Vitamin D Deficiency and Secondary Hyperparathyroidism in the Elderly: Consequences for Bone Loss and Fractures and Therapeutic Implications
Paul Lips
Department of Endocrinology, Institute for Endocrinology,
Reproduction and Metabolism (EVM-Institute) and Institute for Research
in Extramural Medicine (EMGO-Institute), Vrije Universiteit Medical
Center, 1007 MB Amsterdam, The Netherlands
Correspondence: Address all correspondence and requests for reprints to: Paul Lips, M.D., Ph.D., Afdeling Endocrinologie, Vrije Universiteit Medical Center, Postbus 7057, 1007 MB Amsterdam, The Netherlands. E-mail:
p.lips{at}vumc.nl
Vitamin D deficiency is common in the elderly, especially inthe
housebound and in geriatric patients. The establishmentof strict
diagnostic criteria is hampered by differences inassay methods for
25-hydroxyvitamin D. The synthesis of vitaminD3 in the
skin under influence of UV light decreases with agingdue to
insufficient sunlight exposure, and a decreased functionalcapacity of
the skin. The diet contains a minor part of thevitamin D
requirement. Vitamin D deficiency in the elderly isless common in the
United States than elsewhere due to the fortificationof milk and use
of supplements. Deficiency in vitamin D causessecondary
hyperparathyroidism, high bone turnover, bone loss,mineralization
defects, and hip and other fractures. Less certainconsequences include
myopathy and falls. A diet low in calciummay cause an increased
turnover of vitamin D metabolites andthereby aggravate vitamin D
deficiency. Prevention is feasibleby UV light exposure, food
fortification, and supplements. VitaminD3 supplementation
causes a decrease of the serum PTH concentration,a decrease of bone
turnover, and an increase of bone mineraldensity. Vitamin
D3 and calcium may decrease the incidence ofhip and other
peripheral fractures in nursing home residents.Vitamin D3
is recommended in housebound elderly, and it maybe cost-effective
in hip fracture prevention in selected riskgroups.
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