 89-116.
- P. Lips, K.D. Cashman, C. Lamberg-Allardt, H.A. Bischoff-Ferrari, B. Obermayer-Pietsch, M.L. Bianchi, J. Stepan, G. El-Hajj Fuleihan, Roger Bouillon, Current vitamin D status in European and Middle East countries and strategies to prevent vitamin D deficiency: a position statement of the European Calcified Tissue Society, European Journal of Endocrinology, 180 (2019) 23-54.
- S.J. Wimalawansa, M.S. Razzaque, N.M. Al-Daghri, Calcium and vitamin D in human health: Hype or real?, Journal of Steroid Biochemistry and Molecular Biology, 180 (2018) 4–14.
- R. Bouillon, Comparative analysis of nutritional guidelines for vitamin D, Nature Reviews Endocrinology, 13 (2017) 466-79.
- N. Binkley, B. Dawson-Hughes, R. Durazo-Arvizu, M. Thamm, L. Tian, J.M. Merkel, J.C. Jones, G.D. Carter, C.T. Sempos, Vitamin D measurement standardization: The way out of the chaos, Journal of Steroid Biochemistry and Molecular Biology, 173 (2017) 117–21.
- M. Herrmann, C_J.L. Farrell, I. Pusceddu, N. Fabregat-Cabello, E. Cavalier, Assessment of vitamin D status - a changing landscape, Clinical Chemistry and Laboratory Medicine, 55 (2017) 3–26.
- C.T Sempos, A.C. Heijboer, D.D. Bikle, J. Bollerslev, R. Bouillon, P.M. Brannon, H.F. DeLuca, G. Jones, C.F. Munns, J.P. Bilezikian, A. Giustina , N. Binkley, Vitamin D assays and the definition of hypovitaminosis D: results from the First International Conference on Controversies in Vitamin D, British Journal of Clinical Pharmacology, 84 (2018) 2194–2207.
- R.A. Durazo-Arvizu, L. Tian, S.P.J. Brooks, K. Sarafin, K.D. Cashman, M. Kiely, J. Merkel, G.L. Myers, P.M. Coates, C.T. Sempos, The Vitamin D Standardization Program (VDSP) Manual for Retrospective Laboratory Standardization of Serum 25-Hydroxyvitamin D Data, Journal of AOAC International, 100 (2017) 1234–1243.
- R. Bouillon, C. Marcocci, G. Carmeliet, Daniel Bikle, J. H. White, B. Dawson-Hughes, P.Lips, C.F. Munns, Marise Lazaretti-Castro, A. Giustina, J. Bilezikian, Skeletal and Extraskeletal Actions of Vitamin D: Current Evidence and Outstanding Questions, Endocrine Reviews, 40 (2019) 1109-1151.
- L.S. Bislev, L. Langagergaard Rødbro, T. Sikjær, L. Rejnmark, Effects of Elevated Parathyroid Hormone Levels on Muscle Health, Postural Stability and Quality of Life in Vitamin D-Insufficient Healthy Women: A Cross-Sectional Study, Calcified Tissue International, 105 (2019) 642-650.
- D. Moher, A. Liberati, J. Tetzlaff, D.G. Altman, The PRISMA Group Preferred Reporting Items for Systematic Reviews and Meta-Analyses: The PRISMA Statement, PLOS Medicine, 6 (2009) e1000097.
- H. Balshem, M. Helfand, H.J. Schünemann, A.D. Oxman, R. Kunz, J. Brozek, Vist GE, Falck-Ytter Y, Meerpohl J, Norris S, Guyatt GH, Grade guidelines: 3 ratng the quality of evidence. Journal of Clinical Epidemiology, Maryland Heights, 64(4) (2011) 401-406.
- J. Higgins, S. Green, (2011) Cochrane Handbook for Systematic Reviews of Interventions, Version 5.1.0, The Cochrane Collaboration.
- E.M. Lewiecki, Nonresponders to osteoporosis therapy, Journal of Clinical Densitometry, 6 (2003) 307-314.
- S. Adami, S. Giannini, G. Bianchi, L. Sinigaglia, O. Di Munno, C.E. Fiore, S. Minisola, M. Rossini, Vitamin D status and response to treatment in post-menopausal osteoporosis, Osteoporosis International, 20 (2009) 239-44.
- S Shab-Bidar, S.P. Bours, P.P. Geusens, R.Y. Van der Velde, M.J. Janssen, J.P. Van den Bergh, Suboptimal effect of different vitamin D3 supplementations and doses adapted to baseline serum25(OH)D on achieved 25(OH)D levels in patients with a recent fracture: a prospective observational study, journal of the European Society of Endocrinology, 169 (2013) 597-604.
- I.J. Zotarelli Filho, A.V.G. Ramirez, D. Ribas Filho, Major Meta-Analysis, Randomized Clinical Studies, and International Consensus on Serum Levels and Importance of Supplementing Vitamin D: State of the art. MedNEXT Journal of Medical and Health Sciences, 2 (2021) 54-66.
- A.C. Looker, Serum 25¬hydroxyvitamin D and risk of major osteoporotic fractures in older U.S. adults, Journal of Bone and Mineral Research, 28 (2013) 997-1006.
- H.A. Bischoff-Ferrari, B. Dawson-Hughes, H.B. Staehelin, J.E. Orav, A.E. Stuck, R. Theiler, J.B. Wong, A. Egli, D.P. Kiel, J. Henschkowski, Fall prevention with supplemental and active forms of vitamin D: a meta¬-analysis of randomised controlled trials, British medical journal, 339 (2009) 3692.
- Y. Noguchi, H. Kawate, M. Nomura, R. Takayanagi, Eldecalcitol for the treatment of osteoporosis, Clinical interventions in aging, 8 (2013) 1313-1321.
- H. Hagino, T. Takano, M. Fukunaga, M. Shiraki, T. Nakamura, T. Matsumoto, Eldecalcitol reduces the risk of severe vertebral fractures and improves the health¬related quality of life in patients with osteoporosis, Journal of bone and mineral metabolism, 31 (2013) 183-189.
- T. Nakamura, T. Takano, M. Fukunaga, M. Shiraki, T. Matsumoto, Eldecalcitol is more effective for the prevention of osteoporotic fractures than alfacalcidol, Journal of bone and mineral metabolism, 31 (2013) 417-422.
- H.A. Bischoff-Ferrari, Should vitamin D administration for fracture prevention be continued? A discussion of recent meta-analysis findings, Zeitschrift für Gerontologie und Geriatrie, 52 (2019) 428-432.
- A. Zittermann, S. Pilz, Vitamin D and Cardiovascular Disease: An Update, Anticancer Research, 39 (2019) 4627-4635.
- S. Thanapluetiwong, A. Chewcharat, K. Takkavatakarn, K. Praditpornsilpa, S. Eiam-Ong, P. Susantitaphong, Vitamin D supplement on prevention of fall and fracture: A Meta-analysis of Randomized Controlled Trials. Medicine (Baltimore), 99 (2020) e21506.
- Q. Wang, D. Yu, J. Wang, S. Lin, Association between vitamin D deficiency and fragility fractures in Chinese elderly patients: a cross-sectional study, Annals of Palliative Medicine, 9 (2020) 1660-1665.
- D.J. Llewellyn, I.A. Lang, K.M. Langa, G. Muniz-Terrera, C.L. Phillips, A. Cherubini, Vitamin D and risk of cognitive decline in elderly persons, Archives of Internal Medicine, 170 (2010) 1135-41.
- S. Nagpal, S. Na, R. Rathachalam, Non calcemic actions of vitamina D receptor ligands, Endocrine Reviews, 26 (2005) 662-687.
- R.K. Visweswaran, H. Lekha, Extraskeletal effects and manifestations of Vitamin D deficiency, Indian Journal of Endocrinology and Metabolism, 17 (2013) 602-610.
- C. Annweiler, M. Beaudenon, J. Gautier, R. Simon, V. Dubée, J. Gonsard, E. Parot-Schinkel, COvid-19 and high-dose VITamin D supplementation TRIAL in high-risk older patients (COVIT-TRIAL): study protocol for a randomized controlled trial, Trials, 21 (2020) 1031.
- F. Macaya, C.E. Paeres, A. Valls, A. Fernández-Ortiz, J.G.D. Castillo, F.J. Martín-Sánchez, I. Runkle, M.A.R. Herrera, Interaction between age and vitamin D deficiency in severe COVID-19 infection, Nutricion Hospitalaria, 37 (2020) 1039-1042.
- A.K.J. Mandal, V. Baktash, T. Hosack, C.G. Missouris, Vitamin D status and COVID-19 in older adults, Aging Clinical and Experimental Research, 32 (2020) 2425-2426.