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1.
Nutrients ; 15(3)2023 Jan 30.
Artículo en Inglés | MEDLINE | ID: mdl-36771403

RESUMEN

Introduction: All epidemiological studies suggest that vitamin D deficiency is prevalent among the Polish general population. Since vitamin D deficiency was shown to be among the risk factors for many diseases and for all-cause mortality, concern about this problem led us to update the previous Polish recommendations. Methods: After reviewing the epidemiological evidence, case-control studies and randomized control trials (RCTs), a Polish multidisciplinary group formulated questions on the recommendations for prophylaxis and treatment of vitamin D deficiency both for the general population and for the risk groups of patients. The scientific evidence of pleiotropic effects of vitamin D as well as the results of panelists' voting were reviewed and discussed. Thirty-four authors representing different areas of expertise prepared position statements. The consensus group, representing eight Polish/international medical societies and eight national specialist consultants, prepared the final Polish recommendations. Results: Based on networking discussions, the ranges of total serum 25-hydroxyvitamin D concentration indicating vitamin D deficiency [<20 ng/mL (<50 nmol/L)], suboptimal status [20-30 ng/mL (50-75 nmol/L)], and optimal concentration [30-50 ng/mL (75-125 nmol/L)] were confirmed. Practical guidelines for cholecalciferol (vitamin D3) as the first choice for prophylaxis and treatment of vitamin D deficiency were developed. Calcifediol dosing as the second choice for preventing and treating vitamin D deficiency was introduced. Conclusions: Improving the vitamin D status of the general population and treatment of risk groups of patients must be again announced as healthcare policy to reduce a risk of spectrum of diseases. This paper offers consensus statements on prophylaxis and treatment strategies for vitamin D deficiency in Poland.


Asunto(s)
Suplementos Dietéticos , Deficiencia de Vitamina D , Humanos , Polonia/epidemiología , Vitamina D , Deficiencia de Vitamina D/tratamiento farmacológico , Deficiencia de Vitamina D/epidemiología , Deficiencia de Vitamina D/prevención & control , Vitaminas , Colecalciferol , Calcifediol
2.
Nutrients ; 13(4)2021 Apr 10.
Artículo en Inglés | MEDLINE | ID: mdl-33920130

RESUMEN

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.


Asunto(s)
Suplementos Dietéticos , Osteoporosis/epidemiología , Sarcopenia/epidemiología , Deficiencia de Vitamina D/complicaciones , Vitamina D/análogos & derivados , Anciano , Anciano de 80 o más Años , Comorbilidad , Interacciones Farmacológicas , Anciano Frágil , Humanos , Osteoporosis/sangre , Osteoporosis/etiología , Osteoporosis/prevención & control , Polifarmacia , Calidad de Vida , Sarcopenia/sangre , Sarcopenia/etiología , Sarcopenia/prevención & control , Vitamina D/administración & dosificación , Vitamina D/sangre , Vitamina D/metabolismo , Deficiencia de Vitamina D/sangre , Deficiencia de Vitamina D/tratamiento farmacológico , Deficiencia de Vitamina D/epidemiología
3.
Pol Arch Intern Med ; 130(10): 853-859, 2020 10 29.
Artículo en Inglés | MEDLINE | ID: mdl-32579313

RESUMEN

INTRODUCTION: Vitamin D status is known to change with age. However, little is known about vitamin D status in centenarians. OBJECTIVES: The aim of the study was to assess vitamin D status and correlations among the levels of parathyroid hormone (PTH), 25­hydroxycholecalciferol (25[OH]D), 1,25-dihydroxycholecalciferol (1,25[OH]D), calcium, inorganic phosphorus, and alkaline phosphatase (ALP) activity in centenarians. PATIENTS AND METHODS: The study group included 97 participants: 81 women and 16 men (median [interquartile range [IQR]) age, 101.4 [100.5-102.16] years). Centenarians were visited at their homes where examinations were conducted and blood samples collected. The control group consisted of 57 elderly subjects: 35 women and 22 men (median [IQR] age, 65.9 [65.3-66.5] years). The concentrations of PTH, 25(OH)D, and 1,25(OH)D were measured in frozen plasma samples, and calcium, phosphorus, and ALP levels, in serum samples. RESULTS: The median calcium level was 8.88 mg/dl in centenarians versus 9.52 mg/dl in 65­year-old subjects (P <0.01); ALP, 223 IU versus 190 IU (P = 0.01); phosphorus, 3.01 mg/dl versus 3.23 mg/dl (P = 0.13); PTH, 45.59 pg/ml versus 29.27 pg/ml (P <0.01); 25(OH)D, 7.39 ng/ml versus 19.81 ng/ml (P <0.01); 1,25(OH)D, 57.5 pmol/l versus 78.6 pmol/l (P <0.01). Only centenarians demonstrated correlations among the measured laboratory parameters. CONCLUSIONS: Considering lower 25(OH)D, 1,25(OH)D, and calcium concentrations in the majority of centenarians, as well as the negative correlation between vitamin D active metabolites and PTH, vitamin D and calcium should be systematically supplemented in the oldest of the elderly.


Asunto(s)
Hormona Paratiroidea , Vitamina D , Anciano , Anciano de 80 o más Años , Calcio , Femenino , Humanos , Masculino , Polonia , Vitaminas
4.
Artículo en Inglés | MEDLINE | ID: mdl-29904370

RESUMEN

INTRODUCTION: Vitamin D deficiency is an important public health problem worldwide. Vitamin D deficiency confers a significant risk for both skeletal and non-skeletal disorders and a number of lifelong negative health outcomes. The objectives of this evidence-based guidelines document are to provide health care professionals in Poland, an updated recommendation for the prevention, diagnosis and treatment of vitamin D deficiency. METHODS: A systematic literature search examining the prevention and treatment strategies for vitamin D deficiency was conducted. Updated recommendations were developed using the Grading of Recommendations, Assessment, Development and Evaluation system describing the strength of the recommendation and the quality of supporting evidence. Twenty-seven contributors representing different areas of expertise and medical specialties, including pediatricians, geriatricians, endocrinologists, epidemiologists, nephrologists, gynecologists and obstetricians evaluated the available published evidence related to vitamin D, formulated the goals of this document and developed a common consolidated position. The consensus group, representing six national specialist consultants and eight Polish and international scientific organizations/societies, participated in the process of grading evidence and drawing up the general and specific recommendations. RESULTS: The updated recommendations define the diagnostic criteria for the evaluation of vitamin D status and describe the prevention and treatment strategies of vitamin D deficiency in the general population and in groups at increased risk of the deficiency. Age- and weight-specific recommendations for prevention, supplementation and treatment of vitamin D deficiency are presented, and detailed practice guidance is discussed regarding the management in primary and specialized health care. CONCLUSION: Vitamin D deficiency remains still highly prevalent in Poland, in all age groups. Currently, there is a great necessity to implement a regular supplementation with recommended doses and to develop an effective strategy to alleviate vitamin D deficiency in the population. These updated recommendations are addressed to health professionals and the authorities pursuing comprehensive health policies and should also be included in public health programs aimed at preventing a broad spectrum of chronic diseases.

5.
J Steroid Biochem Mol Biol ; 175: 125-135, 2018 01.
Artículo en Inglés | MEDLINE | ID: mdl-28216084

RESUMEN

Research carried out during the past two-decades extended the understanding of actions of vitamin D, from regulating calcium and phosphate absorption and bone metabolism to many pleiotropic actions in organs and tissues in the body. Most observational and ecological studies report association of higher serum 25-hydroxyvitamin D [25(OH)D] concentrations with improved outcomes for several chronic, communicable and non-communicable diseases. Consequently, numerous agencies and scientific organizations have developed recommendations for vitamin D supplementation and guidance on optimal serum 25(OH)D concentrations. The bone-centric guidelines recommend a target 25(OH)D concentration of 20ng/mL (50nmol/L), and age-dependent daily vitamin D doses of 400-800IU. The guidelines focused on pleiotropic effects of vitamin D recommend a target 25(OH)D concentration of 30ng/mL (75nmol/L), and age-, body weight-, disease-status, and ethnicity dependent vitamin D doses ranging between 400 and 2000IU/day. The wise and balanced choice of the recommendations to follow depends on one's individual health outcome concerns, age, body weight, latitude of residence, dietary and cultural habits, making the regional or nationwide guidelines more applicable in clinical practice. While natural sources of vitamin D can raise 25(OH)D concentrations, relative to dietary preferences and latitude of residence, in the context of general population, these sources are regarded ineffective to maintain the year-round 25(OH)D concentrations in the range of 30-50ng/mL (75-125nmol/L). Vitamin D self-administration related adverse effects, such as hypercalcemia and hypercalciuria are rare, and usually result from taking extremely high doses of vitamin D for a prolonged time.


Asunto(s)
Suplementos Dietéticos , Deficiencia de Vitamina D/dietoterapia , Vitamina D/análogos & derivados , Vitamina D/administración & dosificación , Adolescente , Adulto , Factores de Edad , Peso Corporal , Conducta Alimentaria , Femenino , Humanos , Hipercalcemia/sangre , Hipercalcemia/inducido químicamente , Hipercalcemia/patología , Hipercalciuria/sangre , Hipercalciuria/inducido químicamente , Hipercalciuria/patología , Lactante , Recién Nacido , Masculino , Persona de Mediana Edad , Vitamina D/efectos adversos , Vitamina D/sangre , Deficiencia de Vitamina D/sangre
6.
Endokrynol Pol ; 64(4): 319-27, 2013.
Artículo en Inglés | MEDLINE | ID: mdl-24002961

RESUMEN

INTRODUCTION: Adequate Vitamin D intake and its concentration in serum are important for bone health and calcium-phosphate metabolism as well as for optimal function of many organs and tissues. Documented trends in lifestyle, nutritional habits and physical activity appear to be associated with moderate or severe Vitamin D deficits resulting in health problems. Most epidemiological studies suggest that Vitamin D deficiency is prevalent among Central European populations. Concern about this problem led to the organising of a conference focused on overcoming Vitamin D deficiency. METHODS: After reviewing the epidemiological evidence and relevant literature, a Polish multidisciplinary group formulated theses on recommendations for Vitamin D screening and supplementation in the general population. These theses were subsequently sent to Scientific Committee members of the 'Vitamin D - minimum, maximum, optimum' conference for evaluation based on a ten-point scale.With 550 international attendees, the meeting 'Vitamin D - minimum, maximum, optimum' was held on October 19-20, 2012 in Warsaw(Poland). Most recent scientific evidence of both skeletal and non-skeletal effects of Vitamin D as well as the results of panellists' voting were reviewed and discussed during eight plenary sessions and two workshops. RESULTS: Based on many polemical discussions, including post-conference networking, the key opinion leaders established ranges of serum 25-hydroxyVitamin D concentration indicating Vitamin D deficiency [< 20 ng/mL (< 50 nmol/L)], suboptimal status [20-30 ng/mL(50-75 nmol/L)], and target concentration for optimal Vitamin D effects [30-50 ng/mL (75-125 nmol/L)]. General practical guidelines regarding supplementation and updated recommendations for prophylactic Vitamin D intakes in Central European neonates, infants, children and adolescents as well as in adults (including recommendations for pregnant and breastfeeding women and the elderly) were developed. CONCLUSIONS: Improving the Vitamin D status of children, adolescents, adults and the elderly must be included in the priorities of physicians,healthcare professionals and healthcare regulating bodies. The present paper offers elaborated consensus on supplementation guidance and population strategies for Vitamin D in Central Europe.


Asunto(s)
Suplementos Dietéticos , Promoción de la Salud/organización & administración , Deficiencia de Vitamina D/diagnóstico , Deficiencia de Vitamina D/prevención & control , Vitamina D/administración & dosificación , Adolescente , Adulto , Factores de Edad , Anciano , Niño , Preescolar , Europa (Continente) , Femenino , Humanos , Lactante , Recién Nacido , Tamizaje Masivo/métodos , Persona de Mediana Edad , Osteoporosis Posmenopáusica/prevención & control , Polonia , Guías de Práctica Clínica como Asunto , Embarazo , Complicaciones del Embarazo/prevención & control , Deficiencia de Vitamina D/epidemiología
7.
Endokrynol Pol ; 61(6): 723-9, 2010.
Artículo en Inglés | MEDLINE | ID: mdl-21104649

RESUMEN

Vitamin D is necessary in maintaining appropriate calcium and phosphate homeostasis in the body (classical function) and ensuring appropriate functioning of many tissues, organs and cells, unrelated to mineral economy (non-classical function). Vitamin D deficiency in adults may cause osteomalacia, increase fracture risk in osteoporosis, induce cardiovascular diseases, diabetes type 1 and 2, multiple sclerosis, Lesniowski-Crohn disease, and cancer, including colon, breast, and prostate cancer. Possible causes of vitamin D deficiency in a healthy population include decreased cutaneous synthesis and an inadequate intake of vitamin D, both in food and in supplements. Vitamin D deficiency level (25(OH) D. 〈 20 ng/mL), is fairly widespread, being found in a substantial percentage of healthy subjects around the world, regardless of race, gender and age. Daily vitamin D dose, as determined by the Food and Nutrition Board in 1997, is now rather insufficient, the biggest problem being associated with maximal vitamin D levels (50 µg/day) in actually available food supplements. Nowadays, it is recommended that adults need a minimum of 800-1,000 U/day when their exposure to the sun is inadequate (in Poland from October to April). This dosage should be provided to all subjects who avoid sunlight, as well as to those aged over 65 because of their slower skin synthesis of vitamin D and for its proven anti-fracture and anti-fall effects.


Asunto(s)
Deficiencia de Vitamina D/prevención & control , Vitamina D/administración & dosificación , Vitamina D/metabolismo , Adulto , Anciano , Calcio/metabolismo , Enfermedades Cardiovasculares/epidemiología , Causalidad , Comorbilidad , Diabetes Mellitus/epidemiología , Fracturas Óseas/prevención & control , Humanos , Persona de Mediana Edad , Esclerosis Múltiple/epidemiología , Neoplasias/epidemiología , Osteoporosis/epidemiología , Fosfatos/metabolismo , Polonia/epidemiología , Piel/metabolismo , Deficiencia de Vitamina D/epidemiología
8.
Med Wieku Rozwoj ; 14(2): 218-23, 2010.
Artículo en Polaco | MEDLINE | ID: mdl-20919473

RESUMEN

Adequate vitamin D intake and its status as well outdoor physical activity are important not only for normal bone development and Ca-P metabolism, but for optimal function of many organs and tissues throughout the body. Due to documented changes in dietary habits and physical activity level, both observed in growing children and adults, the prevalence of vitamin D insufficiency is continuously increasing. National Consultants and experts in this field established the Polish recommendations for prophylactic vitamin D supplementation in infants, toddlers, children and adolescents as well as in adults, including pregnant and lactating women based on current literature review. Taking into consideration pleyotropic vitamin D action and safety aspects serum 25-hydroxyvitamin D (25-OHD) level of 20-60 ng/ml (50-750 nmol/l) in children and 30-80 ng/ml (75-200 nmol/I) in adults is considered as optimal. Sunlight exposure inducing vitamin D production in the skin is main endogen source of vitamin D in the body but sunscreens may reduce skin synthesis by 90%. In Poland, skin synthesis is effective only from April to September so other sources of vitamin D such as diet and supplements play an important role. All newborns should be supplemented with 400 IU/d of vitamin D beginning from the first few days of life and continue during infancy. In formula fed infants vitamin D intake from the diet should be taken into account. In preterm infants higher total vitamin D intake (400-800 IU/day) is recommended till 40 weeks post conception. Total vitamin D intake in children and adolescents required from all sources (diet and/or supplements) should be 400 IU/d between October and March and throughout the whole year in case of inadequate vitamin D skin synthesis during the summer months. In overweight/obese children supplementation with higher dosage of vitamin D up to 800-1000 IU/d should be considered. Adults require 800-1000 IU/d of vitamin D. In pregnant and lactating women such supplementation is recommended in case of inadequate intake from diet and/or skin synthesis supplementation. Monitoring of serum 25-OHD level to define optimal dosage should be considered.


Asunto(s)
Guías de Práctica Clínica como Asunto , Deficiencia de Vitamina D/prevención & control , Vitamina D/administración & dosificación , Adolescente , Adulto , Niño , Preescolar , Suplementos Dietéticos , Femenino , Humanos , Lactante , Alimentos Infantiles , Recién Nacido , Lactancia/fisiología , Masculino , Persona de Mediana Edad , Polonia/epidemiología , Embarazo , Complicaciones del Embarazo/epidemiología , Complicaciones del Embarazo/prevención & control , Prevalencia , Piel/metabolismo , Luz Solar , Vitamina D/biosíntesis , Deficiencia de Vitamina D/epidemiología , Adulto Joven
9.
Pol Merkur Lekarski ; 28(164): 130-3, 2010 Feb.
Artículo en Polaco | MEDLINE | ID: mdl-20369742

RESUMEN

Appropriate state procurement system for vitamin D is important not only for the proper functioning of the skeletal, maintaining calcium and phosphorus homeostasis, but also for a number of other organs and tissues in our body. In connection with the change in lifestyle including dietary habits change, the widespread use of UV filters and less outdoor activity, observed an increase in the percentage of vitamin D deficiency, both in population and developmental age and adults. Based on the results of recent scientific research team of experts provides recommendations for preventive Polish supply of vitamin D in infants, children, adolescents and adults, including pregnant women and nursing mothers.


Asunto(s)
Deficiencia de Vitamina D/prevención & control , Vitamina D/administración & dosificación , Adolescente , Adulto , Lactancia Materna , Niño , Suplementos Dietéticos , Conducta Alimentaria , Femenino , Alimentos Fortificados , Humanos , Lactante , Recién Nacido , Masculino , Polonia , Embarazo , Adulto Joven
10.
Ginekol Pol ; 81(2): 149-53, 2010 Feb.
Artículo en Polaco | MEDLINE | ID: mdl-20232716

RESUMEN

Adequate vitamin D intake and its status are important not only for bone health and Ca-P metabolism, but for optimal function of many organs and tissues throughout the body. Due to documented changes in dietary habits and physical activity level, both observed in growing children and adults, the prevalence of vitamin D insufficiency is continuously increasing. Basing on current literature review and opinions of National Consultants and experts in the field, polish recommendations for prophylactic vitamin D supplementation in infants, toddlers, children and adolescents as well as in adults, including pregnant and lactating women have been established.


Asunto(s)
Conservadores de la Densidad Ósea/uso terapéutico , Conocimientos, Actitudes y Práctica en Salud , Prevención Primaria/organización & administración , Luz Solar , Deficiencia de Vitamina D/prevención & control , Vitamina D/uso terapéutico , Adolescente , Adulto , Niño , Protección a la Infancia/estadística & datos numéricos , Femenino , Humanos , Bienestar del Lactante/prevención & control , Recién Nacido , Masculino , Programas Nacionales de Salud/normas , Fenómenos Fisiológicos de la Nutrición , Estado Nutricional , Polonia/epidemiología , Embarazo , Complicaciones del Embarazo/prevención & control , Garantía de la Calidad de Atención de Salud/normas , Sociedades Médicas/normas , Adulto Joven
11.
Endokrynol Pol ; 61 Suppl 1: 39-45, 2010.
Artículo en Polaco | MEDLINE | ID: mdl-22127635

RESUMEN

Vitamin D is necessary in maintaining appropriate calcium and phosphate homeostasis in the body (classical function) and ensuring appropriate functioning of many tissues, organs and cells, unrelated to mineral economy (non-classical function). Vitamin D deficiency in adults may cause osteomalacia, increase fracture risk in osteoporosis, induce cardiovascular diseases, diabetes type 1 and 2, multiple sclerosis, Lesniowski-Crohn disease, and cancer, including colon, breast, and prostate cancer. Possible causes of vitamin D deficiency in a healthy population include decreased cutaneous synthesis and an inadequate intake of vitamin D, both in food and in supplements. Vitamin D deficiency level (25(OH) D. <20 ng/mL), is fairly widespread, being found in a substantial percentage of healthy subjects around the world, regardless of race, gender and age. Daily vitamin D dose, as determined by the Food and Nutrition Board in 1997, is now rather insufficient, the biggest problem being associated with maximal vitamin D levels (50 µg/day) in actually available food supplements. Nowadays, it is recommended that adults need a minimum of 800-1,000 U/day when their exposure to the sun is inadequate (in Poland from October to April). This dosage should be provided to all subjects who avoid sunlight, as well as to those aged over 65 because of their slower skin synthesis of vitamin D and for its proven anti-fracture and anti-fall effects.


Asunto(s)
Conservadores de la Densidad Ósea/administración & dosificación , Suplementos Dietéticos , Alimentos Fortificados , Deficiencia de Vitamina D/prevención & control , Vitamina D/administración & dosificación , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Calcio/metabolismo , Calcio/uso terapéutico , Niño , Preescolar , Femenino , Fracturas Óseas/prevención & control , Humanos , Lactante , Recién Nacido , Masculino , Persona de Mediana Edad , Osteoporosis/prevención & control , Fósforo , Polonia , Raquitismo/prevención & control , Piel/metabolismo , Luz Solar , Deficiencia de Vitamina D/complicaciones , Adulto Joven
12.
Ginekol Pol ; 79(11): 780-4, 2008 Nov.
Artículo en Polaco | MEDLINE | ID: mdl-19140502

RESUMEN

Vitamin D deficiency is a common occurrence and concerns people all around the world, not withstanding pregnant women. Vitamin D is essential for normal mineralization of the fetal skeleton. Latest reports have confirmed that an optimal vitamin D supply is of great importance for health course of pregnancy and it influences the general state of the child's health after birth, as well as their whole life. It seems that the Recommended Dietary Allowance (the RDA) of vitamin D in pregnancy and lactation of 200-400 IU/d is too small and it needs to be changed. In this article we present: a new definition of vitamin D deficiency; its epidemiology and changes of calcium homeostasis during pregnancy and lactation; a review of literature related to the influence of vitamin D deficiency on the health of the mother and child, as well as controversies related to supplementary doses of vitamin D.


Asunto(s)
Fenómenos Fisiológicos Nutricionales del Lactante , Lactancia/metabolismo , Complicaciones del Embarazo/prevención & control , Embarazo/metabolismo , Deficiencia de Vitamina D/prevención & control , Vitamina D/administración & dosificación , Medicina Basada en la Evidencia , Femenino , Conocimientos, Actitudes y Práctica en Salud , Humanos , Recién Nacido , Fenómenos Fisiologicos Nutricionales Maternos , Intercambio Materno-Fetal , Política Nutricional
13.
Endokrynol Pol ; 58(2): 130-8, 2007.
Artículo en Polaco | MEDLINE | ID: mdl-17578829

RESUMEN

INTRODUCTION: Obese patients may have abnormal calcium homeostasis because of unbalanced diet and decreased sun exposure. Bariatric surgery itself may lead to disturbances in calcium homeostasis (and in consequence changes in bone mass) or increase preexisting metabolic derangements. The aim of the study was: 1. To assess calcium homeostasis and biochemical markers of bone turnover in patients with morbid obesity. 2. To determine the impact of bariatric surgery on parameters mentioned above. 3. To establish recommendations for supplementation with calcium and vitamin D in morbidly obese patients after bariatric surgery. MATERIAL AND METHODS: Serum calcium, parathormone (PTH), vitamin D (25(OH)D), biochemical markers of bone turnover (beta-CrossLaps as a marker of bone resorption and osteocalcin as a marker of bone formation) and urine calcium as well as fat mass, lean mass and bone mineral content (by DXA) were measured before bariatric surgery of the stomach (VBG or GBP) in 57 morbidly obese patients (48 women, 9 men; mean age 35.9 y). The same procedures were repeated six months after operation in 28 of them (24 women, 4 men). Daily calcium intake was also determined based on food questionnaire. RESULTS: Biochemical findings in the group of patients before bariatric surgery were as follows: serum calcium, beta-CrossLaps and urine calcium were within normal range, PTH concentration was increased to 81.0 pg/ml and 25(OH)D as well as osteocalcin concentration decreased (4.9 ng/ml and 13.6 ng/ml, respectively). Six months after bariatric surgery there was no change in serum and urine calcium, PTH concentration decreased to normal level (46.8 pg/ml), 25(OH)D concentration increased to 6.5 ng/ml (not significant) and still remained below normal range. Markers of bone turnover--both resorption and formation--increased (beta-CrossLaps over normal range to 0.594 ng/ml, osteocalcin to normal range 26.8 ng/ml). Daily calcium intake was below RDA before and after bariatric procedure. CONCLUSIONS: 1. Patients with morbid obesity have secondary hyperparathyroidism and deficiency of vitamin D. 2. Abrupt weight loss after bariatric surgery is accompanied by the regression of secondary hyperparathyroidism, decrease of the deficiency of vitamin D and increase in bone turnover. 3. Supplementation with vitamin D and calcium is recommended for patients with morbid obesity after bariatric surgery.


Asunto(s)
Remodelación Ósea , Huesos/metabolismo , Calcio/metabolismo , Obesidad Mórbida/metabolismo , Obesidad Mórbida/cirugía , Adulto , Cirugía Bariátrica , Biomarcadores/sangre , Índice de Masa Corporal , Calcio de la Dieta , Femenino , Derivación Gástrica , Humanos , Masculino , Osteocalcina/sangre , Hormona Paratiroidea/sangre , Vitamina D/sangre , Pérdida de Peso
14.
Endokrynol Pol ; 56(3): 225-32, 2005.
Artículo en Polaco | MEDLINE | ID: mdl-16350714

RESUMEN

UNLABELLED: Complete androgenic blockade used in the treatment of advanced prostatic carcinoma can be attained by administration of antiandrogens in orchidectomized patients or by combined therapy with LH-RH analogs and antiandrogens. The treatment, however, decreases the influence of both androgens end estrogens on bone tissue and may result in bone mass loss and increased propensity to fractures. The purpose of the study was to determine the influence of complete androgenic blockade on bone mass and skeletal metabolism in men with advanced prostatic carcinoma and to assess whether 1alpha-OH vitamin D3 (1alpha-OHD3) together with calcium supplementation is able to prevent bone mass loss in men treated with complete androgenic blockade. 51 patients with advanced prostatic carcinoma, with skeletal metastases, aged 44 - 86, mean 68 ys were included into a 12-month prospective study. All patients were treated with orchidectomy followed by therapy with flutamide in a dose of 750 mg daily. 26 patients were additionally given 1alpha-OHD3 in a dose of 0.5 microg/d and calcium carbonate in an initial dose of 1 g daily. It was found that the 12-month treatment with complete androgenic blockade resulted in a decrease in bone mineral density (BMD) by 8.1% in the lumbar spine, by 6.3% in the femoral neck and by 3.5% in the total skeleton. Therapy with 1alpha-OHD3 and CaCO3 caused complete inhibition of bone tissue loss in the lumbar spine and resulted in an increase in BMD by 2.2% in femoral neck and by 1.9% in the total skeleton. None of the examined patients experienced any skeletal fractures. In both groups of patients a prompt decrease in serum alkaline phosphatase activity - a marker of osteoblast activity and an increase in fasting urine calcium creatinine ratio indicating acceleration of bone resorption were found. CONCLUSIONS: in patients with advanced prostatic carcinoma treated with complete androgenic blockade acceleration of bone mass loss is observed; treatment with 1alpha-OHD3 and CaCO3 is able to prevent both trabecular and compact bone loss.


Asunto(s)
Antineoplásicos Hormonales/efectos adversos , Conservadores de la Densidad Ósea/administración & dosificación , Calcio de la Dieta/administración & dosificación , Hidroxicolecalciferoles/administración & dosificación , Orquiectomía/efectos adversos , Osteomalacia/prevención & control , Neoplasias de la Próstata/terapia , Anciano , Anciano de 80 o más Años , Antagonistas de Andrógenos/administración & dosificación , Antagonistas de Andrógenos/efectos adversos , Antineoplásicos Hormonales/administración & dosificación , Densidad Ósea/efectos de los fármacos , Regeneración Ósea/efectos de los fármacos , Calcio/sangre , Quimioterapia Combinada , Flutamida/administración & dosificación , Flutamida/efectos adversos , Humanos , Masculino , Persona de Mediana Edad , Osteomalacia/etiología , Estudios Prospectivos
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