Home | About us | Editorial board | Search | Ahead of print | Current issue | Archives | Submit article | Instructions | Subscribe | Advertise | Contacts | Login 
  Users Online: 102 Home Print this page Email this page Small font sizeDefault font sizeIncrease font size  

 Table of Contents  
Year : 2018  |  Volume : 8  |  Issue : 4  |  Page : 139-146

Vitamin D deficiency in elderly: Risk factors and drugs impact on vitamin D status

1 Department of Geriatric Medicine, Hospital of Pierre Oudot, Bourgoin-Jallieu City, Isère Department, Region of Auvergne-Rhône-Alpes, France
2 Department of Ophthalmology and Visual Sciences, University of British Columbia, Vancouver, British Columbia, Canada

Date of Web Publication4-Oct-2018

Correspondence Address:
Dr. Hasan Kweder
Hospital of Pierre Oudot, Bourgoin-Jallieu
Login to access the Email id

Source of Support: None, Conflict of Interest: None

DOI: 10.4103/ajm.AJM_20_18

Rights and Permissions

Introduction: Vitamin D (VD) deficiency is a major public health problem worldwide. In spite of its high prevalence, particularly among elderly people, VD deficiency is still underestimated by many physicians. Increasingly, VD deficiency is associated with several known geriatric syndromes. Methods: The study sample consisted of 125 patients, aged 75 years and older, admitted to the acute geriatric unit. The plausible association between the serum 25-hydroxyvitamin D [25(OH)D] level and patient age, sex, body mass index, renal function, cholecystectomy history, and the prescribed drugs had been investigated. The Fisher's exact test was used to conduct the statistical analysis of data. Results: Surprisingly, furosemide treatment was correlated with normal 25(OH)D levels and an increased incidence of secondary hyperparathyroidism. Unlike the other four parameters mentioned above, our data showed that only the patient sex exhibited a significant association with 25(OH)D level as elderly males suffered from a serious VD deficiency as compared to elderly females. Conclusion: Old age is an independent risk factor for VD deficiency. The supplementary dose of VD should be precisely defined to achieve the optimal serum 25(OH)D level in elderly people. The definition of the normal serum 25(OH)D threshold in elderly furosemide-treated patients is worth of further studies.

Keywords: Furosemide, geriatrics, Vitamin D deficiency

How to cite this article:
Kweder H, Eidi H. Vitamin D deficiency in elderly: Risk factors and drugs impact on vitamin D status. Avicenna J Med 2018;8:139-46

How to cite this URL:
Kweder H, Eidi H. Vitamin D deficiency in elderly: Risk factors and drugs impact on vitamin D status. Avicenna J Med [serial online] 2018 [cited 2020 Nov 26];8:139-46. Available from: https://www.avicennajmed.com/text.asp?2018/8/4/139/242766

   Introduction Top

Vitamin D (VD) or calciferol, a fat-soluble vitamin,[1] is chemically classified as a steroid.[2] There are two main sources of VD: the dietary and the endogenous synthesis. Vitamin D2 (ergocalciferol) is obtained from plants. While a small quantity of Vitamin D3 (cholecalciferol) is provided by animal-derived food, the main natural VD source is skin synthesis during sunlight exposure (exposure to ultraviolet B).[3],[4],[5] Regardless of its source, VD is hydroxylated in the liver to 25-hydroxyvitamin D [25(OH)D]. 25(OH)D is then converted in the kidneys to its active form, namely 1,25-dihydroxyvitamin D [1,25(OH)2D]. Serum 25(OH)D level is often seen as a reflection of the total VD status.[6]

VD plays a crucial role in blood calcium and phosphate homeostasis supporting the body's metabolic functions, neuromuscular transmission, and bone mineralization.[7] Furthermore, VD supplementation accelerates fracture-healing rates and decreases the risk of bone fracture.[8] In regard to the elderly, a direct association between low 25(OH)D levels and frailty syndrome has recently been reported.[9]

It is worth mentioning, here, that VD also has noncalcemic and nonskeletal effects. Several studies have reported an inverse association between VD levels and the risk of oral, gastrointestinal, urinary, ocular, and respiratory infections. In addition, VD is widely known for its potent immunomodulatory role since a strong relationship between VD deficiency and the prevalence of autoimmune disorders was observed.[10] Other experimental and clinical studies have underscored the association between VD status and some neurological functions in human and animal models. Indeed, it has been reported that obese rats treated with VD supplementation showed a reduced inflammatory biomarkers in the hippocampus.[11] Moreover, VD supplementation has also shown a significant improvement in the cognitive performance in elderly patients with senile dementia.[12] VD deficiency affects the endocrinal function as it leads to increasing insulin resistance and an alteration in pancreatic β-cell function.[13] Furthermore, VD supplementation decreases the fasting blood glucose in type 2 diabetic patients.[14] Several clinical and epidemiological studies have highlighted the association between VD deficiency and various cardiovascular disorders, such as coronary artery disease, high blood pressure, congestive heart failure, peripheral arterial occlusive disease, stroke, and subarachnoid hemorrhage.[15],[16],[17],[18],[19],[20],[21],[22] Furthermore, many studies underscored the association between the low serum VD levels and many other diseases such as diabetic retinopathy, migraine, bladder carcinoma, and colorectal cancer.[23],[24],[25],[26]

Although these documented associations between VD deficiency and prevalence of many disorders prevalence have been noted, the available studies conducted on the VD supplementation therapeutic effects have resulted in paradoxical data raising the need for further preclinical, epidemiological, and clinical studies to puzzle out the complex therapeutic benefits of VD.[10]

VD deficiency is a pandemic nutritional problem throughout the world.[27],[28],[29],[30],[31] Interestingly, VD deficiency has been reported even in some equatorial countries, where people can get adequate sun exposure.[32],[33],[34] It has been reported that more than one-third of human adults have low 25(OH)D levels.[35] In addition, VD deficiency is often severe and significantly more seen in elderly people.[36]

The present study aims to evaluate the potential relationship between VD deficiency and six given risk factors: age, sex, body mass index (BMI), renal function, history of cholecystectomy, and the most frequent drugs taken by the elderly.

   Methods Top

Study design

Data of all patients admitted to the acute geriatric unit between November 2015 and April 2016 were analyzed. There were 125 patients, 52 men and 73 women. Patients were divided into two subgroups according to their age: old-old (≥75–84 years) and oldest-old patients (>84 years) [Figure 1].[37] These patients were interviewed and asked about their current intake of VD supplements as well as any previous prescription of VD taken during the preceding 3 years. Since VD supplementation could affect the serum 25(OH)D level for 3 years,[38] an inability to obtain a detailed medication history for the preceding 3 years was the sole exclusion criteria.
Figure 1: Age and sex distribution of the study sample of elderly patients. Patients were divided into two subgroups based on their age: old-old and oldest-old

Click here to view

We studied the association between serum 25(OH)D level and six parameters: age, sex, BMI, renal function, cholecystectomy history, and the influence of the prescribed drugs, such as furosemide, hydrochlorothiazide, fluindione, Coumadin, aspirin, clopidogrel, nebivolol, bisoprolol, irbesartan, amlodipine, atorvastatin, oxazepam, lorazepam, zopiclone, zolpidem, esomeprazole, tramadol, and modopar. To obtain the most accurate results possible, we excluded patients having VD supplementation when we studied the association between 25(OH)D status and these parameters.

Laboratory assessments

On the same day, serum concentrations of calcium, albumin, intact parathyroid hormone (PTH), creatinine, and 25(OH)D were measured.

25(OH)D levels were categorized as follows: (1) very severe VD deficiency: <12.5 nmol/L; (2) severe VD deficiency: 12.5–24 nmol/L; (3) moderate VD deficiency: 25–49 nmol/L; (4) minor VD deficiency: 50–74 nmol/L; and (5) normal VD level: 75–175 nmol/L.[39],[40],[41]

Glomerular filtration rate (GFR) was estimated by the CKD-EPI (Chronic Kidney Disease – Epidemiology Collaboration) equation in ml/min/1.73m2. GFR levels were classified as the following: (1) normal GFR: ≥90; (2) slightly decreased GFR: 60–89; (3) chronic renal failure (CRF) at stage 3A: GFR between 45 and 59; (4) CRF at stage 3B: GFR between 30 and 44; (5) CRF at stage 4: GFR between 15 and 29; and (6) CRF stage 5: GFR <15 ml/min/1.73 m2.[42],[43]

The BMI was calculated as weight/height2 in kg/m2. Patient nutrition status was classified as follows: (1) very severe malnutrition: BMI <18; (2) malnutrition: BMI between 18 and 20.99; (3) normal body weight: BMI between 21 and 24.99; (4) preobesity: BMI between 25 and 29.99; (5) class I obesity: BMI between 30 and 34.99; (6) class II obesity: BMI between 35 and 39.99; and (7) class III obesity: BMI ≥40.[44],[45]

Statistical analysis

Data were analyzed using the Fisher's exact test. P < 0.05 was considered statistically significant.

   Results Top

A high frequency of Vitamin D deficiency in the elderly

Most patients had 25(OH)D levels that were less than those currently recommended for optimal health. Furthermore, very severe and severe forms accounted for up to 43% [Figure 2].
Figure 2: Vitamin D status in the study patient sample. More than a quarter of the patients were classified as “very sever Vitamin D deficiency” group. The Vitamin D recommended level was found only in 15% of the patients. No toxic levels were detected

Click here to view

Few elderly people receive Vitamin D supplementation

Our data showed that no VD supplement treatment was given to more than 75% of patients during the preceding 3 years [Figure 3]a. Patients' age and gender had no association with this gap of VD prescription [Figure 3]b.
Figure 3: The rate of Vitamin D prescription. (a) The large majority of patients did not receive any Vitamin D supplementary treatment. (b) Vitamin D prescription in the different patient's subgroups

Click here to view

Elderly men are more likely to suffer from very severe Vitamin D deficiency

Our data analysis showed that the prevalence of very severe VD deficiency in elderly men and elderly women was 44% and 26%, respectively. This difference was statistically significant [Figure 4].
Figure 4: The sex effect on Vitamin D deficiency in elderly people. Elderly men are more affected by Vitamin D deficiency than women (P Fisher = 0.041: men vs. women in the “very severe Vitamin D deficiency” group)

Click here to view

There is no relationship between Vitamin D deficiency and age among the elderly

Our results showed that no significant difference in serum 25(OH)D level was observed between “old-old” and “oldest-old” subgroups [Figure 5], indicating that the age cannot be considered as a risk factor of VD deficiency in elderly people.
Figure 5: The age effect on Vitamin D deficiency in elderly people. No significant effect of patient age was observed on their Vitamin D status (P Fisher ≥0.3)

Click here to view

Vitamin D deficiency affects elderly people with normal renal function

GFR was evaluated in patients with very severe VD deficiency. We found that those patients had normal or mildly impaired renal function [Figure 6], indicating that elderly people can suffer from VD deficiency regardless of renal function status.
Figure 6: Renal function status in elderly people with very severe Vitamin D deficiency. 24% of patients had very severe Vitamin D deficiency despite of normal renal function

Click here to view

Obesity in elderly people does not worsen Vitamin D deficiency

Our data showed that no relationship was observed between the calculated BMI and the serum 25(OH)D level [Figure 7]. P Fisher < 0.05 was 0.256 for the comparison between obese patients and those with a normal BMI.
Figure 7: The effect of body mass index in elderly people on their Vitamin D deficiency. No significant difference in Vitamin D status was found (P Fisher ≥0.1)

Click here to view

Cholecystectomy has no effect on 25-hydroxyvitamin D level in the elderly

Our findings showed that cholecystectomy does not affect the VD deficiency prevalence in the elderly [Figure 8]. P Fisher = 0.38 for the comparison between patient with VD deficiency and those with normal 25(OH)D status. P Fisher = 0.43 for the comparison between patient with very severe VD deficiency and those with normal 25(OH)D status.
Figure 8: The association between Vitamin D status in elderly people and cholecystectomy history. Cholecystectomy has no significant effect on Vitamin D deficiency

Click here to view

Furosemide increases serum 25-hydroxyvitamin D levels

Furosemide is a loop diuretic commonly used in elderly patients (38% of our patients). Our data analysis showed that the furosemide therapy was significantly associated with normal serum 25(OH)D levels [Figure 9]. P Fisher = 0.037 for the comparison between patients with VD deficiency and those with normal 25(OH)D status. P Fisher = 0.024 for the comparison between patients with very severe VD deficiency and those with normal 25(OH)D status.
Figure 9: Furosemide treatment affects the Vitamin D status in elderly patients. Normal serum Vitamin D levels are more likely associated with the furosemide administration

Click here to view

Furosemide increases the risk of secondary hyperparathyroidism

Our results showed that furosemide administration was associated with a greater chance of developing secondary hyperparathyroidism (sHPT). This association was statistically significant (P Fisher = 0.0084) [Figure 10].
Figure 10: The relationship between furosemide treatment and parathyroid hormone status. A significant association between the increased level of parathyroid hormone and the furosemide treatment was observed (P Fisher = 0.0084)

Click here to view

   Discussion Top

The prevalence of VD deficiency is still notably elevated. In the current study, only 15% of elderly people showed normal serum 25(OH)D level. Recent studies from France have also shown a small percentage of elderly people with normal VD status (6%–7.5%).[46],[47]

A large-scale study has investigated the VD deficiency prevalence in adults aged 18–74 years in France.[39] This study demonstrated that very severe, severe, and moderate VD deficiencies were reported in 0%, 4.4%, and 36.7% of individuals, respectively. Furthermore, more than 50% of individuals had a serum 25(OH)D level >50 nmol/L. Nevertheless, the prevalence in the present study was 27%, 16%, 27%, and 30% for very severe, severe, moderate VD deficiency, and for those with serum 25(OH)D levels >50 nmol/L, respectively.

These outcomes demonstrate that VD deficiency is a public health problem, predominately in the elderly. Lack of physical activities and sun exposure are most likely the key reasons behind this relevant VD deficiency in elderly people.[48] In addition, VD synthesis in the skin is reported to be widely diminished in the elderly.[49]

An adequate VD and calcium intake should be achieved at any age, especially in childhood and in the elderly.[50] Our data analysis showed that 78% of elderly people had not received any VD supplementation during the last 3 years. Furthermore, 90% of elderly patients are not taking any current VD supplements. A daily VD intake of 400 IU is recommended in France for individuals aged 65 years and over.[51] However, many recent studies have recommended a daily dietary intake of VD ranging from 800 to 1000 IU.[52],[53],[54] Unfortunately, these recommendations are poorly followed in clinical practice, even in high-risk individuals for VD deficiency.[55] The daily average of VD intake in the elderly ranges from 100 to 200 IU in the developed countries, such as the UK, Ireland, Denmark, the Netherlands, France, Germany, Hong Kong, Japan, and Canada.[36]

Our results showed that the very severe VD deficiency is seen more frequently in elderly men. This result seems to be inconsistent with the findings of some previous studies.[56],[57],[58],[59],[60] These studies have reported that the low 25(OH)D levels in the elderly were seen more commonly in women compared to men.

As recently reported by Cheng et al.,[57] our data demonstrated that although VD deficiency is common in elderly people,[61],[62] the difference between old-old and oldest-old individuals is insignificant. Thus, all old people could be at a high risk of VD deficiency and they should receive VD supplement treatment regardless of their ages.

In the present study, no association between obesity and VD deficiency in the elderly was observed. This result seems to be consistent with a recent study from France.[60] While Araghi et al.[63] concluded that obesity in the elderly was associated with an increase in VD deficiency prevalence, Cheng et al.[57] demonstrated that this relationship with obesity was seen only in elderly women.

The surgical history of cholecystectomy is frequently seen in elderly people. In the present study, 20% of the patients had undergone cholecystectomy. Given that bile salts are required for an efficient lipid and fat-soluble molecule absorption such as VD, cholecystectomy affects VD absorption.[64],[65] To the best our knowledge, to date, no data are available in the literature on the effect of cholecystectomy on 25(OH)D level in the elderly. Our analysis result did not show any association between cholecystectomy and 25(OH)D status. This outcome could be due to the recovery of postcholecystectomy syndrome within several weeks.[66]

Renal function alterations are associated with an increasing VD deficiency rate.[67] Indeed, it is due to the decreased renal 1-α-hydroxylase activity in addition to diminished hepatic 25-hydroxylase function related to uremia.[43],[68],[69] Our study showed that elderly people can suffer from very severe VD deficiency, even with normal renal function status.

PTH plays a key role in calcium metabolism in the body as it stimulates bone reabsorption, increases serum calcium and phosphorus levels, and promotes synthesis of 1,25(OH)2D.[70] The main regulator for PTH secretion is the calcium-sensitive receptor (CaSR).[71] Activation of CaSR by calcium inhibits rapidly PTH synthesis. In addition, the parathyroid glands express high levels of VD receptors, which, when activated by binding to 1,25(OH)2D, decreases PTH synthesis. In contrast, VD deficiency stimulates PTH synthesis.[72] Furosemide is a loop diuretic that enhances urinary calcium excretion.[73] Our study showed that furosemide treatment is associated with an increased prevalence rate of sHPT in the elderly. This effect is already observed in furosemide-treated patients in the general population.[74],[75],[76],[77] Hyperparathyroidism is associated with progressive vascular calcification and increases cardiovascular morbidity and mortality.[78],[79],[80]

sHPT is one of the methods used to determine the reference range for serum 25(OH)D concentration. Using this method, the lowest normal limit of serum 25(OH)D concentration is found to be 75 nmol/L.[81] Surprisingly, we demonstrated in the present study that furosemide administration is associated with normal serum 25(OH)D levels. Thus, the current normal threshold of serum 25(OH)D concentration for furosemide-treated patients must be reconsidered.

Some pharmacological therapies for systolic heart failure are associated with reduced morbidity and mortality, such as beta-blockers, angiotensin-converting enzyme inhibitors, angiotensin receptor blockers, and aldosterone antagonists.[82] However, many recent studies highlighted the high mortality rates associated with furosemide use.[83],[84],[85] It may be worthwhile, in the future studies, to investigate the plausible association between the furosemide-induced sHPT and the increased mortality. Therefore, our findings suggest that the increase of the minimal normal VD levels in serum up to an adequate proportional value associated with normal PTH concentration may lead to reduce the furosemide-related mortality.

   Conclusion Top

VD has all the characters of a hormone.[86] In the clinical practice, hypothyroidism, adrenal insufficiency, or other endocrine disorders get the full attention of physicians with good established treatment protocols; VD deficiency should be fully treated; and such a high rate of VD deficiency should not be accepted.

Like many other studies conducted in Europe, the present work showed that in such a rich region of the world, VD deficiency issues in the elderly cannot be adequately resolved by a simple change in food habits or even by food enrichment. Thus, pharmacological supplementation seems to be essential to prevent VD deficiency.

Our study indicates, for the first time, the great importance in determining the normal 25(OH)D threshold for furosemide-treated individuals.

Financial support and sponsorship


Conflicts of interest

There are no conflicts of interest.

   References Top

Albahrani AA, Greaves RF. Fat-soluble vitamins: Clinical indications and current challenges for chromatographic measurement. Clin Biochem Rev 2016;37:27-47.  Back to cited text no. 1
Harrison HE. Parathyroid hormone and Vitamin D. Yale J Biol Med 1966;38:393-409.  Back to cited text no. 2
Avioli LV. Editorial: Vitamin D, the kidney and calcium homeostasis. Kidney Int 1972;2:241-6.  Back to cited text no. 3
Shah D, Gupta P. Vitamin D deficiency: Is the pandemic for real? Indian J Community Med 2015;40:215-7.  Back to cited text no. 4
[PUBMED]  [Full text]  
Rosen CJ. Clinical practice. Vitamin D insufficiency. N Engl J Med 2011;364:248-54.  Back to cited text no. 5
Holick MF. Vitamin D status: Measurement, interpretation, and clinical application. Ann Epidemiol 2009;19:73-8.  Back to cited text no. 6
Molina P, Carrero JJ, Bover J, Chauveau P, Mazzaferro S, Torres PU, et al. Vitamin D, a modulator of musculoskeletal health in chronic kidney disease. J Cachexia Sarcopenia Muscle 2017;8:686-701.  Back to cited text no. 7
Clutton J, Perera A. Vitamin D insufficiency and deficiency in patients with fractures of the fifth metatarsal. Foot (Edinb) 2016;27:50-2.  Back to cited text no. 8
Gutiérrez-Robledo LM, Ávila-Funes JA, Amieva H, Meillon C, Acosta JL, Navarrete-Reyes AP, et al. Association of low serum 25-hydroxyvitamin D levels with the frailty syndrome in Mexican community-dwelling elderly. Aging Male 2016;19:58-63.  Back to cited text no. 9
Prietl B, Treiber G, Pieber TR, Amrein K. Vitamin D and immune function. Nutrients 2013;5:2502-21.  Back to cited text no. 10
Hajiluian G, Abbasalizad Farhangi M, Nameni G, Shahabi P, Megari-Abbasi M. Oxidative stress-induced cognitive impairment in obesity can be reversed by Vitamin D administration in rats. Nutr Neurosci 2017;2017:1-9.  Back to cited text no. 11
Gangwar AK, Rawat A, Tiwari S, Tiwari SC, Narayan J, Tiwari S, et al. Role of Vitamin-D in the prevention and treatment of Alzheimer's disease. Indian J Physiol Pharmacol 2015;59:94-9.  Back to cited text no. 12
Park S, Kim DS, Kang S. Vitamin D deficiency impairs glucose-stimulated insulin secretion and increases insulin resistance by reducing PPAR-γ expression in nonobese type 2 diabetic rats. J Nutr Biochem 2016;27:257-65.  Back to cited text no. 13
Calvo-Romero JM, Ramiro-Lozano JM. Metabolic effects of supplementation with Vitamin D in type 2 diabetic patients with Vitamin D deficiency. Diabetes Metab Syndr 2016;10:72-4.  Back to cited text no. 14
Alvarado Y, Perez A, Rodriguez-Vega G. Effects of Vitamin D deficiency in aneurismal subarachnoid hemorrhage. Crit Care Med 2015;43 12 Suppl 1:138.  Back to cited text no. 15
Chung PW, Park KY, Kim JM, Shin DW, Park MS, Chung YJ, et al. 25-hydroxy Vitamin D status is associated with chronic cerebral small vessel disease. Stroke 2015;46:248-51.  Back to cited text no. 16
Mancuso P, Rahman A, Hershey SD, Dandu L, Nibbelink KA, Simpson RU, et al. 1,25-dihydroxyvitamin-D3 treatment reduces cardiac hypertrophy and left ventricular diameter in spontaneously hypertensive heart failure-prone (cp/+) rats independent of changes in serum leptin. J Cardiovasc Pharmacol 2008;51:559-64.  Back to cited text no. 17
Nsengiyumva V, Fernando ME, Moxon JV, Krishna SM, Pinchbeck J, Omer SM, et al. The association of circulating 25-hydroxyvitamin D concentration with peripheral arterial disease: A meta-analysis of observational studies. Atherosclerosis 2015;243:645-51.  Back to cited text no. 18
Pilz S, März W, Wellnitz B, Seelhorst U, Fahrleitner-Pammer A, Dimai HP, et al. Association of Vitamin D deficiency with heart failure and Sudden cardiac death in a large cross-sectional study of patients referred for coronary angiography. J Clin Endocrinol Metab 2008;93:3927-35.  Back to cited text no. 19
Rahman A, Hershey S, Ahmed S, Nibbelink K, Simpson RU. Heart extracellular matrix gene expression profile in the Vitamin D receptor knockout mice. J Steroid Biochem Mol Biol 2007;103:416-9.  Back to cited text no. 20
Tishkoff DX, Nibbelink KA, Holmberg KH, Dandu L, Simpson RU. Functional Vitamin D receptor (VDR) in the t-tubules of cardiac myocytes: VDR knockout cardiomyocyte contractility. Endocrinology 2008;149:558-64.  Back to cited text no. 21
Weber KT, Simpson RU, Carbone LD. Vitamin D and calcium dyshomoeostasis-associated heart failure. Heart 2008;94:540-1.  Back to cited text no. 22
Gungor A, Ates O, Bilen H, Kocer I. Retinal nerve fiber layer thickness in early-stage diabetic retinopathy with Vitamin D deficiency. Invest Ophthalmol Vis Sci 2015;56:6433-7.  Back to cited text no. 23
Mottaghi T, Askari G, Khorvash F, Maracy MR. Effect of Vitamin D supplementation on symptoms and C-reactive protein in migraine patients. J Res Med Sci 2015;20:477-82.  Back to cited text no. 24
[PUBMED]  [Full text]  
Zhang H, Zhang H, Wen X, Zhang Y, Wei X, Liu T, et al. Vitamin D deficiency and increased risk of bladder carcinoma: A meta-analysis. Cell Physiol Biochem 2015;37:1686-92.  Back to cited text no. 25
Marques Vidigal V, Aguiar Junior PN, Donizetti Silva T, de Oliveira J, Marques Pimenta CA, Vitor Felipe A, et al. Genetic polymorphisms of Vitamin D metabolism genes and serum level of Vitamin D in colorectal cancer. Int J Biol Markers 2017;32:e441-6.  Back to cited text no. 26
Burnand B, Sloutskis D, Gianoli F, Cornuz J, Rickenbach M, Paccaud F, et al. Serum 25-hydroxyvitamin D: Distribution and determinants in the Swiss population. Am J Clin Nutr 1992;56:537-42.  Back to cited text no. 27
Flicker L, Mead K, MacInnis RJ, Nowson C, Scherer S, Stein MS, et al. Serum Vitamin D and falls in older women in residential care in Australia. J Am Geriatr Soc 2003;51:1533-8.  Back to cited text no. 28
Ginde AA, Liu MC, Camargo CA Jr. Demographic differences and trends of Vitamin D insufficiency in the US population, 1988-2004. Arch Intern Med 2009;169:626-32.  Back to cited text no. 29
Genuis SJ, Schwalfenberg GK, Hiltz MN, Vaselenak SA. Vitamin D status of clinical practice populations at higher latitudes: Analysis and applications. Int J Environ Res Public Health 2009;6:151-73.  Back to cited text no. 30
Oliveri B, Plantalech L, Bagur A, Wittich AC, Rovai G, Pusiol E, et al. High prevalence of Vitamin D insufficiency in healthy elderly people living at home in Argentina. Eur J Clin Nutr 2004;58:337-42.  Back to cited text no. 31
Hashemipour S, Larijani B, Adibi H, Javadi E, Sedaghat M, Pajouhi M, et al. Vitamin D deficiency and causative factors in the population of Tehran. BMC Public Health 2004;4:38.  Back to cited text no. 32
Riaz H, Finlayson AE, Bashir S, Hussain S, Mahmood S, Malik F, et al. Prevalence of Vitamin D deficiency in Pakistan and implications for the future. Expert Rev Clin Pharmacol 2016;9:329-38.  Back to cited text no. 33
Trilok Kumar G, Chugh R, Eggersdorfer M. Poor Vitamin D status in healthy populations in India: A review of current evidence. Int J Vitam Nutr Res 2015;85:185-201.  Back to cited text no. 34
Fanari Z, Hammami S, Hammami MB, Hammami S, Abdellatif A. Vitamin D deficiency plays an important role in cardiac disease and affects patient outcome: Still a myth or a fact that needs exploration? J Saudi Heart Assoc 2015;27:264-71.  Back to cited text no. 35
Lips P. Vitamin D deficiency and secondary hyperparathyroidism in the elderly: Consequences for bone loss and fractures and therapeutic implications. Endocr Rev 2001;22:477-501.  Back to cited text no. 36
Comploj E, West J, Mian M, Kluth LA, Karl A, Dechet C, et al. Comparison of complications from radical cystectomy between old-old versus oldest-old patients. Urol Int 2015;94:25-30.  Back to cited text no. 37
Martinaityte I, Kamycheva E, Didriksen A, Jakobsen J, Jorde R. Vitamin D stored in fat tissue during a 5-year intervention affects serum 25-hydroxyvitamin D levels the following year. J Clin Endocrinol Metab 2017; 102:3731-8.  Back to cited text no. 38
ENNS: Étude Nationale Nutrition Santé. Translated title: National study of nutritional health. Nutritional situation in France in 2006 according to the objective indicators and les scales of the national program of nutritional health. Saint-Maurice: INVS; 2007.  Back to cited text no. 39
Hanley DA, Cranney A, Jones G, Whiting SJ, Leslie WD, Cole DE, et al. Vitamin D in adult health and disease: A review and guideline statement from osteoporosis Canada. CMAJ 2010;182:E610-8.  Back to cited text no. 40
Benhamou CL, Souberbielle JC, Cortet B, Fardellone P, Gauvain JB, Thomas T. For the research and information group of osteoporosis. The vitamin D in adults. Recommendations of the GRIO. Presse Med 2011;40:673-82.  Back to cited text no. 41
Levey AS, Coresh J, Balk E, Kausz AT, Levin A, Steffes MW, et al. National kidney foundation practice guidelines for chronic kidney disease: Evaluation, classification, and stratification. Ann Intern Med 2003;139:137-47.  Back to cited text no. 42
HAS. Chronic kidney disease in adults; 2012.  Back to cited text no. 43
WHO Expert Consultation. Appropriate body-mass index for Asian populations and its implications for policy and intervention strategies. Lancet 2004;363:157-63.  Back to cited text no. 44
HAS. Management strategy in case of protein-energy malnutrition in the elderly; 2007.  Back to cited text no. 45
Annweiler C, Pochic S, Fantino B, Legrand E, Bataille R, Montero-Odasso M, et al. Serum Vitamin D concentration and short-term mortality among geriatric inpatients in acute care settings. Adv Ther 2010;27:245-9.  Back to cited text no. 46
Crétel E, Veen I, Pierres A, Binan Y, Robert P, Loundou AD, et al. Immune profile of elderly patients admitted in a geriatric short care unit. Rev Med Interne 2011;32:275-82.  Back to cited text no. 47
Wyskida M, Wieczorowska-Tobis K, Chudek J. Prevalence and factors promoting the occurrence of Vitamin D deficiency in the elderly. Postepy Hig Med Dosw (Online) 2017;71:198-204.  Back to cited text no. 48
Holick MF, Matsuoka LY, Wortsman J. Age, Vitamin D, and solar ultraviolet. Lancet 1989;2:1104-5.  Back to cited text no. 49
Briot K, Cortet B, Thomas T, Audrand M, Blaine H, Breuilf V, et al. Update 2012 of the French recommendations for the medicinal treatment of postmenopausal osteoporosis. Rev Rhum 2012;79:264-74.  Back to cited text no. 50
Martin A. Recommended nutritional intake for the French population. 3rd ed. Paris: Tec and Doc, Lavoisier; 2001.  Back to cited text no. 51
Bischoff-Ferrari H. Vitamin D: What is an adequate Vitamin D level and how much supplementation is necessary? Best Pract Res Clin Rheumatol 2009;23:789-95.  Back to cited text no. 52
Ross AC, Manson JE, Abrams SA, Aloia JF, Brannon PM, Clinton SK, et al. The 2011 report on dietary reference intakes for calcium and Vitamin D from the institute of medicine: What clinicians need to know? J Clin Endocrinol Metab 2011;96:53-8.  Back to cited text no. 53
Souberbielle JC, Body JJ, Lappe JM, Plebani M, Shoenfeld Y, Wang TJ, et al. Vitamin D and musculoskeletal health, cardiovascular disease, autoimmunity and cancer: Recommendations for clinical practice. Autoimmun Rev 2010;9:709-15.  Back to cited text no. 54
Cianferotti L, Parri S, Gronchi G, Civinini R, Brandi ML. The use of cholecalciferol in patients with hip fracture. Clin Cases Miner Bone Metab 2017;14:48-53.  Back to cited text no. 55
Carrillo-Vega MF, García-Peña C, Gutiérrez-Robledo LM, Pérez-Zepeda MU. Vitamin D deficiency in older adults and its associated factors: A cross-sectional analysis of the Mexican health and aging study. Arch Osteoporos 2017;12:8.  Back to cited text no. 56
Cheng Q, Du Y, Hong W, Tang W, Li H, Chen M, et al. Factors associated to serum 25-hydroxyvitamin D levels among older adult populations in urban and suburban communities in Shanghai, China. BMC Geriatr 2017;17:246.  Back to cited text no. 57
Huang CH, Huang YA, Lai YC, Sun CK. Prevalence and predictors of hypovitaminosis D among the elderly in subtropical region. PLoS One 2017;12:e0181063.  Back to cited text no. 58
Lopes JB, Fernandes GH, Takayama L, Figueiredo CP, Pereira RM. A predictive model of Vitamin D insufficiency in older community people: From the São Paulo aging & health study (SPAH). Maturitas 2014;78:335-40.  Back to cited text no. 59
Annweiler C, Riou J, Alessandri A, Gicquel D, Henni S, Féart C, et al. Clinical identification of geriatric patients with hypovitaminosis D: The 'Vitamin D status predictor for geriatrics' study. Nutrients 2017;9: pii: E658.  Back to cited text no. 60
Mithal A, Wahl DA, Bonjour JP, Burckhardt P, Dawson-Hughes B, Eisman JA, et al. Global Vitamin D status and determinants of hypovitaminosis D. Osteoporos Int 2009;20:1807-20.  Back to cited text no. 61
Pinkas J, Bojar I, Gujski M, Bartosińska J, Owoc A, Raczkiewicz D, et al. Serum lipid, Vitamin D levels, and obesity in perimenopausal and postmenopausal women in non-manual employment. Med Sci Monit 2017;23:5018-26.  Back to cited text no. 62
Araghi SO, van Dijk SC, Ham AC, Brouwer-Brolsma EM, Enneman AW, Sohl E, et al. BMI and body fat mass is inversely associated with Vitamin D levels in older individuals. J Nutr Health Aging 2015;19:980-5.  Back to cited text no. 63
Koricheva ES, Il'chenko AA, Selezneva EIa, Drozdov VN. Disorders of bone mineral density in patients with cholelithiasis and postcholecystectomic syndrome. Eksp Klin Gastroenterol 2010;4:14-20.  Back to cited text no. 64
Marcinowska-Suchowierska EB, Tałałaj MJ, Włodarcyzk AW, Bielecki K, Zawadzki JJ, Brzozowski R, et al. Calcium/phosphate/Vitamin D homeostasis and bone mass in patients after gastrectomy, vagotomy, and cholecystectomy. World J Surg 1995;19:597-601.  Back to cited text no. 65
Stoker GE, Buchowski JM, Stoker ME. Prior cholecystectomy as a predictor of preoperative Vitamin D deficiency in adults undergoing spine surgery. Arch Surg 2012;147:577-8.  Back to cited text no. 66
Chonchol M, Scragg R. 25-hydroxyvitamin D, insulin resistance, and kidney function in the Third National Health and Nutrition Examination Survey. Kidney Int 2007;71:134-9.  Back to cited text no. 67
Ernandez T, Stoermann-Chopard C. Vitamin D and chronic kidney disease: Increasing role for an old vitamin. Rev Med Suisse 2012;8:2140-5.  Back to cited text no. 68
Michaud J, Naud J, Ouimet D, Demers C, Petit JL, Leblond FA, et al. Reduced hepatic synthesis of calcidiol in uremia. J Am Soc Nephrol 2010;21:1488-97.  Back to cited text no. 69
Saliba W, El-Haddad B. Secondary hyperparathyroidism: Pathophysiology and treatment. J Am Board Fam Med 2009;22:574-81.  Back to cited text no. 70
McCann LM, Beto J. Roles of calcium-sensing receptor and Vitamin D receptor in the pathophysiology of secondary hyperparathyroidism. J Ren Nutr 2010;20:141-50.  Back to cited text no. 71
Gallieni M, Cozzolino M, Fallabrino G, Pasho S, Olivi L, Brancaccio D, et al. Vitamin D: Physiology and pathophysiology. Int J Artif Organs 2009;32:87-94.  Back to cited text no. 72
Constant J. Pearls and pitfalls in the use and abuse of diuretics for chronic congestive heart failure. Cardiology 1999;92:156-61.  Back to cited text no. 73
Stein MS, Scherer SC, Walton SL, Gilbert RE, Ebeling PR, Flicker L, et al. Risk factors for secondary hyperparathyroidism in a nursing home population. Clin Endocrinol (Oxf) 1996;44:375-83.  Back to cited text no. 74
Karlsson SL, Indridason OS, Franzson L, Sigurdsson G. Prevalence of secondary hyperparathyroidism (SHPT) and causal factors in adult population in Reykjavík area. Laeknabladid 2005;91:161-9.  Back to cited text no. 75
Arampatzis S, Gaetcke LM, Funk GC, Schwarz C, Mohaupt M, Zimmermann H, et al. Diuretic-induced hyponatremia and osteoporotic fractures in patients admitted to the emergency department. Maturitas 2013;75:81-6.  Back to cited text no. 76
Drinka PJ, Krause PF, Nest LJ, Goodman BM. Determinants of parathyroid hormone levels in nursing home residents. J Am Med Dir Assoc 2007;8:328-31.  Back to cited text no. 77
Aktas Yılmaz B, Akyel A, Kan E, Ercin U, Tavil Y, Bilgihan A, et al. Cardiac structure and functions in patients with asymptomatic primary hyperparathyroidism. J Endocrinol Invest 2013;36:848-52.  Back to cited text no. 78
Ozdemir D, Kalkan GY, Bayram NA, Onal ED, Ersoy R, Bozkurt E, et al. Evaluation of left ventricle functions by tissue Doppler, strain, and strain rate echocardiography in patients with primary hyperparathyroidism. Endocrine 2014;47:609-17.  Back to cited text no. 79
Torres PA, De Broe M. Calcium-sensing receptor, calcimimetics, and cardiovascular calcifications in chronic kidney disease. Kidney Int 2012;82:19-25.  Back to cited text no. 80
HAS. Clinical utility of the vitamin D assay; 2013.  Back to cited text no. 81
Nair AP, Timoh T, Fuster V. Contemporary medical management of systolic heart failure. Circ J 2012;76:268-77.  Back to cited text no. 82
Kapelios CJ, Kaldara E, Ntalianis A, Sousonis V, Repasos E, Sfakianaki T, et al. High furosemide dose has detrimental effects on survival of patients with stable heart failure. Hellenic J Cardiol 2015;56:154-9.  Back to cited text no. 83
Rokutan H, Suckow C, von Haehling S, Strassburg S, Bockmeyer B, Doehner W, et al. Furosemide induces mortality in a rat model of chronic heart failure. Int J Cardiol 2012;160:20-5.  Back to cited text no. 84
Singh A, Blackwell J, Neher J. Clinical inquiries. Does furosemide decrease morbidity or mortality for patients with diastolic or systolic dysfunction? J Fam Pract 2005;54:370-2.  Back to cited text no. 85
Annweiler C, Souberbielle JC, Schott AM, de Decker L, Berrut G, Beauchet O, et al. Vitamin D in the elderly: 5 points to remember. Geriatr Psychol Neuropsychiatr Vieil 2011;9:259-67.  Back to cited text no. 86


  [Figure 1], [Figure 2], [Figure 3], [Figure 4], [Figure 5], [Figure 6], [Figure 7], [Figure 8], [Figure 9], [Figure 10]

This article has been cited by
1 The implications of vitamin D deficiency on COVID-19 for at-risk populations
Rosemary DeLuccia,Deborah Clegg,Deeptha Sukumar
Nutrition Reviews. 2020;
[Pubmed] | [DOI]
2 Age-Related Changes and Sex-Related Differences in Brain Iron Metabolism
Tanja Grubic Kezele,Bo×ena Curko-Cofek
Nutrients. 2020; 12(9): 2601
[Pubmed] | [DOI]
3 Effects of vitamin D supplementation on 25(OH)D concentrations and blood pressure in the elderly: a systematic review and meta-analysis
Farapti Farapti,Chusnul Fadilla,Niwanda Yogiswara,Merryana Adriani
F1000Research. 2020; 9: 633
[Pubmed] | [DOI]
4 Effects of vitamin D supplementation on 25(OH)D levels and blood pressure in the elderly: a systematic review and meta-analysis
Farapti Farapti,Chusnul Fadilla,Niwanda Yogiswara,Merryana Adriani
F1000Research. 2020; 9: 633
[Pubmed] | [DOI]
5 Effects of vitamin D supplementation on 25(OH)D levels and blood pressure in the elderly: a systematic review and meta-analysis
Farapti Farapti,Chusnul Fadilla,Niwanda Yogiswara
F1000Research. 2020; 9: 633
[Pubmed] | [DOI]
6 Double COVID-19 Confirmed Case Fatality Rate in Countries with High Elderly Female Vitamin D Deficiency Prevalence
Alex Bńcker,Myron Mageswaran
SSRN Electronic Journal. 2020;
[Pubmed] | [DOI]
7 Hypovitaminosis D in the Greek Elderly Population DoesnŠt Concern Only Patients with Hip Fracture
Ioannis Papaioannou,Georgia Pantazidou,Ifigeneia Kostoglou-Athanasiou,Panagiotis Korovessis
Cureus. 2020;
[Pubmed] | [DOI]
8 Vitamin D and Cytokine Profiles in Patients With Systemic Sclerosis
Vanessa Hax,Andrese Aline Gasparin,Laiana Schneider,Odirlei AndrÚ Monticielo,Helena Margot Flores Soares,Marianna do Amaral Streit,Bianca Pfaffenseller,Ricardo Machado Xavier,Rafael Mendonša da Silva Chakr
JCR: Journal of Clinical Rheumatology. 2020; 26(7): 289
[Pubmed] | [DOI]
9 Effect of Vitamin D2 Fortification Using Pleurotus ostreatus in a Whole-Grain Cereal Product on Child Acceptability
Cristina Proserpio,Vera Lavelli,Francesca Gallotti,Monica Laureati,Ella Pagliarini
Nutrients. 2019; 11(10): 2441
[Pubmed] | [DOI]


    Similar in PUBMED
   Search Pubmed for
   Search in Google Scholar for
 Related articles
    Access Statistics
    Email Alert *
    Add to My List *
* Registration required (free)  

  In this article
    Article Figures

 Article Access Statistics
    PDF Downloaded431    
    Comments [Add]    
    Cited by others 9    

Recommend this journal